[Nasendoscopic comparison for cleft palate repair after velopharyngeal muscle reconstruction].

OBJECTIVE: To find out the nasendoscopic changes of velopharyngeal configuration and movement after palatoplasty with or without velopharyngeal muscle reconstruction. METHODS: The nasendoscopy was taken in forty-one patients with palatoplasty, 22 repaired by velopharyngeal muscle reconstruction and 19 with modified von Langenbeck's procedure (non-reconstructive group). RESULTS: In patients with velopharyngeal muscle reconstruction, the velopharyngeal ports are smooth and full with a definite reduction in size than patients without velopharyngeal muscle reconstruction. During phonation, the complete and marginal velopharyngeal competence rate in reconstructive group (90.91%) is higher than the group of non-reconstruction (37.31%) The major velopharyngeal closure is circular movement in reconstructive group, otherwise coronal closure in nonconstructive group. CONCLUSIONS: Based the observation of nasendoscopy, the velopharyngeal muscle reconstruction in palatoplasty has more definite improvement to velopharyngeal closure than non-reconstructive procedure. Palatoplasty with velopharyngeal muscle reconstruction could reduce the size of velopharyngeal port and make the complete velopharyngeal closure easier.

[A comparison of the velopharyngeal closure after palatoplasty between with or without velopharyngeal muscular reconstruction].

OBJECTIVE: To evaluate the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velopharyngeal closure under the lateral radiography. METHODS: The lateral radiographs and cephalometric analysis were taken in sixty-two patients with cleft palate and velopharyngeal insufficiency, 32 repaired with velopharyngeal muscular reconstruction and 30 with modified von Langenbeck's procedure (non-reconstructive group). RESULTS: In patients with velopharyngeal muscular reconstruction, the velopharyngeal competence, the reductive rate of nasopharynx, the distance reduction in lower part of the mobile nasopharynx during phonation and the distance in middle part of mobile nasopharyngo in rest were superior to that without velopharyngeal muscular reconstruction, and there were variform PPW eminence-soft palate contact in velopharyngeal closure. The patients with complete or good velopharyngeal closure had a definite reduction in nasopharynx, compared to the patients with velopharyngeal insufficiency in the non-reconstructive group. CONCLUSIONS: The functional area for velopharyngeal closure after palatoplasty might be located in the middle part of mobile nasopharynx. The velopharyngeal muscular reconstruction in palatoplasty could reduce the size of nasopharynx and improve the coordination movement of velopharyngeal closure.

[Mid-premaxillary sutural distraction osteogenesis for repair of alveolus cleft: an experimental study in dogs].

OBJECTIVE: To explore a new technique for repair of alveolar cleft by sutural distraction osteogenesis. METHODS: Nine 8-weeks mongrel dogs were used in this study, three being in the control group, six in the experimental group. Alveolar cleft model was created surgically in all animals. Two weeks later, a U-shaped distractor made of Ni-Ti memory alloy wire was insterted into the premaxilla to distract the mid-premaxillary suture. When the premaxilla of the cleft side approached the ipsilateral maxilla, periosteoplasty of the alveolar cleft was performed. The distractor was removed at two weeks after periosteoplasty. The results were evaluated clinically, radiographically, morphologically and histologically. RESULTS: The cleft model in dogs was stable and similar to the human alveolar cleft. In experimental dogs, the premaxilla was moved gradually toward the maxilla so that the cleft was closed. The distracted mid-premaxillary suture showed a gradually widened traingle, with its tip being posterior. The density of the distracted traingle suture was increased gradually. Bony repair was achieved completely at the cleft three months post-periosteoplasy. The morphology of the mid-premaxillary suture was restored. CONCLUSION: The alveolar cleft could be repaired by the technique of mid-premaxilla suture distraction.

[Sutural distraction osteogenesis for primary cleft palate repair: a preliminary clinical report].

OBJECTIVE: To probe the possibility of a new technique of primary cleft palate repair by sutural distraction osteogenesis. METHODS: The distractor was made of TiNi-shape memory alloy with 2 secure and 2 active arms. Under general anesthesia, 1 hole was drilled on each maxillary process and horizontal plate of palatine. The four arms of the distractor were inserted into holes. The palatine bones would then be distracted and moved medially and posteriorly. After 4 to 5 months' distraction, the two cleft edges approached gradually. The residual cleft, according to its width, was repaired by direct stitch of muco-periosteum incised at cleft edges, or with an additional relaxing incision on one side of the palate. Direct measurement of width of maxillary arch and the cleft, and the length of the hard palate was performed before and after distraction to evaluate the effects of distraction. RESULTS: Eight cleft children at their 2 to 4 years of age were treated by the new technique. Two of them terminated the procedure due to premature dislocation of the distractor. Six children underwent 37 to 126 days' distraction. Dramatic narrowing of the cleft and lengthening of hard palate were seen in these children, with the average narrowing of the cleft being 6.5 mm and average lengthening of the hard palate being 4.8 mm. CONCLUSION: It is clinically demonstrated that palatal tissue regeneration and cleft closure or narrowing and hard palate lengthening could be achieved by the technique of sutural distraction osteogenesis.