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A Comparative Study to Evaluate the Functional Effect of Unilateral Uvuloplasty after Primary Palatoplasty.

Rossell-Perry P, Olivencia-Flores C, Gavino-Gutierrez AM, Caceres-Nano E, Cotrina-Rabanal O - Plast Reconstr Surg Glob Open (2015)

Bottom Line: In addition, postoperative dimensions of the velopharynx were measured by a single-blind examiner using a computed tomography scan.Our comparative study found statistically significant differences between the 2 groups in favor of the unilateral uvuloplasty group.We observed that the use of unilateral uvuloplasty for uvular reconstruction reduces the velopharyngeal space and the frequency of hypernasality in patients with bilateral cleft palate.

View Article: PubMed Central - PubMed

Affiliation: San Martin de Porres University, Lima, Peru; "Outreach Surgical Center Lima Peru," ReSurge Int, Lima, Peru; Plastic Surgery Service, Edgardo Rebagliatti Martins Hospital, Lima, Peru; A.B. PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; School of Pedagogic Training, Lima, Peru; and ARMONIZAR Foundation, Lima, Peru.

ABSTRACT

Background: The conventional method for uvular repair suturing the 2 hemi-uvulas of the palatal cleft together in the midline does not allow us to obtain a proper anatomical repair. In our hands, the midline straight closure frequently causes retraction of the uvular tissues with the consequent abnormal appearance of the uvula. We described before a method for uvular repair in patients with cleft palate. The technique consists in preserving one of the hemi-uvulas, which is moved to the midline to form the definitive uvula. The purpose of this study was to evaluate the functional effects of the unilateral uvuloplasty for uvular repair in a group of patients with bilateral cleft palate.

Methods: This is a retrospective, single-blinded cohort study between 2 groups of 90 patients with bilateral cleft palate who were operated on using the conventional and unilateral uvuloplasty methods of uvular repair from 2000 to 2009. Data collection was accomplished by physical examination to evaluate the presence of postoperative fistulas and hypernasal speech determined at 6 months to 5 years after surgery. In addition, postoperative dimensions of the velopharynx were measured by a single-blind examiner using a computed tomography scan.

Results: Our comparative study found statistically significant differences between the 2 groups in favor of the unilateral uvuloplasty group.

Conclusions: We observed that the use of unilateral uvuloplasty for uvular reconstruction reduces the velopharyngeal space and the frequency of hypernasality in patients with bilateral cleft palate.

No MeSH data available.


Related in: MedlinePlus

Diagram of the velopharyngeal space comparing 2 techniques of uvuloplasty. A, Conventional uvuloplasty. B, Unilateral uvuloplasty. PPW indicates posterior pharyngeal wall; V, velum; X, lateral point at the base of the excised uvula.
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Figure 6: Diagram of the velopharyngeal space comparing 2 techniques of uvuloplasty. A, Conventional uvuloplasty. B, Unilateral uvuloplasty. PPW indicates posterior pharyngeal wall; V, velum; X, lateral point at the base of the excised uvula.

Mentions: We preserved the larger hemi-uvula and excised the smaller hemi-uvula as shown in Figures 4 and 5. The incision for the excised hemi-uvula side was extended laterally to the junction between the soft palate and the top of the tonsillar pillars (point 1 in Fig. 1). This incision let us move the uvula to the central position and reduced the velopharyngeal space (Fig. 6). Then, a small triangle from the edge of the nasal mucosa was excised to avoid redundant tissue (Fig. 1, dotted line). A mucosal incision was made along the cleft margin of the soft palate and extended up to the base of the preserved hemi-uvula. Then, we turned the incision 90° for ~1 cm. The incision only included the oral mucosa. The uvularis muscle was preserved (Fig. 7). Blood was supplied to the preserved uvula by the vascular plexus of the nasal mucosa and the uvularis muscle. The nasal and oral mucosa were carefully repaired with 5-0 absorbable sutures by bringing points 1 and 3 together and points 2 and 4 together using corner stitches for a border-to-border approximation (Figs. 8 and 9). Finally, a unilimb Z-plasty was performed in which a triangle of mucosa from the excised uvula side was placed over the preserved uvula to provide additional length in the repaired palate (Figs. 1 and 9).


A Comparative Study to Evaluate the Functional Effect of Unilateral Uvuloplasty after Primary Palatoplasty.

Rossell-Perry P, Olivencia-Flores C, Gavino-Gutierrez AM, Caceres-Nano E, Cotrina-Rabanal O - Plast Reconstr Surg Glob Open (2015)

Diagram of the velopharyngeal space comparing 2 techniques of uvuloplasty. A, Conventional uvuloplasty. B, Unilateral uvuloplasty. PPW indicates posterior pharyngeal wall; V, velum; X, lateral point at the base of the excised uvula.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494485&req=5

Figure 6: Diagram of the velopharyngeal space comparing 2 techniques of uvuloplasty. A, Conventional uvuloplasty. B, Unilateral uvuloplasty. PPW indicates posterior pharyngeal wall; V, velum; X, lateral point at the base of the excised uvula.
Mentions: We preserved the larger hemi-uvula and excised the smaller hemi-uvula as shown in Figures 4 and 5. The incision for the excised hemi-uvula side was extended laterally to the junction between the soft palate and the top of the tonsillar pillars (point 1 in Fig. 1). This incision let us move the uvula to the central position and reduced the velopharyngeal space (Fig. 6). Then, a small triangle from the edge of the nasal mucosa was excised to avoid redundant tissue (Fig. 1, dotted line). A mucosal incision was made along the cleft margin of the soft palate and extended up to the base of the preserved hemi-uvula. Then, we turned the incision 90° for ~1 cm. The incision only included the oral mucosa. The uvularis muscle was preserved (Fig. 7). Blood was supplied to the preserved uvula by the vascular plexus of the nasal mucosa and the uvularis muscle. The nasal and oral mucosa were carefully repaired with 5-0 absorbable sutures by bringing points 1 and 3 together and points 2 and 4 together using corner stitches for a border-to-border approximation (Figs. 8 and 9). Finally, a unilimb Z-plasty was performed in which a triangle of mucosa from the excised uvula side was placed over the preserved uvula to provide additional length in the repaired palate (Figs. 1 and 9).

Bottom Line: In addition, postoperative dimensions of the velopharynx were measured by a single-blind examiner using a computed tomography scan.Our comparative study found statistically significant differences between the 2 groups in favor of the unilateral uvuloplasty group.We observed that the use of unilateral uvuloplasty for uvular reconstruction reduces the velopharyngeal space and the frequency of hypernasality in patients with bilateral cleft palate.

View Article: PubMed Central - PubMed

Affiliation: San Martin de Porres University, Lima, Peru; "Outreach Surgical Center Lima Peru," ReSurge Int, Lima, Peru; Plastic Surgery Service, Edgardo Rebagliatti Martins Hospital, Lima, Peru; A.B. PRISMA, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; School of Pedagogic Training, Lima, Peru; and ARMONIZAR Foundation, Lima, Peru.

ABSTRACT

Background: The conventional method for uvular repair suturing the 2 hemi-uvulas of the palatal cleft together in the midline does not allow us to obtain a proper anatomical repair. In our hands, the midline straight closure frequently causes retraction of the uvular tissues with the consequent abnormal appearance of the uvula. We described before a method for uvular repair in patients with cleft palate. The technique consists in preserving one of the hemi-uvulas, which is moved to the midline to form the definitive uvula. The purpose of this study was to evaluate the functional effects of the unilateral uvuloplasty for uvular repair in a group of patients with bilateral cleft palate.

Methods: This is a retrospective, single-blinded cohort study between 2 groups of 90 patients with bilateral cleft palate who were operated on using the conventional and unilateral uvuloplasty methods of uvular repair from 2000 to 2009. Data collection was accomplished by physical examination to evaluate the presence of postoperative fistulas and hypernasal speech determined at 6 months to 5 years after surgery. In addition, postoperative dimensions of the velopharynx were measured by a single-blind examiner using a computed tomography scan.

Results: Our comparative study found statistically significant differences between the 2 groups in favor of the unilateral uvuloplasty group.

Conclusions: We observed that the use of unilateral uvuloplasty for uvular reconstruction reduces the velopharyngeal space and the frequency of hypernasality in patients with bilateral cleft palate.

No MeSH data available.


Related in: MedlinePlus