| BackgroundSubmucous cleft palate was a relatively special type of cleft palate.Its clinical classic triad were bifid uvula,the midline zona pellucida of the soft palate and palpable bone defect on the posterior edge of the hard palate.There were still major controversies in the diagnosis and treatment.Some patients were asymptomatic until they are adults,so there were controversies in the optimal timing of surgery,operation methods and the necessity of preventive operation.With the popularization of computer tomography(CT)examination,the bony defect of the hard palate can be observed intuitively and clearly.Recently,some studies had found the differences in the bony defect of the hard palate in submucous cleft palate.However,studies on the bony defect of the hard palate in submucous cleft palate were still limited.There was no systematic research on the characteristics of palatal bony defect and the relations between the characteristics of palatal bony defect and the velopharyngeal function in submucous cleft palate patients.Purpose1.To analyze the data collected from medical records for 279 submucous cleft palate patients which included age of operation,reasons for admitting in hospital and companied diseases.2.To analyze the palatal bony defect in submucous cleft palate patients in the length,width,shape and other characteristics.3.Looking for the relations between the characteristics of palatal bony defect and the velopharyngeal function in submucous cleft palate patients.Materials and methods1.Retrospective clinical analysis of submucous cleft palate patients Included 279 patients from 2013.01.01 to 2020.12.31 diagnosed with submucous cleft palate in Peking University Hospital of Stomatology.Searched and recorded the medical record number accord to the medical record number.Following items which were collected from medical records were included:age of operation,reasons for admitting into hospital and the types of accompanied diseases(cleft lip,well-known syndromes,chromosomal diseases,hearing impairment and intelligence retardation.Statistical analysis was made on the distribution of age of operation,reasons for admitting into hospital and the types of accompanied diseases.2.Study on the characteristics of palatal bony defect A total of 222 patients with preoperative spiral CT data among 279 submucous cleft palate patients were included.The pre-operative CT data sets were reconstructed into a threedimensional model to produce a direct image of the cleft palate.The followed characteristics of the palatal bony defect were recorded:whether the palatal bony defect involved the incisive foramen,the morphology of the fissure edges of the palatal bony defect and the apex of the palatal bony defect fissure.Used Digimizer Version 4.2.6.0 software to measure the width and length of the palatal bony defect and the hard palate,and calculate the ratio of the width and length respectively.Checked whether the ratio of the width and length of the palatal bony defect to the hard palate conforms to the normal distribution,and used the chi-square test to analyze whether there was correlation between the severity of the palatal bony defect,the shape of the palatal bony defect and the apex of the palatal bony defect fissure.3.Study on the relationship between the palatal bony defect and velopharyngeal function A total of 109 patients with preoperative spiral CT data and preoperative nasopharyngoscopy examination.According to the degree of velopharyngeal closure during nasopharyngoscopy examination,it was divided into five groups:complete velopharyngeal closure,marginal velopharyngeal closure,mild velopharyngeal insufficiency,moderate velopharyngeal insufficiency and severe velopharyngeal insufficiency.Calculated the ratio of the width of the palatal bony defect to the hard palate.Divided the complete velopharyngeal closure,marginal velopharyngeal closure,and mild velopharyngeal insufficiency into group A,and divided the moderate velopharyngeal insufficiency and severe velopharyngeal insufficiency into group B.Compared the ratio of the width of the palatal bony defect to the hard palate between two groups.Results1.The results of the retrospective clinical analysis of submucous cleft palate patients1)Age range of operation:0;6～35;2 years old;Average operating age:5;4 years old;Median operating age:4;2 years old.2)Cleft lip occurred in 34(12.2%)patients,and 15(5.4%)patients suffered well known syndromes.3)Regarding to the reasons for admitted in hospital,194(69.5%)patients came for unclear speech.The reason for morphological abnormality of hard and/or soft palate occupied 52(18.6%)and rest of 33(11.9%)patients were belong to other reasons.2.The results of study on the characteristics of palatal bony defect1)The agreement rates of the apex position of the palatal bony defect were 100%intergroup and intra-group.The agreement rates of the palatal bony defect were 75%and 95%intergroup and intra-group respectively.The agreement rates of the apex of the palatal bony defect fissure within the group and between the groups were 95%and 80%intergroup and intra-group respectively.2)There were no significant differences between intergroup and intra-group in calculating the width and length of the palatal bony defect and hard palate.3)The rate of the palatal bony defect involved the incisive foramen was 45.5%(101/222)and 54.5%(121/222)of the patients with the palatal bony defect not involved the incisive foramen.36.5%(81/222)of the patients with the shape of palatal bony defect curved,and 63.5%(141/222)of the patients with the shape of palatal bony defect straight.The apex of the palatal bony defect fissure were divided into open and closed,the rates were 54.1%(120/222)and 45.9%(102/222)respectively.4)The ratio of the width of palatal bony defect to hard palate ranged from 0.1540 to 0.5073,with an average value of 0.3081.The ratio of the width of the palatal bony defect to the hard palate conformed to the normal distribution.5)The ratio of the length of palatal bony defect to hard palate ranged from 0.0891 to 1.0000,with an average value of 0.5316.The ratio of the length of the palatal bony defect to the hard palate did not conform to the normal distribution.6)There were significant differences among the severity of the palatal bony defect,the shape of the palatal bony defect and the apex of the palatal bony defect fissure.3.The results of the study on the relationship between the palatal bony defect and velopharyngeal function1)The Kappa values of the assessment of the velopharyngeal closure function in nasopharyngoscopy examination were 0.694 and 0.583 intra-group and intergroup respectively,indicated good consistency.2)The ratios of complete velopharyngeal closure,marginal velopharyngeal closure,mild velopharyngeal insufficiency,moderate velopharyngeal insufficiency and severe velopharyngeal insufficiency were 11.0%(12),13.8%(15),19.3%(21),27.5%(30)and 28.4%(31)respectively.3)The complete velopharyngeal closure group,marginal velopharyngeal closure group and mild velopharyngeal insufficiency group were classified as group A,and the moderate and severe velopharyngeal insufficiency group were classified as group B.The average ratio of width of palatal bony defect to the hard palate in group A was 0.2794.The average ratio of width of palatal bony defect to the hard palate in group B was 0.3347.Statistics showed that there was significant difference between the two groups.4)More than 95%of the patients with the ratio of the width of palatal bony defect to hard palate(BB’/AA’)>0.34 had moderate to severe velopharyngeal insufficiency,and the ratio of hard palate deformity to hard palate plate width(BB’/AA’)<0.26 The probability of moderate to severe velopharyngeal insufficiency in patients with cleft palate is less than 5%.Conclusions1.The operated age of submucous cleft palate was significantly later than the patients with cleft palate,and most patients were admitted into hospital with the main complaint of speech symptoms.2.There were differences among submucous cleft palate patients in the characteristics of the palatal bony defect.3.There was correlation between the ratio of width of palatal bony defect to the hard palate and the velopharyngeal closure function in submucous cleft palate patients.The worse the velopharyngeal closure function was,the higher the the ratio of width of palatal bony defect to the hard palate was.The doctors should pay more attention to the palatal bony defect in the diagnosis,surgical treatment and speech treatment of patients with severe palatal bony defects.Innovations1.It was the first time to combine subjective evaluation and measurement methods to describe the characteristics of palatal bony defect in submucous cleft palate patients fully and clearly.2.It was the first time to research the relationship between palatal bony defect and velopharyngeal function in submucous cleft palate patients.3.It was the first time to reveal the reason why some submucous cleft palate patients were asymptotic by the characteristics of palatal bony defect and to provide guides for the choice of preventive surgery and operation time. |
PDF Full Text Request