• 대한음성언어의학회:학술대회논문집
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• 대한음성언어의학회 1998년도 제10회 학술대회 심포지움
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• pp.189-189
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• 1998

점막하 구개열(submucous cleft palate)은 특징적인 임상적 해부학적 기형을 나타내는데 이분 구개수(bifid uvula), 근육의 분리(muscular diastasis), 경구개 후연의 절흔(frank notching of the posterior hard palate)등이다. 결국 이러한 기형을 교정하지 않으면 과비음과 공명장애로 인한 조음장애는 사회생활에 중요한 영향을 미치고, 사람의 인상에 나쁜 영향을 주게되어 개인의 인성 형성의 장애와 삶의 질의 저하를 초래하게 된다. (중략)

• Archives of Plastic Surgery
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• 제40권2호
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• pp.97-103
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• 2013

Background Velopharyngeal insufficiency (VPI) may persist after primary repair of the cleft palate, and surgical correction is necessary in many cases. The purpose of this study is to evaluate the effect of double opposing Z-plasty (DOZ) in cleft palate patients suffering from VPI after primary two-flap palatoplasty. Methods Between March 1999 and August 2005, we identified 82 patients who underwent two-flap palatoplasty for cleft palate repair. After excluding the patients with congenital syndrome and mental retardation, 13 patients were included in the final study group. The average age of the patients who underwent DOZ at was 5 years and 1 month. Resonance, nasal emission, and articulation were evaluated by a speech pathologist. The velopharyngeal gaps were measured before and after surgery. Results Six patients attained normal speech capabilities after DOZ. The hypernasality grade was significantly improved after surgery in all of the patients (P=0.0015). Whereas nasal emission disappeared in 8 patients (61.5%), it was diminished but still persisted in the remaining 5 patients. Articulation was improved in all of the cases. In two cases, the velopharyngeal gap was measured using a ruler. The gap decreased from 11.5 to 7 mm in one case, and from 12.5 to 8 mm in the second case. Conclusions The use of DOZ as a surgical option to correct VPI has many advantages compared with other procedures. These include short surgery time, few troublesome complications, and no harmful effects on the dynamic physiological functioning of the pharynx. This study shows that DOZ can be another option for surgical treatment of patients with VPI after two-flap palatoplasty.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.748-752
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• 2007

Purpose: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. Methods: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15 cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap. Results: The patients, after mean 10 months of follow-up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired. Conclusion: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권5호
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• pp.458-460
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• 2001

A 11-month-old infancy was referred for treatment of cleft palate. The patient's congenital deformities had included oronasal fistula on the soft palate and bifid uvula. Furrow double-opposing Z-plasty was performed under general anesthesia. However, postoperative bleeding developed at ward. Despite the pressure of operative wound, venous oozing continued and hemoglobin concentration and RBC were decreased (Hb: 5.5g/dL, RBC: $1.98{\times}10^6/mm^3$). The patient was pale and confused and transferred to Surgical Intensive Care Unit(SICU) We could not keep the peripheral venous line and there was a high risk of hypovolemic shock. Emergency transfusion was performed through the central femoral venous line and emergency operation for bleeding control was carried out. We explored the operation site and found bleeding point from the posterior pharyngeal wall. Electrocoagulation and surgicel packing were carried out and bleeding was stopped.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권3호
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• pp.178-183
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• 2013

Cleft lip arises from congenital underdevelopment with various degrees and patterns. Mulliken named a unilateral incomplete cleft lip with no severe cleft as a lesser-form cleft lip and categorized it into three subgroups. Anatomically categorized subgroups are minor-form, microform, and mini-microform cleft by the extent of vermilion-cutaneous dysjuntion. The vermillion cutaneous notch is more than 3 mm from the regular Cupid's bow peak for minor-form, less than 3 mm for microform, and almost no gap with discontinuity on the vermillion cutaneous border for mini-microform. The treatments are rotational advancement flap for minor-form, double unillimb Z-plasty for microform, and vertical lenticular excision for mini-microform, respectively. This article aims to present the literature review about the incomplete lesser form cleft lip classified by Mulliken and to report our experiences.

• Archives of Plastic Surgery
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• 제33권1호
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• pp.67-74
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• 2006

Palatoplasty using Furlow's double-opposing Z-plasty has been performed from June, 1995 to September, 1999 at Seoul National University Children's Hospital. The goal of this study is to determine the optimal timing of repair and cleft severity affecting velopharyngeal function. This is the retrospective study of patients operated by the second author. The mean age of patients was 10.53 months. The patients could be divided into three groups-isolated cleft palate(n=70), unilateral cleft lip and palate(n=88), and bilateral cleft lip and palate(n=42). To evaluate the velopharyngeal function, we used two parameters, speech evaluation and cineofluorography using DSR(digital subtraction radiography). Also, to determine the relevance between cleft severity and speech development, we measured the distance between maxillary tuberosities and cleft margins. Among 200 patients, about 96% had no or minimal hypernasality and 87% had no or mild nasal emission. The cleft width and length of soft palate seemed not to be related with the speech development. Palatoplasty at the age under 12 months resulted in less 'nasal emission' and better 'articulation' of the parameters that were assessed at the age of 7 years. It can be concluded Furlow palatoplasty shows satisfactory results and also it seems that it is better to perform the operation before the age of 12 months.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.308-312
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• 2006

Time to time, we face patients who missed the proper time for primary palatal repair. Although we do not have enough available documents, it is important to establish efficacy of palatal repair in patients more than 4 years old. From May 1995 to March 2005, we selected 14 patients who underwent palatal repair in more than 4 years old patients and they are able to tolerate speech articulation tests. Out of 14 patients 5 males an 9 females in sex, aged form 4 to 50 years old. 6 patients with incomplete cleft palate and 8 patients with submucous cleft palate. Double reversing Z-plasty(n=5), pushback palatoplasty(n=4), two flap palatoplasty(n=2), von Langenbeck palatoplasty(n=2), and intravelar veloplasty(n=1) were performed. Preoperative and postoperative speech articulation test, "Simple method of speech evaluation in Korean patients with cleft palate", were conducted. Satisfaction rate was sorted into 5 levels. There is no significant statistical correlation in the speech improvement, satisfaction rate, patients sex, cleft type and operative method. But there is significant statistical correlation between the speech improvement and patienet's age. There were better result in younger patient group than aged patients group.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.43-49
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• 2022

Background Cleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital. Methods We retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients' medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test. Results Fistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used. Conclusions The overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

• 대한구순구개열학회지
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• 제7권1호
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• pp.25-34
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• 2004

본 연구는 선천성 구개열 환자에서 구개성형술후 구개 길이가 어느 정도 연장되는지 알아보기 위하여 시행되었다. 199i년 4월부터 2004년 4월까지 10년동안 전남대학교병원 구강악안면외과에서 치료 받은 구개열 환자 중 추적조사가 가능한 112명을 대상으로 역학적 특성, 사용된 구개성형술식, 구개 길이의 연장 정도 및 술후 합병증에 대하여 임상기록을 조사하고 분석하였다. 불완전구개열 및 완전구개열 환자의 비는 1.6:1이었다. 성별분포는 완전구개열에서는 남자가 2.1배 많았고, 불완전구개열에서는 여자가 1.2배 많았다. 불완전구개열에서는 Dorrance법과 Wardill법을, 완전구개 열에서는 Wardill법과 Furlow법, two flap법, Perko법을 많이 사용하였다. 구개열 형태별 구개 길이의 연장 정도는 불완전구개열에서 평균 5.84 m(11.295) 연장되어 완전구개열에서의 평균 4.71 w(9.f%)보다 1.13 mm(1.6%) 더 많이 연장되었으나 통계학적 유의성은 없었다. 구개성형술식에 따른 구개 길이의 연장 정도는 Furlow법에서 5.70 m(10.9%) 연장되어 push back법에서의 5.33 in(10.7%)보다0.37 mm(0.2%) 더 많이 연장되었으나 역시 통계학적 유의성은 없었다. 술후 합병증으로 구개누공이 27예(24%b)로 가장 많이 발생하였다. 이상의 결과에서 구개성형술후 구개 길이가 3.5%부터 24.0%까지 평균 10.8% 연장되어 언어 기능에 기여함을 알 수 있다.