ABSTRACT
Introdução: A palatoplastia com elevação de retalhos mucoperiostais bipediculados pela técnica de Von Langenbeck associada a veloplastia intravelar é técnica mais utilizadas na atualidade apresentando na literatura baixa taxa de fístula oronasal e de insuficiência velofaríngea. O objetivo é apresentar a experiência acumulada do autor e avaliar a incidência de fístula oronasal após 278 casos de palatoplastia primária, pela técnica de Von Langenbeck associada a veloplastia intravelar. Métodos: Estudo retrospectivo de 278 prontuários de pacientes submetidos à palatoplastia primária no Centro de Tratamento de Malformações Craniofaciais Mário Covas - Hospital Guilherme Álvaro - Santos/SP, entre de maio de 2010 a maio de 2018. Resultados: 278 procedimentos de palatoplastia primária pela técnica relatada, 225 (80,9%) em duas etapas cirúrgicas e 53 (19,1%) em única etapa. Masculino 182 (65,5%) e feminino 96 (34,5%). Fissuras labiopalatais esquerda e bilaterais (26,3% e 27%, respetivamente). As fissuras palatais completas corresponderam a 37,4% e a fissura labiopalatal direita com 7,6%. 61 pacientes apresentaram fístula oronasal (21,94%) observando-se uma diminuição progressiva da incidência em cada período. Conclusão: A palatoplastia primária pela técnica de Von Langenbeck associada à veloplastia intravelar é uma técnica reprodutível em uma ou duas etapas cirúrgicas e pode ser considerada segura quando alcançada uma adequada curva de aprendizado apresentando um índice de complicações acorde com a literatura mundial.
Introduction: Palatoplasty with elevated bilateral mucoperiosteal flaps using the von Langenbeck technique associated with intravelar veloplasty is a common procedure with low rates of oronasal fistula (ONF) and velopharyngeal insufficiency. The objective is to present the author's surgical experience and the incidence of ONF among 278 patients who underwent primary palatoplasty using the von Langenbeck technique associated with intravelar veloplasty. Methods: This retrospective study analyzed the medical records of 278 patients who underwent primary palatoplasty at the Mário Covas Treatment Center for Craniofacial Malformations of the Guilherme Álvaro Hospital located in the municipality of Santos, São Paulo, Brazil, between May 2010 and May 2018. Results: A total of 278 primary palatoplasty procedures were performed; of them, 225 (80.9%) were performed in two surgical stages and 53 (19.1%) in one surgical stage. The study population included 182 men (65.5%) and 96 women (34.5%). The prevalence of left and bilateral cleft lip and palate was 26.3% and 27%, respectively, and the prevalence of bilateral cleft palate, and right cleft lip and palate was 37.4% and 7.6%, respectively. Sixty-one patients had ONF (21.94%), the incidence of which decreased progressively throughout the study period. Conclusion: Primary palatoplasty, using the von Langenbeck technique associated with intravelar veloplasty, is reproducible when performed in one or two surgical stages, and considered safe when the learning curve is reached with a complication rate similar to those in the literature.
ABSTRACT
Pain on the soft palate and pharynx can originate in several associated structures. Therefore, diagnosis of patients who complain of discomfort in these areas may be difficult and complicated. Pterygoid hamulus bursitis is a rare disease showing various symptoms in the palatal and pharyngeal regions. As such, it can be one of the reported causes of pain in these areas. Treatment of hamular bursitis is either conservative or surgical. If the etiologic factor of bursitis is osteophytic formation on the hamulus or hypertrophy of the bursa, resection of the hamulus is usually the preferred surgical treatment. We report on a case of bursitis that was managed successfully by surgical treatment and a review of the literature.
Subject(s)
Humans , Bursitis , Facial Pain , Hypertrophy , Palatal Muscles , Palate , Palate, Soft , Pharynx , Rare DiseasesABSTRACT
Objective:To observe the effect of dissection and reconstruction on palatal muscles morphology in cats. Methods: Nine cats were randomly divided into three groups according to the extension of muscle dissection: small area group(<1/3 group),medium area group(1/3-2/3 group)and large-scale area group(>2/3 group).Control group was the normal palatal muscle in any normal side of the palate.Palatal muscles of all experimental groups were dissected from the posterior border of the hard palate and were reconstructed later. The morphology features and ultrastructure of palatal muscles were observed respectively by HE staining and transmission electron microcopy 1-3 month after operation. Results: There were no obvious differences in morphologic features and ultrastructure of palatal muscles between experiment and normal control groups when the range of palatal muscle dissection was less than 2/3. At early stage (1 month) after operation in large-scale area group, the arrangement of muscles fiber were in structural disorder with inflammatory cell infiltration and muscle fibril formation. The Z line was not distinct, muscles fiber became narrow and myocomma arrangement was not fully dense under transmission electron microcopy. At later stage (2 or 3 month after operation) in large-scale area group, the arrangement of muscles fiber were comparatively regular, neonatal muscles fibers became gradually mature and the amount of inflammatory cell had obviously decreased. Ultrastructure study showed that myocomma arrangement was more orderliness, and Z line became more distinct. Conclusion: It suggests that the extensive dissection of palatal muscles carried no fibrosis, and injury musculature could be repaired and regenerated.
ABSTRACT
Objetivo: Demonstrar a eficácia do reposicionamento do músculo elevador do véu palatinoem pacientes portadores de fissura lábio-palatina anteriormente submetidos a palatoplastiapor outras técnicas. Método: Foram realizadas, 16 cirurgias de repalatoplastia posterior comdissecção radical da musculatura do véu palatino. A nasofibroscopia foi o instrumento demensuração da voz no período pré e pós-operatório, 3, 9 e 15 meses após a cirurgia. Duasfonoaudiólogas com experiência no tratamento do fissurado participaram na avaliação davoz nos períodos pré e pós-operatórios, sendo a hipernasalidade classificada em equilíbriooronasal, hipernasalidade leve, moderada e importante. O índice de Kappa foi utilizado paraavaliar o grau de concordância entre os observadores. O teste de igualdade proporcional foiutilizado com o objetivo de comparar as diferenças de voz no pré e pós-operatórios de 3,9 e 15 meses. O valor de p < 0,05 foi adotado para a significância estatística. Resultados:Seis pacientes eram do sexo masculino, com idade média de 17,93 anos. Houve uma boaconcordância entre as avaliadoras, sendo a menor de 76,6% (índice de Kappa). Com o retroposicionamentoda musculatura houve melhora no índice da hipernasalidade (p < 0,05),principalmente na hipernasalidade leve e moderada. Conclusão: Houve grande melhorado quadro da insuficiência velofaríngea após a dissecção radical, o que evidencia que talprocedimento é necessário e deve ser incluído no algoritmo dos protocolos em casos secundáriose preconiza-se que seja usado, também, em casos primários.
Objective: To demonstrate the efficacy of the muscular set back in secondary cases. Method:16 soft palate re-repair were performed with muscular set back. To evaluate the results of thesurgeries through the voice, nasal endoscopies were done pre and post operative (3, 9 and15 months). The results were evaluated by two speech pathologists specialized in cleft lipand palate patients. And the hypernasality was graded as equilibrium, mild, moderate andsevere. The Kappa index was used to evaluate the agreement between the two observers andthe equality of two proportion test gave the statistics significance, as p < 0.05. Results: Sixpatients were males. The mean age was 17.93 years. There was a good concordance betweenthe two evaluators. The least was 76.6% according to the Kappa index. With the retropositioningof the muscles` bundle there was an improvement in the velopharingeal insufficiency (p< 0.05) mainly in the mild and moderate cases. Conclusion: There was a great improvementin velopharingeal incompetence after radical muscle dissection, showing that this procedureis necessary and must be part of secondary palatoplasty protocols. And also must be usedduring primary soft palate repair.