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Der MKG-Chirurg

, Volume 12, Issue 1, pp 2–10 | Cite as

Intravelare Veloplastik und plastischer Verschluss des harten Gaumens

  • S. ReinertEmail author
  • M. Krimmel
Leitthema
  • 23 Downloads

Zusammenfassung

Ziele der Gaumenspaltplastik sind die Wiederherstellung normaler anatomischer Verhältnisse und eine regelrechte Funktion des weichen Gaumens im Hinblick auf die velopharyngeale Kompetenz und die Tubenbelüftung ohne Beeinträchtigung des Gesichtsschädelwachstums. Für den Patienten ist funktionell der plastische Verschluss des weichen Gaumens von größter Bedeutung. Als Verfahren der Wahl kommt hierfür die intravelare Veloplastik mit radikaler Muskelpräparation und Rückverlagerung des M. levator veli palatini unter dem Operationsmikroskop bei minimaler Präparation des harten Gaumens nach Sommerlad in Betracht. Für den plastischen Verschluss des harten Gaumens vor oder nach der intravelaren Veloplastik sind verschiedene Verfahren gebräuchlich (Brücken- und Stiellappen, einschichtiger Vomerlappen). Bei allen primären Spaltoperationen mit Gaumenbeteiligung erfolgt obligat eine HNO-ärztliche Untersuchung, sodass in der gleichen Narkose bei Bedarf eine Otoskopie/Parazentese und in Abhängigkeit vom Befund auch eine Paukendrainage durchgeführt werden kann. Mit verschiedenen mehrstufigen Operationsprotokollen lassen sich bezüglich der Sprechergebnisse und des Oberkieferwachstums ähnliche Ergebnisse erzielen. Literaturdaten zufolge scheint auch die Erfahrung bzw. Technik des Operateurs eine wichtige Rolle zu spielen. Resultiert nach plastischem Velumverschluss eine velopharyngeale Insuffizienz, sollte die muskuläre Velumfunktion neben der klinischen Untersuchung durch weitere apparative Verfahren objektiviert werden. Insgesamt ist in der Spalttherapie die Datenlage für klare evidenzbasierte Aussagen in Anbetracht weniger qualitativ hochwertiger Studien nach wie vor unbefriedigend.

Schlüsselwörter

Gaumenspalte Velum Velopharyngealer Sphinkter Sprechen Oberkiefer 

Intravelar veloplasty and repair of the hard palate

Abstract

The aim of palatoplasty is restoration of normal anatomic relationships and function of the soft palate in terms of velopharyngeal competence and tube ventilation, without impairment of maxillary growth. Repair of the soft palate is of utmost functional importance for the patient. The technique of soft palate repair developed by Sommerlad combines minimal hard palate dissection with “radical” retropositioning of the velar musculature. The repair is performed under the operating microscope. For hard palate repair before or after intravelar veloplasty, different procedures are possible (bridge and pedicle flaps, single-layer Vomer flaps). All patients are subject to ENT examination prior to primary cleft surgery with palatal involvement, so that if necessary, an otoscopy/paracentesis and tympanic drainage can be performed in the same procedure. In terms of speech outcome and maxillary growth, good results can be obtained with different multistep surgical protocols. Literature data suggest that surgical skill may be an important factor in determining success. In case of velopharyngeal dysfunction or insufficiency after veloplasty, clinical examination of the soft palate should be supplemented by instrumental assessments. Unfortunately, the number of prospective clinical trials is still insufficient for detailed evidence-based recommendations in cleft care.

Keywords

Cleft palate Soft palate Velopharyngeal sphincter Speech Maxilla 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Reinert und M. Krimmel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Mund‑, Kiefer- und GesichtschirurgieUniversitätsklinikum TübingenTübingenDeutschland

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