Objective To verify the effect of palatoplasty with or without velopharyngeal muscular reconstruction on the velar movement through the lateral radiography. Methods From October 1988 to October 2000, 62 patients with cleft palate and velopharyngeal insufficiency were treated. Of them, 32 were repaired by velopharyngeal muscular reconstruction (group A) and 30 by modified von Langenbeck’s procedure (group B). The lateral radiographs and cephalometric analysis were taken. The velopharyngeal closure, velar extensibility, the angle changes of velar elevation, the distance changes of velar levator eminence based on anatomy (LEA) to velopharyngeal closure line (VCL), the varieties in LEA, the comparison of LEA and velar levator eminence based on phonation (LEP), the distance comparison between posterior nasal spine (PNS) to LEA and LEP through soft palate line (SPL) were measured. Results During the phonation, group A was significantly greater than group B in the velopharyngeal closure rate(Plt;0.01)， the velar extensibility(Plt;0.05) and the location comparison between LEA and LEP(Plt;0.01); group B was significantly greater than group A in velar elevation angle (Plt;0.05), the varieties in LEA(Plt;0.05). In velar rest position, the distance of LEA to VCL was greater inB group than in A group(Plt;0.01). There was significant difference in thedistance comparison between LEA and LEP(Plt;0.05), difference between LEA and LEP(Plt;0.01) and the distance PNS-SPL-LEA and PNSSPL-LEP(Plt;0.05) within group B; contrary to the results within group A(P＞0.05). Conclusion The velopharyngeal muscular reconstruction in palatoplasty can result in a near normalizationof anatomic measurement of velar levator muscles and improve the velar functionand velopharyngeal competence. Repositioning of velar muscles in a more anatomic correct, transverse position is more important to improve the velar length andaccordant velar movement with velopharyngeal muscles in functional palatoplasty. The velar angle change and velar elevation during phonation are not determinative factors for velopharyngeal competence.
To explore the effects of tissue expansion on the anastomoses and the survival of the axial pattern flap with a crossing area supply so as to improve the survival of crossing area axial pattern flap and to provide a new idea for the development of original crossing area axial flap. Methods The experiment included two parts. Experiment A was divided into expansion group and control group. Square flaps were randomly designed on own control bilaterally in each animal with a boundary of midl ine. Experiment B was divided into expansion group and delay group. The flaps were also randomly designed on own control bilaterally. Angiographic analysis and gross survival observation were carried on. Results ExperimentA: Angiography showed that there were abundant anastomoses with big cal iber between deep il iac circumflex artery and superior epigastric artery in expansion group and there were only 3-4 anastomoses in control group. Experiment B: Angiography showed that there were abundant anastomoses with big cal iber in expansion group and there were two arterial systems with relatively less anastomoses and smaller cal iber in delay group. The survival rates in expansion group was significantly higher than that in the control group (90.16% ± 3.61% vs 72.67% ± 5.35%) in experiment A, and in experiment B the survival rate was 92.08% ± 3.30% in the expansion group and 80.79% ± 4.52% in the delay group, showing significant difference (P lt; 0.01). Conclusion Expansi on prefabrication can and improve the survival of the crossing area supply axial pattern flap. The mechanism is the bridging effect.