手術治療2 咽頭弁形成術

Pharyngeal Flap Surgery

はじめに

　ヒトが社会生活を営むうえでことばを使ったコミュニケーションは非常に重要な位置を占める。ことばを使うために鼻咽腔閉鎖機能は必要不可欠であり，先天的な機能不全を回復する口蓋形成術を行っても鼻咽腔閉鎖機能不全が残存する場合には，再口蓋形成術や咽頭弁形成術，咽頭形成術，脂肪注入などが選択肢となる。

　そのなかでも鼻咽腔閉鎖機能改善を得やすい治療手段として知られる咽頭弁形成術は，口蓋裂に対する手術として，1876年にSchoenborn 1）が17歳の女性に対して治療した方法を初めて報告した。以来，さまざまな方法が考案され報告されてきたが，著者は1975年にIsshikiら 2）が発表した折り畳み咽頭弁形成術を主に用いている。

　咽頭弁形成術は改善効果を得やすい術式である反面，合併症などへの注意も必要である。本稿では著者が用いている咽頭弁形成術について，適応判断も含めて述べる。

　Verbal communication is extremely important in human social life. Velo-pharyngeal closure is essential for speaking, and if the velo-pharyngeal closure function remains impaired even after a palatoplasty is performed to restore congenital anomalies, the potential options are re-palatoplasty, pharyngeal flap, pharyngoplasty, and fat injection.

　Among these, the use of a pharyngeal flap, which is known as the most effective treatment for improving velo-pharyngeal function, has been developed in various ways as a surgical method for cleft palate. A reliable improvement in the pharyngeal flap is desired as a last resort, but in many cases where such a flap is indicated, the abnormality of Veauʼs cleft muscles remains, and its reconstruction is thus also necessary. For this reason, I usually reconstruct Veauʼs cleft muscles using the modified Furlow technique when performing a folded pharyngeal flap surgery. Since a pharyngeal flap physically narrows the nasopharynx, there is a risk of the postsurgery development of obstructive sleep apnea syndrome. In addition, since this is a surgical treatment performed during a young patientʼs growth, the judgment of surgical indications is extremely important. It is necessary to make this judgment carefully in collaboration with a speech therapist and not based only on an objective evaluation using imaging tests.