腭裂患者术后腭咽闭合状况的研究

目的：研究腭裂术后患者语音清晰度同腭咽功能的关系。方法：回顾性研究，将23名行腭裂修复术的复查患者按语音清晰度差异，分成语音缺陷组（IAr)和语音清晰组（NAr)，用鼻咽纤维镜观察并摄录他们的腭咽图像，用腭咽图像分析软件测定患者发[a],[i]二个单韵母时的腭咽闭合不全率（RVPI），矢状闭合不全率（RSVPI），冠状闭合不全率（RCVPI），对两组患者以上3个指标进行了对照。结果：发[a]时2组患者RVPI无明显差异。发[i]时有显著性差异；2组发二音时软腭动度均有明显差异；侧壁动度均无差别。结论；术后患者发[i]时的RVPI及软腭动度可以作为评价腭咽功能及语音清晰度的指标。     

应用鼻咽镜对74例腭裂术后患者腭咽闭合功能的评价

应用鼻咽镜(NPF)对74例完全性腭裂术后患者进行了随访,术式均为二大瓣术。48例术后腭咽闭合功能良好,手术成功率为64.86%(48/74)。术后腭咽闭合不全(VPI)发生率有随手术年龄增大而增高的趋势,且 VPI 病员半环状和环状关闭类型比例明显高于手术后腭咽闭合完全的病员(X~2=6.39,P<0.05)。作者分析了其原因并提出预防和改进措施。对需要行咽成形术者,作者建议先作NPF检查,根据咽侧壁的不同活动度来设计手术方法,可提高手术成功率。     

腭裂术后患者腭咽闭合功能的定量研究

对４３例腭成形术后语言障碍患者和６０例正常构音者的腭咽闭俣功能进行了观察，并借助计算机把鼻咽纤维内窥镜对静止位、／ａ／、／ｓ／、／ｍ／的图像作了定量研究。     

腭裂手术年龄对腭咽闭合功能影响的研究

目的通过回顾性调查,研究在不同年龄修复腭裂后腭咽闭合功能恢复的规律。方法将102例年龄在10岁以上,腭裂术后2年以上的单侧完全性唇腭裂患者,根据接受腭裂手术的年龄分为三组,A组:0~3.00岁手术组(n=37)、B组:3.01~6.00岁手术组(n=36)和C组:6.01岁以上手术组(n=29)。随访时进行鼻咽纤维镜检查,对其最大腭咽闭合程度进行等级评价。并对不同手术年龄组间的腭咽闭合程度进行统计学检验。结果统计学检验显示腭咽闭合程度在A组与B组以及A组与C组间差异有显著性(P<0.05),B组与C组间差异有显著性趋势(P=0.051)。说明0~3.00岁接受腭裂修复术患者术后腭咽闭合功能的恢复要明显优于3.01岁以上接受腭裂修复术的患者,而3.01~6.00岁接受腭裂修复术患者术后腭咽闭合功能的恢复要优于6.01岁以上接受腭裂修复术的患者。结论在不同年龄进行腭裂修复术其术后腭咽闭合功能恢复的程度不同。手术年龄越小,恢复程度越好。     

腭裂术后腭咽闭合功能检测方法的研究

作者应用鼻咽内窥镜、电视摄录像系统、计算机等，对１０３例腭裂术后病员进行了腭咽闭合功能的定性和定量分析。从腭咽闭合类型分类研究中发现，闭合不全组冠状类型明显低于闭合完全组（Ｐ＜０．０５）。从术后腭咽闭合功能角度来比较不同手术年龄之效果，结果表明术后腭咽闭合不全率与手术年龄成正比，其中（３岁组的腭咽闭会不全为２８．５７％，而≥７岁组高达９６．４３％（Ｐ＜０．０１）。     

腭咽闭合功能生理参数的研究

目的 为区分腭裂术后生理性和病理性腭咽闭合不全，必须提出健康人群生理性ＶＰＩ－这一客观指标。     

综合征性腭裂与腭裂术后腭咽闭合不全

腭裂修复术后的语音恢复 ,一直是备受外科医师和语音治疗师关注的焦点问题之一 ,随着腭裂修复手术年龄的下降 ,术后的语音效果得到明显提高 ,但无论手术年龄多小 ,仍有 5 %～ 10 %的患者术后存在腭裂语音[1] ,而腭裂语音的产生与术前的口鼻腔相通和术后的腭咽闭合不全有直接的关系。为什么腭裂术后有一定比例的患者发生腭咽闭合不全 ?除了学者们公认的影响因素 ,如 :手术年龄、手术技术以及患者的解剖生理条件外[1] ,腭裂伴有其他先天畸形也是非常重要的影响因素。据文献报道共有 178种伴有唇腭裂的综合征、序列征、联合征以及其他畸形 ,占…     

鼻咽纤维镜在腭裂术后语音效果随访中的应用

本文作者运用鼻咽纤维镜对本科所做的37例腭裂术后病人进行了随访。文童介绍了检查内容方法和结果,并对腭裂病人发音清晰度的有关因素进行了讨论。体会到鼻咽纤维镜在腭裂术后语音效果随访中十分有价值,其操作简便,无损伤,是一种既能直观检查病人腭咽部情况又能客观检测腭咽闭合功能的方法。     

幼儿腭裂术后语言发育与腭咽闭合功能恢复关系的研究

目的 探讨幼儿腭裂患者术后口语语言发育对腭咽闭合功能恢复的影响.方法 普通话腭裂术后患者78例,腭裂手术年龄平均14.9个月,对其手术后(30±3)个月时的录音资料整理、转译判听及分析.分别统计平均发音次数(mean utterance count,MUC)和平均特定口辅音正确发生次数(mean special consonant correct count,MSCC).应用统计学方法分析MUC和MSCC的相关性.结果 本组78例的MUC:5.5～54.4次/min,平均26.8次/min;MSCC:0～8.4次/min,平均1.1次/min.MUC和MSCC呈正相关关系,相关系数为0.360(P＜0.01).结论 患者发音频数越高越有助于腭裂术后腭咽闭合功能的恢复.     

Treatment algorithm for velopharyngeal dysfunction in patients with cleft palate: a systematic review

The aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm. A systematic review was done, by searching Pubmed, Scopus, and Web of Science electronic databases, following the PRISMA guidelines. Articles reporting speech assessment results of secondary VPI surgeries on non-syndromic patients with CP. Surgical techniques were categorised into two groups; palatal and pharyngeal surgeries. Raw data were extracted to compare speech outcome and complication of each technique, with special emphasis on the factors affecting the patients’ selection for each technique. Our results showed comparable success and complication rates among these techniques. However, the factors governing selection of each technique were identified and taken into consideration to reach a preliminary algorithm. A preliminary treatment algorithm is described based on the results of our review; the most important factors affecting the technique choice are: VP gap size, LVP position, palatal mobility, palatal scarring, VP closure pattern, and age of the patient.     

Preoperative pharyngeal depth is associated with postoperative velopharyngeal function following primary cleft palate repair at the age of five and above

To determine prognostic factors for postoperative velopharyngeal function following the primary cleft palate repair at the age of five and above.This study reviewed patients with cleft palate who had undergone Furlow palatoplasty at age 5 or older from 2009 to 2014. We obtained intraoperative measurements, including velar length, pharyngeal depth, cleft width, maxillary width, cleft palate index (cleft width/maxillary width) and palatopharyngeal ratio (velar length/pharyngeal depth), as well as speech evaluation results at least 1 year after surgery. Logistic regression and retrospective analyses were performed to determine factors associated with speech performance after the primary cleft palate repair.Among the six intraoperative measurements of velopharyngeal morphology, only pharyngeal depth was incorporated into the regression model, and was found to have an inverse association with postoperative velopharyngeal function, Exp (B) 0.883 (95% CI 0.798-0.976). Moreover, a pharyngeal depth greater than 16 mm was significantly associated with a higher risk of postoperative velopharyngeal insufficiency (P < 0.01).Pharyngeal depth is potentially a prognostic indicator for the primary management of cleft palate in older patients. Pharyngoplasty may need to be considered when the pharyngeal depth is large and the patient’s access to surgery is limited.     

Results of speech improvement following simultaneous push-back together with velopharyngeal flap surgery in cleft palate patients

ObjectiveVelopharyngeal insufficiency (VPI) can be caused by a variety of disorders. The most common cause of VPI is the association with cleft palate. The aim of this study was to evaluate the effectiveness of different surgical techniques for cleft palate patients with VPI: 1) velopharyngoplasty with an inferiorly based posterior pharyngeal flap (VPP posterior, Schönborn–Rosenthal), and 2) combination of VPP posterior and push-back operation (Dorrance).Patients and methods41 subjects (26 females, 15 males) with VPI were analysed. Hypernasality was judged subjectively and nasalance data were assessed objectively using the NasalView^® system preoperative and 6 months postoperative.ResultsSubjective analysis showed improved speech results regarding hypernasality for all OP-techniques with good results for VPP posterior and VPP posterior combined with push-back with success rates of 94.4% and 87.7%, respectively. Objective analysis showed a statistically significant reduction of nasalance for both VPP posterior and VPP posterior combined with push-back (p < 0.01). However, there were no statistically significant differences concerning measured nasalance values postoperatively between the VPP posterior and VPP posterior combined with push-back.ConclusionBased on our findings, both VPP posterior and VPP posterior combined with push-back showed good results in correction of hypernasality in cleft patients with velopharyngeal insufficiency.     

电子纤维鼻咽喉镜对腭咽环扎术疗效的评价

目的 应用电子纤维鼻咽喉镜观察腭咽环扎术后患者腭咽闭合功能，评价该手术的远期疗效。方法 选择腭咽环扎术后16年的腭裂患者23例，用电子纤维鼻咽喉镜观察患者在吞咽和发音时的咽侧壁、咽后壁、软腭的运动情况。结果 电子纤维鼻咽喉镜系统直接观察到发音时咽侧壁的运动及软腭的上、下、前、后运动，软腭与咽后壁的关系，软腭长度及在矢状面上提升的高度。结论 腭咽环扎术能有效地改善腭咽闭合功能；电子纤维鼻咽喉镜可直接观察到腭咽部的运动情况，是评价术后腭咽闭合功能的有效方法。     

咽后壁瓣断蒂对腭咽闭合影响的探讨

目的 探讨咽后壁瓣成形术后腭咽闭合功能不全(velopharyngeal insufficiency,VPI)及其并发症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)治疗中咽后壁瓣断蒂的作用.方法 1993至2008年于北京大学口腔医学院·口腔医院唇腭裂治疗中心接受咽后壁瓣断蒂术患者20例(不完全腭裂11例、完全性唇腭裂9例),20例断蒂术前均行鼻咽纤维镜、头颅定位侧位X线片检查及语音录音,对有OSAHS主述者行睡眠呼吸监测.全部患者术后48 h后进行语音评价.术中单纯断蒂14例,断蒂后重新改变咽成形术式6例.结果 ①14例成形术后语音改善不明显,仍存在过高鼻音,咽后壁瓣断蒂术后语音改善明显;②3例成形术后虽发音正常但出现呼吸道阻塞症状,断蒂术后呼吸睡眠状况改善,语音仍正常;③3例成形术后发音正常,因正颌手术的麻醉需要断蒂,断蒂后的语音无明显改变.结论 咽后壁瓣成形术后出现OSAHS或仍存在VPI,需手术断蒂或其他类型咽成形术治疗;断蒂的时间应在咽后壁瓣成形术半年后.     

A treatment algorithm for secondary cleft palate repair based on age and preoperative velopharyngeal closure ratio

This study aimed to find a surgical treatment algorithm for secondary velopharyngeal insufficiency (VPI), with Furlow palatoplasty or posterior pharyngeal flap (PPF), balancing speaking and breathing. Non-syndromic cleft palate patients with secondary VPI who underwent Furlow palatoplasty or PPF were reviewed. A multinomial logistic regression model was employed to estimate the association between preoperative variables and surgical outcomes. A series of multinomial logistic regression models was utilized to determine the cut-off value of the significant predictors for subgroup comparison. In total, 203 patients were enrolled, with 73 receiving Furlow palatoplasty and 130 receiving PPF. The surgical outcomes of the two techniques were significantly different (p = 0.005). Age was a significant predictor in all intragroup comparative analyses. Preoperative VCR was associated with postoperative velopharyngeal function in patients undergoing Furlow palatoplasty (p = 0.042). The best cut-off values were an age of 13 years and a VCR of 70%. Surgical outcomes in both group B (age <13, VCR <70%; p = 0.017) and group C (age ≥13, VCR ≥70%; p = 0.003) differed significantly between the two surgical techniques. Within the limitations of the study, it is seems that in patients aging <13 years and with a VCR of ≥70%, Furlow palatoplasty should be preferred whenever appropriate to receive adequate velopharyngeal function.     

Le Fort I osteotomy in cleft patients: Maxillary advancement and velopharyngeal function

BackgroundMaxillary advancement may affect speech in cleft patients.AimsTo evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients.MethodsNinety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n = 24) osteotomy at Helsinki Cleft Palate and Craniofacial Center.Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre- and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student's t-test and Mann–Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability.ResultsThe mean advancement of A point was 4.0 mm horizontally (range: −2.8–11.3) and 3.9 mm vertically (range −14.2–3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy.ConclusionsThe amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.     

腭裂整复术后腭帆提肌运动能力的观察

目的 观察腭裂及单纯唇裂患者在不同语音状态下腭帆提肌伸缩能力和倾斜角度的差异.方法 使用MRI拍摄3组研究对象:①单纯唇裂组(对照组)8例;②腭裂术后腭咽闭合功能不全组(velopharyngeal incompetence,VPI组)7例;③腭裂术后腭咽闭合功能完全组(velopharyngeal competence,VPC组)l0例,在静止位以及发"a"、"i"、"m"音时腭帆提肌的影像,并分析各图像中腭帆提肌垂直段的长度以及相对于面中份矢状面角度变化.结果 3组儿童随发"a"、"i"、"m"音,腭帆提肌垂直段的长度收缩率依次为[(13.5±11.7)%、(11.1±10.8)%、(8. 2±14.3)%];随发"a"、"i"、"m"音,相对于面中份矢状面角度依次变小[(43.18±4.984)°、(43.08±4.879)°、(39.48±5.046)°];3组研究对象发音时腭帆提肌长度和角度的变化差异无统计学意义(P＞0.05).结论 腭裂患者术后腭帆提肌的运动能力与单纯唇裂患者基本相同.     

腭咽阻塞器在腭裂术后腭咽闭合不全语音障碍中的治疗作用

目的 :探讨腭咽阻塞器对腭裂术后腭咽闭合不全 (VPI)的语音功能障碍的治疗作用。方法 :应用腭咽阻塞器治疗腭裂术后VPI患者 13 5例 ,分别于治疗前 ,治疗后 180d、1年、2年 ,观察VPI患者的腭咽闭合不全率 (RVPI)、腭咽闭合不全改善率 (IRVPI)、各单元音共振峰频率F3以及语音效果的变化。结果 :腭咽阻塞器治疗后 ,VPI患者的RVPI逐渐降低 ,IRVPI逐渐增高 ,且各单元音共振峰F3逐渐增高 ,接近正常人 ,与治疗前比较差异有显著性 (P <0 .0 1)。去除阻塞器后 ,45例患者腭咽闭合正常 ,语音恢复正常 ,45例患者腭咽闭合基本正常 ,语音基本正常。结论 :腭咽阻塞器治疗腭咽闭合不全具有恢复语音功能的作用