华西改良腭咽肌瓣和Hogan咽后壁瓣术后腭咽功能及语音的对比研究

目的:通过对比研究华西改良腭咽肌瓣和Hogan咽后壁瓣2种术式在大龄腭裂患者术后腭咽功能和语音状况的变化,为临床大龄患者最佳术式的选择提供参考。方法:选择2009-01～2011-01行Hogan咽后壁瓣咽成形术(PF组,32例)和华西改良腭咽肌瓣咽成形术(P+SP组,49例)的患者,对其术后的腭咽闭合状况、共鸣、鼻漏气及辅音正确率、鼻呼吸通畅度进行分析对比统计。结果:PF组术后21例(62.50%)腭咽闭合完全;6例(18.75%)术后语音完全清晰。P+SP组术后VPC 30例(61.22%)腭咽闭合完全;13例(25.63%)语音完全清晰。PF组术后20例(62.5%)出现打鼾现象,P+SP组术后32例(65.31%)患者出现打鼾现象。PF和P+SP术式对术后腭咽闭合完全率、高鼻音、鼻漏气、辅音正确率以及呼吸的改变无差别。结论:2种术式都能显著提高患者的腭咽闭合率和语音清晰度。     

腭咽闭合不全的个体化治疗策略

目的 探讨腭裂术后腭咽闭合不全的个体化治疗方式.方法 对48例腭裂术后腭咽闭合不全患者进行病史回顾、查体、鼻咽纤维镜检查以及语音评估,根据检查结果分为3型.A型:腭咽闭合率在80％以上,软腭后缘距离咽后壁6 mm以内.B型:腭咽闭合率在80％以下,软腭短,咽侧壁动度较差.C型:腭咽闭合率在80％以下,软腭短,咽侧壁动度较好.对这3型患者分别采取不同的手术方式进行治疗.结果 所有48例患者经个体化手术治疗后,腭咽闭合率以及语音效果都得到明显改善和提高.结论 对腭裂术后腭咽闭合不全的患者,应在详细检查的基础上针对性地施行个体化手术治疗方案.     

Hogan法治疗大龄腭咽闭合不全患者的临床疗效分析

目的 探讨使用Hogan法咽后壁组织瓣转移术治疗大龄腭咽闭合不全（VPI）患者的临床疗效。方法收集33例腭裂术后VPI患者，年龄10～35岁，平均年龄20.4岁。所有患者均行Hogan法咽后壁组织瓣转移术治疗腭咽闭合不全。采用汉语语音清晰度测定法评估患者语音情况，鼻咽纤维镜（NPF）评估腭咽闭合程度，并进行分级。平均随访时间13.3个月。结果 33例患者术后创口均达到Ⅰ期愈合。术后语音清晰度明显提高，鼻漏气及高鼻音减少，与术前相比差异有统计学意义（P<0.05）。NPF检查示，术后腭咽闭合功能明显改善，30例（91%）患者腭咽闭合率达到Ⅰ级，3例（9%）患者达到Ⅱ级。结论 Hogan法咽后壁组织瓣转移术可显著改善大龄VPI患者的腭咽闭合状况，减少鼻漏气和高鼻音。     

改良腭咽肌瓣重建腭裂术后腭咽闭合功能的临床研究

目的:研究改良腭咽肌瓣重建腭咽闭合功能治疗中的应用。方法:对25例腭裂术后腭咽闭合不全的患者实施改良的腭咽肌组织瓣转移术。结果:手术效果好,高位形成新的咽环,腭咽肌瓣同软腭协同作用完成腭咽闭合。鼻音计检测鼻音化率明显降低,语音功能改善。结论:改良腭咽肌组织瓣转移术用于治疗腭裂术后腭咽闭合功能不全,具有创伤小,手术时间短,并发症较少,手术效果稳定可靠。     

腭咽闭合功能不全语音清晰度评价

目的　研究腭咽闭合功能不全患者的语音清晰度。方法　 10 0例腭咽闭合功能不全患者 ,其中 15例为腭裂 ,2 1例为先天性腭咽闭合不全 ,5 6例为腭裂术后腭咽闭合不全 ,8例为咽成形术后腭咽闭合不全 ,对照组为 32名健康人。 3名语音专业人员共同评价汉语语音清晰度 ,并且分析语音障碍和语音清晰度的关系。结果　健康组的语音清晰度为 99 0 % ,腭咽闭合功能不全组为35 5 % ,其中未手术腭裂组为 19 9% ,先天性腭咽闭合不全为 32 8% ,腭裂术后腭咽闭合不全为4 0 3% ,咽成形术后腭咽闭合不全为 35 2 % ,统计分析显示健康组和病例组各类型之间差异有显著性 (P <0 0 1)。结论　①腭咽闭合功能不全异常语音的语音清晰度差 ,并伴过度鼻音 ;②腭咽闭合不全异常语音中 ,腭裂患者的语音清晰度最低 ,其余依次为先天性腭咽闭合不全、咽成形术后腭咽闭合不全和腭裂术后腭咽闭合不全     

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     

大年龄腭裂患者术后腭咽闭合功能的影响因素

目的 研究2岁以上腭裂患者术后腭咽闭合功能的影响因素。方法 对245例2岁以上腭裂患儿术后腭咽闭合功能和可能影响术后腭咽闭合功能的因素（腭咽比值、腭裂类型、手术年龄、术式）进行回顾性研究。结果 腭咽闭合不全（ VPI）组和腭咽闭合完全（ VPC）组术前相对裂隙宽度、腭咽比值差异无统计学意义。不同年龄组、不同腭裂类型术后腭咽闭合率未见明显差异。不同的术式术后腭咽闭合率差异有统计学意义。结论 大年龄腭裂患者的治疗不宜照搬 2岁以下患儿单纯行腭裂整复术的常规治疗方案。裂隙的大小不是影响大年龄腭裂患者术后腭咽闭合功能的主要因素。 Sommerlad腭帆提肌重建术 +腭咽肌瓣咽成形术可明显改善大年龄患者术后腭咽闭合功能,在一期手术时应采用这种腭咽联合手术。     

腭帆提肌重建联合腭咽环扎术在腭裂修复中的应用

目的：探讨腭帆提肌重建联合腭咽环扎术在腭裂修复中的应用效果。方法：应用腭帆提肌重建联合腭咽环扎术修复较宽大腭裂26例,观察其修复腭裂后的伤口愈合和语音恢复效果。结果：术后均一期愈合,无复裂和瘘发生。随访16例患者,其鼻漏气得到有效控制,语音清晰度状况优良。结论：腭帆提肌重建联合腭咽环扎修复术可较好的恢复腭部的形态和腭咽功能,具有方法简单、创伤小和效果好的特点。     

腭裂整复术中肌肉功能性重建的研究进展

腭裂是口腔颌面部常见的先天性疾病之一，影响患者的饮食、语音和听力等重要的生理功能。行软腭内成形术重建腭咽肌肉，可以提高术后腭咽闭合率，改善患者术后的听力和语言能力。目前，腭裂整复时重建腭咽肌肉功能性已被大多数外科医生所认同，主要分歧在于术中肌肉解剖的程度、重建方式和肌肉功能性重建对腭咽功能、语音和听力的影响。本文就软腭内成形术与肌肉解剖、软腭内成形术与软腭功能、软腭内成形术与听力和软腭内成形术与术后腭瘘等研究进展作一综述。     

大龄腭裂患者术后腭咽闭合功能的影响因素分析

目的 探究大龄腭裂患者一期腭裂整复术后腭咽闭合功能的影响因素。方法 本研究回顾了2009—2014年间在四川大学华西口腔医院唇腭裂外科以Furlow术式行手术治疗的大龄腭裂患者（手术年龄≥5岁）,收集其软腭长度、咽腔深度、腭裂宽度、上颌宽度、腭裂指数和腭咽比6项指标的术中测量数据以及术后至少1年的语音复诊结果,进行logistic回归分析。结果 共纳入患者131人,其中男性70人,女性61人。logistic回归分析发现患者咽腔深度同术后腭咽功能强相关,咽腔深度越大,术后腭咽闭合不全风险升高。咽腔深度大于16 mm的患者术后腭咽闭合功能显著性降低,其他测量指标同术后腭咽功能无明显关联性。结论 大龄腭裂患者咽腔深度是其术后腭咽功能的敏感预测指标。对于咽腔深度大于16 mm的患者,可考虑一期手术时同步实施腭咽联合手术,以创造更好的腭咽闭合条件。     

Clinical outcomes of the furlow z-plasty for primary cleft palate repair

Objective: To review the clinical outcomes following the Furlow Z-plasty for primary cleft palate repair. The primary objective was to determine if the presence of an associated sequence or syndrome (i.e., Pierre Robin sequence), age at palate repair, cleft type, or surgeon experience influenced speech outcomes after a Furlow Z-plasty. Design: The outcomes of 140 patients who underwent palate repair were analyzed retrospectively. Speech evaluations were performed to score the severity of hypernasality, nasal escape, articulation errors, and velopharyngeal insufficiency. Results: The mean age at latest evaluation was 4 years 9 months (age range 2 years old to 12 years old and 4 months). Of the 140 patients, 83% had no evidence of hypernasality, 91% had no presence of nasal escape, and 69% had no articulation errors. Overall, 84% of patients had no evidence of velopharyngeal insufficiency. Secondary posterior pharyngeal flap to correct velopharyngeal insufficiency was required in only 2.1% of patients. The formation of an oronasal fistula occurred in only 3.6% of patients. Nonsyndromic patients with Pierre Robin sequence and syndromic patients did just as well as purely nonsyndromic patients in terms of velopharyngeal insufficiency, hypernasality, and nasal escape. Syndromic patients were more likely to make mild-to-moderate articulation errors. In addition, age at palate repair, cleft type, and surgeon experience had no statistically significant effect on speech results. Conclusions: The Furlow Z-plasty yielded excellent speech results in our patient population with minimal and acceptable rates of fistula formation, velopharyngeal insufficiency, and the need for additional corrective surgery.     

Nasopharyngoscopy of the normal velopharyngeal sphincter: an experiment of biofeedback

In a single normal subject, nasopharyngoscopy was used as an instrument for visual biofeedback of the velopharyngeal sphincter during speech. The goal of the experiment was for the subject to alter the velopharyngeal valving pattern observed during spontaneous speech by manipulating the relative contributions of the velum and pharyngeal walls. After six sessions, each lasting twenty minutes, the subject was able to change velopharyngeal valving pattern at will during short samples of connected speech. This implies the role of learning in velopharyngeal valving and a degree of physiologic plasticity in the velopharyngeal sphincter. The procedure is felt to have possible application to a variety of conditions which have velopharyngeal insufficiency as a symptom.     

A pilot study of the effects of transpalatal maxillary advancement on velopharyngeal closure in cleft palate patients

BACKGROUND AND AIMS: Impaired velopharyngeal closure function is sometimes a complication of a standard Le Fort I maxillary advancement in cleft palate patients. The transpalatal Le Fort I osteotomy has been suggested as an alternative technique that may avoid this problem. The aim of this pilot study was to examine the effects of the transpalatal approach on velopharyngeal function in a series of cleft palate patients. PATIENTS: Sixteen consecutive patients with a history of cleft palate exhibiting maxillary hypoplasia who underwent a transpalatal Le Fort I osteotomy. METHODS: All patients had a simultaneous audio/video speech recording and nasopharyngoscopy examination prior to maxillary advancement, followed by a repeat of the same examinations at least 1 year post-operatively. Velopharyngeal function was measured in two ways: by direct observation using nasopharyngoscopy, and indirectly by means of perceptual assessment. Reliability studies of the two measures were performed with satisfactory results. RESULTS: No statistically significant difference was found between the pre- and post-operative data in either the perceptual speech assessment or nasopharyngoscopy examination. CONCLUSION: These results indicate that maxillary advancement by transpalatal Le Fort I osteotomy does not adversely affect velopharyngeal closure function.     

腭裂咽成形术后患者语音治疗疗效评价

目的:对腭咽成形术后存在语音障碍的患者进行语音治疗,通过治疗前后语音清晰度比较,评价该方法的疗效。方法:咽成形术后患者82例,年龄4~31岁。采用汉语语音清晰度测试表对患者进行治疗前后语音清晰度检测,根据代偿性发音特点进行系统化语音训练:①腭咽闭合功能锻炼;②音素→音节→词组→短句→短文、会话。训练时按发音部位由前→后,按发音方法由易→难、送气音→不送气音、塞音→擦音→塞擦音。训练周期1.5~12个月,平均3.83个月。结果:以腭咽闭合不全型为特点的代偿性语音患者共71例;其中声门塞音患者语音清晰度由治疗前的46.27%提高到治疗后的97.16%;咽摩擦音患者由治疗前的57.19%提高到治疗后的97.72%。以腭咽闭合良好型为特点的代偿性语音共11例,腭化、侧化音患者语音清晰度由治疗前的71.10%提高到治疗后的98.55%;3组经t检验,P均<0.001,具有极显著性差异。结论:对咽成形术后腭咽闭合不全型的代偿性发音,首先加强腭咽闭合功能,再建立正确的发音部位和方法;对咽成形术后腭咽闭合良好型的代偿性发音,可直接建立正确的发音部位和方法。     

腭裂患者错误构音的相关因素研究

目的 通过对比研究腭咽闭合完全后构音的变化来探讨构音与腭咽功能和手术年龄的相关性,并同时探讨影响患者手术前后辅音脱落变化的相关因素。方法 选择2011年1-12月符合纳入标准的48例非综合征型腭裂患者,其中男18例,女30 例,平均年龄（13.3±5.8）岁。回顾性分析其相关语音数据,对其术前与术后的构音变化情况进行非参数检验,对构音改变程度与手术年龄等进行相关性分析。以P<0.05为具有统计学意义。结果 经过非参数检验腭咽闭合完全后构音的变化有统计学意义（Z=-3.796,P=0.000）;术后构音恢复正常的百分比与手术年龄负相关（R=-0.487,P=0.000）。辅音脱落的改变程度与手术年龄呈正相关（R=0.589,P=0.000）;与复诊时间呈负相关（R=-0.235,P=0.040）;与性别呈正相关（R=0.404,P=0.047）。结论 腭咽闭合完全后构音明显好转,语音清晰度明显改善;患者达到腭咽闭合完全的年龄越小,术后构音恢复正常的百分比越高。辅音脱落的改变与患者年龄和性别呈正相关,与复诊时间呈负相关。     

鼻咽纤维镜生物反馈治疗在腭裂术后语音治疗中的应用

目的了解鼻咽纤维镜生物反馈治疗在腭裂术后语音治疗中的作用。方法采用鼻咽纤维镜在直视监控下让患者按规定语音材料在治疗师指导下进行发音练习,通过视一听反馈调节机制使患者自行调节腭咽部肌肉等结构功能以形成完全、持续的腭咽闭合,同时配合常规语音训练改善发音技能。结果共有8例患者接受治疗。其中5例患者腭咽闭合恢复正常,2例咽后壁瓣术后患者一侧孔闭合,另一侧孔仍为闭合不全状态,1例患者训练2次后中途退出治疗。结论鼻咽纤维镜能使病人在视一听反馈状态下在较短时间内改善腭咽闭合功能,但主要适用于具有腭咽闭合潜能的患者,如边缘性腭咽闭合或腭咽闭合不连续等腭咽闭合协调异常等患者。     

Buccinator sandwich pushback: a new technique for treatment of secondary velopharyngeal incompetence.

OBJECTIVE: A small percentage of patients have inadequate velopharyngeal closure, or secondary velopharyngeal incompetence, following primary palatoplasty. Use of the buccinator musculomucosal flap has been described for primary palate repair with lengthening, but its use in secondary palate lengthening for the correction of insufficient velopharyngeal closure has not been described. This study presents the results of a series of patients who had correction of secondary velopharyngeal incompetence using bilateral buccinator musculomucosal flaps used as a sandwich. PATIENTS: In this prospective study between 1995 and 1998, a group of 16 patients with insufficient velopharyngeal closure as determined by speech assessment and videoradiography were selected. Nasopharyngoscopy was carried out in addition in a number of cases. Case selection was a result of these investigations and clinical examination in which the major factor in velopharyngeal insufficiency was determined to be short palatal length. DESIGN: The patients underwent palate lengthening using bilateral buccinator musculomucosal flaps as a sandwich. All patients were assessed 6 months postoperatively. The operative technique, postoperative course, and recorded postoperative complications including partial/total flap necrosis and residual velopharyngeal insufficiency were evaluated. Preoperative and postoperative speech samples were rated by an independent speech therapist. RESULTS: Ninety-three percent (15 of 16) had a significant improvement in velopharyngeal insufficiency, and 14 patients had no hypernasality postoperatively. Both cases of persistent mild hypernasality had had a recognized postoperative complication. CONCLUSION: The sandwich pushback technique for the correction of persistent velopharyngeal incompetence was successful in achieving good speech results.     

Intraindividual change in the occurrence of Passavant's ridge due to change in velopharyngeal sphincter function: a videofluoroscopic study

Passavant's ridge was studied by means of videofluoroscopy and nasopharyngoscopy in 80 patients with hypernasal speech. In patients with Passavant's ridge an improvement of the sphincter function was found to be associated with an enlargement of the ridge. It was also observed that the ridge could disappear if complete velopharyngeal closure was achieved without surgical intervention of the ridge area. The results indicate that Passavant's ridge is of compensatory origin.     

Diagnosis of velopharyngeal incompetence after primary cleft palate repair]

Fifty four patients who had had primary cleft palate surgery and whose speech remained defective were examined by speech intelligibility test, lateral videofluoroscopy and flexible nasopharyngoscopy. We found that there are obvious individual differences in the velopharyngeal closure pattern of the patients with speech deficiency following primary surgery. The velopharyngeal closure patterns can be grouped into five categories according to the manner of the velum and lateral pharyngeal wall movements. The criteria of the classification and its significance are discussed in this paper.     

Speech outcome after closure of oronasal fistulas with bone grafts.

PURPOSE: The purpose of this prospective study was to evaluate the outcome of speech after complete closure of oronasal fistulas with bone grafts and to determine the possible relationship between outcome of speech and the size and location of the oronasal fistulas. PATIENTS AND METHODS: Ten unilateral cleft lip and palate patients with postoperative oronasal fistulas, ranging in age from 7 to 14 years, underwent secondary alveolar cleft repair and closure of the oronasal fistulas with an iliac bone graft. All patients underwent videofluoroscopic evaluation of the velopharyngeal valve, audiologic assessment, and speech evaluation (resonance, nasal emission, articulation, intelligibility, and nasalance) preoperatively. The examinations were repeated 3 months postoperatively. RESULTS: Six patients had preoperative velopharyngeal competency (60%). Of the 4 patients with slight to mild velopharyngeal incompetency preoperatively, 2 developed velopharyngeal competency postoperatively. All patients had satisfactory audiologic function preoperatively. Every patient also was intelligible before and after surgery. Eight patients (80%) showed nasal emission before surgery and 7 of these patients improved postoperatively (P <.01). Nine patients had articulation errors before surgery, with no significant improvement postoperatively. Nasalance was significantly improved in selected sequences. All patients had variable levels of nasality preoperatively; 8 showed a significant decrease of nasality postoperatively (P <.002). The results were not related to location or size of the oronasal fistulas. CONCLUSION: A significant improvement in speech is noticeable after closure of oronasal fistulas. Early oronasal fistula closure might prevent permanent speech distortions acquired by the cleft palate patients at an early age.