651名唇腭裂患者腭咽闭合状况数字化头影测量片分析

目的：了解唇腭裂患者的腭咽闭合状况。方法：选取2011年1月～2012年7月四川大学华西口腔医院放射科拍摄的651例唇腭裂患者的数字化头影测量x线片，对患者腭咽闭合状况进行分析。结果：患者平均年龄15．59岁；腭咽闭合尚可者140例（21．51％），腭咽闭合不全者508例（78．03％），不易判断者3例（0．46％）；不同患者拍片类型不同，同时拍摄非造影静止位片和非造影发音片者最多，占总数的40．71％。结论：X线头颅侧位片对了解唇腭裂患者腭咽闭合状况有积极作用。     

腭咽闭合功能生理参数的研究(NPF检测法)

目的为区分腭裂术后生理性和病理性腭咽闭合不全（ｖｅｌｏｐｈａｒｙｎｇｅａｌｉｎｃｏｍｐｅｃｔｅｎｃｅ，ＶＰＩ），必须提出健康人群生理性ＶＰＩ———这一客观指标。方法采用鼻咽纤维内窥镜（ｎａｓｏｐｈａｒｙｎｇｅａｌｆｉｂｒｏｓｃｏｐｅ，ＮＰＦ）对８９０名发音正常的健康人的腭咽闭合进行动态观察，检测音素为／ｉ／、／ｕ／两元音，并以腭咽闭合不全率（ＲＶＰＩ）作为客观指标进行定量分析。结果发／ｉ／时出现ＶＰＩ者１１７名（１３１５％），ＲＶＰＩ均值为（１１２８５±７２４８）％；发／ｕ／时出现ＶＰＩ者１００名（１１２４％），ＲＶＰＩ均值为（９０６６±６１６２）％。年龄和性别经统计学分析，差异均无显著性。结论本结果可作为发音正常人群的ＶＰＩ生理参数，为评价腭裂术后腭咽功能提供依据     

电子鼻咽镜下正常成人发音与鼓气状态下腭咽闭合功能的比较研究

目的　比较正常成人在发音与鼓气状态下腭咽闭合的差异。方法　通过电子鼻咽镜（Nasopharyngeal fiberscope,NPF）对26 名健康成年人发[i]音以及鼓气状态下腭咽闭合率进行比较分析。结果　发音状态下腭咽闭合不全率的均值为4.88%,标准差为2.31%,鼓气状态下腭咽闭合不全率的均值为50.60%,标准差为16.80%。经过统计学分析,鼓气状态下腭咽闭合不全率大于发音状态下的腭咽闭合不全率,两者存在显著性差异。结论　非言语活动下（以鼓气为例）腭咽闭合的程度小于言语状态下腭咽闭合程度,提示言语材料较非言语材料对训练腭咽闭合功能更为有效。     

咽扩约肌成形术治疗腭裂临床效果评价

目的：了解咽扩约肌成形术在治疗腭裂中临床效果。方法：腭裂修复时间期咽扩约肌成形，并对部分3年以上患者36例与同期用咽后壁瓣主后患者30例进行比较，分别令其朗读《汉语腭裂字表》同时录音，然后7名听力语音正常的医护人员试听录音并计算正确率。结果：咽扩约肌成形组：语音正常25例（69．44％），基本正常8人（22．22％），中度发音异常2例（5．56％），明显发音异常1例（2．78％），严重发音异常0例，咽后壁瓣移植组；语音正常15例（50．00％），基本正常7例（23．33％），中度发音异常5例（16．67％），明显发音异常2例（6．67％），严重发音异常1例（3．33％）。结论：咽扩约肌成形术后能使腭裂患者语音明显改善，临床效果优于咽后壁瓣移植术。     

110例腭裂术后患者代偿性构音的特点及治疗策略探讨

目的:旨在初步探讨唇腭裂患者汉语普通话代偿性构音(compensatory articulation,CA)的特点和治疗对策。方法:对110名腭裂术后患者的语音进行回顾性分析,利用主观判听和鼻咽纤维镜检查的方法对患者的腭咽闭合功能进行评估,分析不同腭咽功能CA的发生情况;根据语音主观判听的记录结果,从音韵的角度,对代偿性发音进行研究。结果:腭咽闭合不全者60例中30例(50%)存在CA,腭咽闭合完全者50例中8例(16%)存在CA。从发音方式上来讲,CA好发于送气音/p/、/t/、/k/、/q/、/c/、/ch/;从发音位置上来讲,CA在舌尖音、舌面音、舌根音的发生率较高。结论:CA是音韵错误,在语言治疗和评估时应该加入音韵的分析内容和治疗措施。     

正常人腭咽闭合不全参数—X线头影测量研究

目的　建立正常人生理性腭咽闭合不全参数，为评价腭裂患者腭咽闭合功能和软腭活动提供一种客观的方法。方法　采用 Ｘ 线头影定位测量分析技术对 ２２２ 名腭咽闭合不全（ｖｅｌｏｐｈａｒｙｎｇｅａｌｉｎｃｏｍ ｐｅｔｅｎｃｅ， Ｖ Ｐ Ｉ）的正常人群进行分析研究，建立了正常人 Ｘ线头颅定位测量腭咽闭合功能参数。结果　 Ｘ 线的腭咽闭合矢状收缩不全率（ Ｒ Ｖ Ｓ Ｒ）与鼻咽内窥镜检查的腭咽闭合不全率（ Ｒ Ｖ Ｐ Ｉ）呈显著的相关关系。结论　 Ｘ 线头影测量方法是评价腭咽闭合功能和软腭活动的一种有效方法。     

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）。     

咽后壁瓣术后形态变化的临床研究

目的　研究上、下蒂型咽后壁瓣对腭咽闭合功能及患者发音的影响。方法　采用鼻咽纤维镜、头影测量及语音评价的方法 ,对咽后壁瓣的形态、腭咽闭合功能及语音清晰度进行对照定量分析。结果　上蒂型咽后壁瓣腭咽闭合不全率及矢状收缩不全率均小于下蒂型咽后壁瓣 ,两者的语音清晰度无明显区别。结论　上蒂型咽后壁瓣术式优于下蒂型咽后壁瓣术式 ,且患者术后均应进行系统的语音评估及治疗     

应用鼻咽纤维镜评价腭咽闭合功能的定量分析研究

目的检测利用鼻咽纤维镜（ＮＰＦ）评价腭咽闭合功能的可靠性。方法对１６名发音无异常的成年男性进行了不同深度以及不同时间的ＮＰＦ检测。结果显示腭咽闭合不全率（ＲＶＰＩ）相对稳定。结论ＲＶＰＩ可作为评价腭咽闭合功能的指标，并具有良好的重复性和可靠性     

先天性腭裂患者术中凿断翼钩对语音及中耳功能的影响

目的：研究在腭裂修复术中，凿断翼钩对腭裂患者中耳及语音的影响。方法：复习133例腭裂手术患者的临床资料，所有患者均排除全身多发畸形及腭心面综合征；手术采用von Langenbeck方法90例，Veau两瓣法43例；术中凿断翼钩的67例，未凿断翼钩的66例。术后在颅颜中心和耳鼻喉科定期复查，进行语音评估和检查中耳有无感染、有无听力障碍。采用Statistica4．0进行统计学分析。结果：翼钩凿断的患者中．最早在11个月后出现中耳炎．最晚在76个月出现中耳炎，平均13．4个月；未凿断翼钩的患者中，最早在12个月出现中耳炎，最晚在120个月出现中耳炎，平均13．9个月。两者无显著差异（P〉0．05）。凿断翼钩有完整评估资料的44例患者中，平均随访51．7个月．其中腭咽闭合（VPC）36例，临界（M）5例，腭咽闭合不全（VPI）3例，分别占81．8％、11．4％和6．8％；未凿断翼钩的44例中，平均随访53．5个月，VPC32例，M8例，VPI4例，分别占77．3％、14．8和7．9％。两者无显著差异（P〉O．05）。结论：翼钩在腭裂手术中的凿断与否，与腭裂患者在术后出现中耳感染之间无显著相关性，与术后出现腭咽闭合不全的几率也无必然的联系。     

Patterns and location of velopharyngeal valving problems: atypical findings on video nasopharyngoscopy

Patterns of velopharyngeal (VP) valving and the location of velopharyngeal gaps were investigated in 246 consecutive nasopharyngoscopy studies. The predominant pattern of closure was coronal (68 percent), followed by the circular (23 percent), circular with a Passavant's ridge (5 percent), and sagittal (4 percent) patterns. Gaps were found in 181 patients; in 121 they were considered typical (centrally located), in 28 they were in one of the lateral aspects of the valve, and in 32 they were attributed to the shape of the adenoid tissue or to abnormalities in the anatomy or function of the posterior border of the soft palate. Atypical findings occurred primarily in patients with a coronal pattern of valving. These findings raise further questions about treatment for patients with atypical valving problems.     

Incongruous movements of the velum and lateral pharyngeal walls.

Five patients evaluated via multi-view videofluoroscopy were found to have incongruous movements between the velum and lateral aspects of the pharyngeal walls. All five patients had velopharyngeal insufficiency resulting from either absent lateral pharyngeal wall motion in the presence of velar mobility or absent velar mobility in the presence of lateral pharyngeal wall motion. The data indicates that these valving patterns are not rare phenomena of velopharyngeal valving. Treatment by pharyngeal flap or other methods for velopharyngeal insufficiency must be suited to these peculiar valving patterns based on adequate diagnostic information.     

Pressure-flow measurements for selected oral and nasal sound segments produced by normal adults.

Pressure-flow data are often used to provide information about the adequacy of velopharyngeal valving for speech. However, there is limited information available concerning simultaneous pressure-flow measurements for oral and nasal sound segments produced by normal speakers. This study provides normative pressure, flow, and velopharyngeal orifice area measurements for selected oral and nasal sound segments produced by 10 male and 10 female adult speakers. An aerodynamic categorization scheme of velopharyngeal function, including one typical category and three atypical categories (open, closed, and mixed) is proposed.     

Pressure-flow measurements for selected oral and nasal sound segments produced by normal adults.

Pressure-flow data are often used to provide information about the adequacy of velopharyngeal valving for speech. However, there is limited information available concerning simultaneous pressure-flow measurements for oral and nasal sound segments produced by normal speakers. This study provides normative pressure, flow, and velopharyngeal orifice area measurements for selected oral and nasal sound segments produced by 10 male and 10 female adult speakers. An aerodynamic categorization scheme of velopharyngeal function, including one typical category and three atypical categories (open, closed, and mixed) is proposed.     

Induced velopharyngeal fatigue effects in speakers with repaired palatal clefts.

OBJECTIVE: To address whether speakers with cleft palate exhibit velopharyngeal mechanism fatigue and are more susceptible to muscle fatigue than are speakers without cleft palate. METHODS: Six adults with repaired palatal clefts and mild-moderate hypernasality served as subjects. Velopharyngeal closure force and levator veli palatini muscle activity were recorded. Subjects were asked to repeat /si/ 100 times while an external load consisting of air pressure (0, 5, 15, 25, 35 cm H2O) was applied via a mask to the nasal side of the velopharyngeal mechanism. Fatigue was defined as a reduction in velopharyngeal closure force across the series of /si/ productions, as evidenced by a negatively sloped regression line fit to the closure force data. RESULTS: Absolute levels of velopharyngeal closure force were much lower than those observed previously in speakers without palatal clefts. All subjects showed evidence of fatigue. Furthermore, all subjects demonstrated exhaustion, where they were unable to close the velopharyngeal port against the nasal pressure load. This occurred at pressure load levels lower than those successfully completed by speakers without cleft palate. CONCLUSIONS: In speakers with a repaired palatal cleft, the velopharyngeal closure muscles may not possess the same strength and/or endurance as in normal speakers. Alternatively, muscles may possess adequate strength, but not be positioned optimally within the velopharynx following cleft palate repair or may be forced to move velopharyngeal structures that are stiffer as a result of surgical scarring.     

正常成人发音和鼓气过程中腭咽闭合的影像学比较研究

目的　比较正常成人发音和鼓气过程中腭咽闭合运动的差异。方法 对12名正常成年女性采取拍摄头颅侧位片的方法,分别拍摄发/i:/音时和鼓气时的头颅侧位片,测量鼓气和发音时的腭咽闭合率和软腭抬升高度。结果 实验对象的鼓气状态下腭咽闭合率的平均值为62.95%,标准差为4.89,言语状态时腭咽闭合率平均值为75.03%,标准差为5.34,两者之间具有显著性差异;鼓气状态软腭抬升高度平均值为0.5833cm,标准差为0.2340,言语状态时软腭抬升高度平均值为1.3259cm,标准差为0.5632,两者之间有显著性差异。结论 鼓气训练从一定程度对腭咽闭合功能的康复治疗有辅助作用,但这一状态下的腭咽闭合率和软腭抬升高度都低于发音时的平均水平,尚不能完全达到正常人发音时所需要的腭咽闭合的状态。鼓气训练对于改善腭咽闭合运动的有效性还需要进一步深入的研究。     

Prediction of deterioration of velopharyngeal function associated with maxillary advancement using electromyography of levator veli palatini muscle.

OBJECTIVE: The purpose of the present study was to examine the possibility that postoperative velopharyngeal function following maxillary advancement could be predicted using preoperative electromyography of the levator veli palatini. DESIGN: Levator muscle electromyography was recorded preoperatively during speech and blowing. Levator activity was expressed as a percentage relative to the maximum value observed throughout the experiment. Postoperative velopharyngeal function was evaluated by means of perceptual judgment and nasoendoscopy. PARTICIPANTS: The subjects were four patients with repaired cleft palates who underwent maxillary advancement, two by osteotomy and two by distraction osteogenesis. None of the subjects presented with preoperative hypernasality, and nasoendoscopy demonstrated complete velopharyngeal closure in all subjects prior to maxillary advancement. RESULTS: Preoperative levator activity for speech of two subjects was similar to that for normal speakers (< 60% of total range), and postoperative nasality and nasoendoscopic findings revealed no detectible changes. For the other two subjects, levator activity for speech exceeded 60% of the total range, similar to that of speakers with velopharyngeal incompetence. These subjects showed increased hypernasality and deteriorated velopharyngeal closure following maxillary advancement. CONCLUSION: The deterioration of velopharyngeal function associated with maxillary advancement was demonstrated for subjects whose levator activity was at higher levels during speech in comparison with maximal activity observed during blowing, regardless of the amount of maxillary advancement. Preoperative levator muscle electromyography could be a predictor in identifying patients at higher risk of postsurgical deterioration of velopharyngeal function.     

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.     

Motor control of velopharyngeal structures during vowel production

This investigation was designed to measure the ability of normal adult speakers to exert voluntary control over velopharyngeal positioning. Speakers were asked to phonate the vowels [a] and [i] at 50 percent and 75 percent of complete velopharyngeal closure, using visual feedback of velopharyngeal opening and closing gestures from a phototransducer. The musculature of the velopharyngeal mechanism was hypothesized to act as a coordinated system that may demonstrate both motor flexibility and plasticity (Folkins, 1985) when forced to function in a novel way. Evidence of both motor system responses to a novel speaking condition was observed. Speakers were able either to phonate at intermediate closure levels without having to learn new motor rules, or to learn new rules for velopharyngeal muscle activation that resulted in the ability over time to position the velopharyngeal mechanism appropriately. As such, support is derived for the notion (Folkins, 1985) that speakers develop motor rules or coordinative structures involving the velopharyngeal mechanism that govern velopharyngeal movement. The characteristics of this coordinative structure framework has not yet been described, however, and are the subject of ongoing research efforts.     

Application of cine computed tomography to the assessment of velopharyngeal form and function

The mechanism of velopharyngeal closure is clearly three-dimensional in nature. Numerous attempts have been made to obtain a comprehensive picture of velopharyngeal movement, with varying degrees of success. A computed tomography scan system has recently been developed that may be used for real-time motion study of various body systems. This preliminary study was designed to assess the applicability of multi-level cine computed tomography scanning as a tool in the three-dimensional analysis of the velopharynx. One normal speaker and one speaker with an unrepaired palatal cleft were asked to phonate while serial sections were taken at 650-millisecond intervals through a number of transverse sections in the velopharyngeal region. This paper includes an explanation of cine CT technology, examples of scans on two speakers with clearly different velopharyngeal mechanisms, and discussion of the potential use of cine computed tomography as a tool in the analysis of both normal and disordered velopharyngeal function.