腭咽环扎术后腭咽闭合功能的评价

为评价腭咽环扎术后腭咽闭合功能,本文对腭咽环扎术后的289例病人进行了信函随访,并对随机抽样复查的20例患者进行了全面的语音检查。采用了鼻咽部敷钡剂后,颅底位和咽腔侧位电视透视、拍片以及EYBH—81型腭咽闭合功能检测仪等综合性检查,并以咽后壁瓣手术及兰氏手术后的患者作为对照。据观察腭咽环扎术能使软腭充分延长,鼻咽腔全面缩小,并且软腭和鼻咽腔活动良好,有利于患者语音功能的改善。其语音效果优于兰氏手术。与咽后壁瓣手术相比,其优点是手术安全、并发症少、效果稳定。     

腭咽环扎术后腭咽闭合功能的远期疗效评价

随机对腭咽环扎术后１６年的部分患者进行了全面检查，包括语音评价，咽腔造影，并使用电子动态喉镜检查腭咽闭合功能。结果１６例患者的语音检查优良率为９３％。研究表明：腭咽环扎术后的腭裂患者其环扎线的向心性牵拉力量使鼻咽腔能从前后左右４个方向将鼻咽腔全面缩小，为语音功能的恢复创造有利条件。同时，咽腔大小随患者年龄增长而改变，不会限制其生长发育。     

腭咽环扎术改善腭咽闭合的X线造影观察

<正> 腭咽环扎术作为一种新的腭咽闭合手术方法,已经在腭裂修复中占有一定的地位。临床上对腭咽环扎术改善患者发音的优良效果已为大量病例观察证实,为了从客观了解腭咽环扎术后腭裂患者咽腔的改变和探讨其改善腭咽闭合的机理,我们从2年来所作46例环扎手术病人中随机抽取13例,作术前术后咽腔造影,发音与不发音各摄侧位X片1张以进行分析观察。     

鼻咽镜、阻塞器在治疗腭咽闭合不全中的应用

目的应用鼻咽纤维镜、腭咽阻塞器治疗腭裂术后腭咽闭合不全。方法腭咽闭合不全患者通过鼻咽镜检查，根据腭咽孔大小、形状制作腭咽阻塞器。结果４５例腭咽闭合不全患者经戴阻塞器治疗后，１００％腭咽闭合不全得到改善，其中１５例（３３％）２年后摘掉阻塞器发音正常。结论联合应用鼻咽镜与腭咽阻塞器是保守治疗腭咽闭合不全的好方法     

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.     

上颌前牵引对唇腭裂术后反患者腭咽闭合功能的影响

目的：探讨上颌前牵引对单侧完全性唇腭裂术后反患者腭咽闭合功能的影响。方法：采用头颅定位侧位Ｘ线片、头颅侧位咽腔造影Ｘ线片及鼻咽纤维镜照相等方法对１０例生长期单侧完全性唇腭裂术后反患者上颌前牵引前后结构测量结果及腭咽闭合功能进行对照定量分析。结果：骨性咽腔深度明显增加；腭咽间隙和腭咽闭合不全率无明显变化；咽后壁动度明显增加，软腭长度及软硬腭夹角轻度增加。结论：上颌前牵引对单侧完全性唇腭裂术后反患者的腭咽闭合功能无影响     

腭帆提肌止点后上推移术与传统腭裂整复术的比较

目的 :研究腭裂功能性整复术 ,提出一种新术式———腭帆提肌止点后上推移术。方法 :在腭帆提肌及相关肌肉尸体解剖基础上 ,应用腭帆提肌止点后上推移腭裂整复术实施 2 0例 ,术后应用鼻咽镜、语音分析进行腭咽闭合功能及语音评价 ,与传统术式进行对照研究。结果 :2 0例手术术后均一期愈合。鼻咽镜检查示全部病例腭咽肌肉运动良好 ,发音时达到完全腭咽闭合 ,语音均得到改善。结论 :腭帆提肌止点后上推移术使软腭充分向后上提拉完成腭咽闭合 ,较好地解决了传统术式术后存在腭咽闭合功能不全的问题 ,是一种较好的腭裂功能性修复方法     

Sommerlad腭帆提肌重建术修复腭裂后腭咽结构特征的分析

目的 分析Sommerlad腭帆提肌重建术后腭咽闭合完全患者生长发育期腭咽结构特征与腭咽功能之间的关系。方法 对18例Sommerlad腭帆提肌重建术修复不完全性腭裂术后腭咽闭合完全患者（T1组）、14例Langenbeck法修复不完全性腭裂术后腭咽闭合不全患者（T2组）及正常人13例（对照组）进行鼻咽纤维镜检测和X线头颅侧位片分析,比较3组间腭咽闭合度、软腭长度、咽腔深度、Adequate ratio（软腭长度/咽腔深度）的差异,分析软腭与咽后壁接触点PPW在腭咽三角的位置关系。结果 T1组18例患者腭咽闭合完全;T2组有7例患者腭咽闭合度达到70%,5例为50%~70%,2例在50%以下。T1组软腭长度、Adequate ratio与对照组无明显差异（P>0.05）,腭咽结构图与对照组相似。T2组软腭长度和Adequate ratio分别为（22.9±2.3） mm、0.95±0.14,均小于T1组[（25.7±2.3） mm、1.43±0.26]及对照组[（29.9±2.7） mm、1.45±0.26],其差异有统计学意义（P<0.05）;PPW点在腭咽三角的位置相对于对照组偏上。结论 Sommerlad腭帆提肌重建术后腭咽闭合完全患者的腭咽结构与正常人相似;Langenbeck法修复术后腭咽闭合不全患者表现为咽腔过深,Adequate ratio值小于1.0,整个腭咽三角呈逆时针偏转上移的特征。     

腭咽环扎术后并发阻塞性睡眠呼吸暂停低通气综合征的手术治疗

目的:探讨环扎线取出术联合腺样体切除术对腭咽环扎术(VRLP)后阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗作用。方法:应用鼻咽纤维喉镜检查6例VRLP后经多导睡眠监测(PSG)确诊为OSAHS患者的上气道形态和腭咽闭合情况,并对患者实施了环扎线取出术和腺样体切除术。术后随访3个月,并进行多导睡眠监测和鼻咽纤维喉镜检查。应用配对t检验和χ2检验对手术前后PSG各检测指标进行了比较。结果:VRLP后上气道在软腭平面形成一环形嵴,OSAHS患者均有腺样体增生肥大,上气道鼻咽部明显狭窄变形。环扎线取出和腺样体切除后,无1例出现腭咽闭合不全,患者上气道形态平滑,睡眠呼吸障碍得到治愈,临床症状消失,睡眠结构恢复正常。PSG各参数在手术前后有极显著性差异(P<0.01)。结论:环扎线取出术联合腺样体切除术,是治疗VRLP后OSAHS的有效方法。     

内窥镜检查法评定腭咽闭合功能

作者用经鼻纤维内窥镜检查法评定腭咽闭合功能,检查健康小儿60例,年龄3岁～16岁,把正常的腭咽闭合分为4型:①环状闭合,咽侧壁和腭帆运动均匀,咽后壁运动较小。②矢状闭合,咽侧壁运动度大,腭帆和     

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.     

Evaluation of velopharyngeal function after later surgical repair of cleft palate. ]

This study detected 60 cases of patients of later surgical cleft palate repairing with different operative procedures,based on nasopharyngeal fiberscope and image processing detective system of nasopharyngeal function.They were divided into two groups,30 cases with Furlow's double reversing Z plasty,and others with traditional palatoplasty.The results were as follows:the type of velopharyngeal closure with later palatoplasty mainly were circus,semi-circus,and the rate of operative success only was 46.6%,which was lower than other reports.Author described that compensation of lateral and posterior pharyngeal wall made the type of velopharyngeal closure.The elder the age,the more the compensation is.For the late cleft palate repair,although the variable surgical procedure made a condition for speech improvement, patients with later cleft palate repair still can't improve their phonation.     

Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient''s compliance and final outcome.     

Velopharyngeal morphology of patients with persistent velopharyngeal incompetence following repushback surgery for cleft palate.

OBJECTIVE: To characterize the velopharyngeal morphology of patients with persistent velopharyngeal incompetence (VPI) following repushback surgery for cleft palate. PARTICIPANTS: Seven patients with moderate to severe VPI following repushback surgery for secondary correction of cleft palate, and 14 patients who had already obtained complete velopharyngeal closure function (VPF) were enrolled. Control data were obtained from the longitudinal files of 20 normal children in Kyushu University Dental Hospital. MAIN OUTCOME MEASURES: Skeletal landmarks and measurements were derived from tracing of lateral roentgenographic cephalograms. The measurements included velar length, pharyngeal depth, and pharyngeal height and the ratio of velar length to pharyngeal depth. Additionally, the configuration of the upper pharynx (pharyngeal triangle) involving the cranial base, cervical vertebrae, and the posterior maxilla and also the position of posterior pharyngeal wall (PPW) in the pharyngeal triangle were analyzed. RESULTS: The VPI group had a significantly shorter velar length and greater pharyngeal depth, resulting in a smaller length/depth ratio than the controls. The points of PPW and cervical vertebrae of the VPI group were located more posteriorly and inferiorly than those in the group with complete VPF after the primary operation and the controls. The positions of cranial base and maxilla were not significantly different. Additionally, the position of PPW in the pharyngeal triangle was located significantly posteriorly and superiorly in the VPI group, compared with the controls. CONCLUSIONS: The craniopharyngeal morphology of patients with persistent VPI was characterized by a short palate, wide-based and counterclockwise-rotated pharyngeal triangle, and posteriorly and superiorly positioned PPW. These might be contributory factors for the prediction of VPF before repushback surgery for cleft palate.     

Velar ascent and morphological factors affecting velopharyngeal function in patients with cleft palate and noncleft controls: a cephalometric study

This study compares velar ascent and morphological factors affecting velopharyngeal function between patients with repaired cleft palate and noncleft controls from early childhood to puberty. Lateral cephalograms obtained at rest and during blowing from 61 patients with repaired unilateral cleft lip and palate (cleft group) and 82 noncleft controls (control group) were divided into four developmental stages according to age and were studied cross-sectionally. Indices of nasopharyngeal area were derived from a coordinate system and landmarks on lateral cephalograms. The cleft group had lesser velar ascent, more posterosuperior position of the posterior maxilla, shorter velar length, and lesser pharyngeal depth than did the control group. There was a strong correlation between the vertical position of the posterior maxilla and the pharyngeal depth in the cleft group. Discriminant analysis revealed that the cleft group could be discriminated from the control group primarily on the basis of pharyngeal depth, velar length, and velar ascent. Our results suggest that the posterosuperior position of the posterior maxilla in patients with repaired cleft palate, resulting in reduced pharyngeal depth, represents an effort to facilitate velopharyngeal closure by means of shorter velar length and lesser velar ascent.     

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.     

The effects of Le Fort I osteotomy with maxillary movement on articulation, resonance, and velopharyngeal function

Articulation, resonance, and velopharyngeal function were evaluated before and after Le Fort I maxillary advancement in 16 patients (seven with cleft lip and palate, one with cleft lip only, and eight without clefts). On the postoperative evaluation, seven of 11 patients with preoperative articulation errors showed an improvement in articulation after surgery. Two patients without clefts showed slight changes in nasal resonance, and two patients (one with cleft lip and palate and one with cleft lip only) developed mild nasal emission. Nine patients showed diminished velopharyngeal contact during speech on videofluoroscopic studies. Compensatory changes in velopharyngeal function were also observed, which included velar stretching and lengthening and increased lateral pharyngeal wall movement.     

Evaluation of dynamic magnetic resonance imaging in assessing velopharyngeal insufficiency during phonation

BACKGROUND: Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated. MATERIALS AND METHODS: A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed. RESULTS: During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm2 preoperatively and 0.21 cm2 postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure. CONCLUSIONS: In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.     

Comparison of Hogan pharyngeal flap and sphincter pharyngoplasty in postoperative velopharyngeal function

The purpose of this study was to compare speech and breathing after sphincter pharyngoplasty and the Hogan pharyngeal flap in the management of cleft-related velopharyngeal insufficiency (VPI). We reviewed 78 patients with VPI who had either the Hogan flap (n = 30) or sphincter pharyngoplasty (n = 48) between 2009 and 2011. Velopharyngeal function, nasal patency, and speech were compared. In the Hogan flap group, 25 patients had achieved velopharyngeal competence and nine had normal speech. In the sphincter pharyngoplasty group, 29 patients achieved velopharyngeal competence and 20 normal speech. The Hogan flap group had a higher rate of velopharyngeal competence (n = 25) than the sphincter pharyngoplasty group (p = 0.033), but there was no significant difference in intelligibility of speech. Eighteen patients in the Hogan flap group and 33 in the sphincter pharyngoplasty group reported symptoms of snoring, with no significant difference in nasal ventilation. Our results suggest that a posterior pharyngeal flap is a more effective technique for managing VPI after repair of cleft palate than sphincter pharyngoplasty, and causes no more postoperative complications in nasal breathing.