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     

鼻咽镜、语图仪与计算机联合应用在诊治腭裂术后病理性语音中的价值

联合应用鼻咽镜、语图仪与计算机技术，对４５例腭裂术后腭咽闭合不全患者保守治疗前后的语音进行评价。结果表明：戴阻塞器并行语音训练２．５～３年，腭咽闭合不全改善率（ＩＲＶＰＩ）达３３．３３％，语图仪分析示语图谱纹较前清晰，着色加深，共振峰值（Ｆ２，Ｆ３）接近正常，嗓音起始时间（ＶＯＴ）负值极少出现，提示腭咽闭合功能良好，口腔不良习惯改正。鼻咽镜、语图仪与计算机分析技术用于腭裂病理性语音分析，评价矫治效果具有重要的临床意义，将提高对腭裂语音的矫治水平。     

腭裂术后腭咽闭合协调异常的训练治疗

腭裂术后腭咽闭合协调异常患者以闭合不全（ＶＰＩ）表现为主，仅靠主要判听或某一项检查骓以确诊，其治疗原则也不同。本文采用主客观检查方法对术后有ＶＰＩ表现者进行综合检查评价，并对其中确诊的１２例腭咽闭合协调异常患者进行针对性腭咽闭合协调功能训练，１－６个月后，所有患者腭咽闭合功能均达到说话时所需水平，配合发音技巧训练后，语音清晰度均提高到８０％以上，说明对腭裂术后有类似ＶＰＩ表现者应进行综合评价，对腭     

气压,气流测定仪对发音辅助器功能的评价

目的客观评价发音辅助器的功能。方法对１２例置发音辅助器患者进行了分析。结果用发音辅助器后增加了口腔压力，降低了鼻腔气流和缩减了腭咽腔闭合的面积。结论发音辅助器能改善腭咽闭合功能，为临床治疗腭咽闭合功能不全提供非手术方法。     

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。     

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     

提取元音第三共振峰测试腭咽闭合功能的研究

应用计算机语音信号分析技术测试了２４名腭裂患者及１０名正常儿童的汉语普通话单元音第三共振频率值,同时测定了正常儿童各单元音腭咽闭合不全率,并作了高元音ｉ和低元音ａ第三共振频率值与其ＲＶＰＩ的相关性性分析。结果表明：腭裂患者的各单元音第三共振璋无统计学差异。     

口腔鳞癌IV型胶原和层粘连蛋白的表达与颈淋巴结转移的关系

目的 探讨口腔鳞癌ＩＶ型胶原（ｃｏｌ ＩＶ）和层粘连蛋白（ＬＮ）的表达及其与临床病理参数的关系。方法 应用免疫组化ＳＡＢＣ法检测了３０例口腔鳞癌组织和５例人正常口腔膜组ＣｏｌⅣ和ＬＮ的表达,并用病理图像分析软件定量分析了两者的表达程度;对ＣｏｌⅣ和ＬＮ的表达与临床病理参数的关系进行了统计学分析。结果 ＣｏｌⅣ和ＬＮ的表达部位相同,主要分布于口腔粘膜和鳞癌组织基底膜;正常粘膜ＣｏｌⅣ和ＬＮ表达完整连     

语音训练对改善轻度腭咽闭合不全患者发音的研究

目的研究语音训练对轻度腭咽闭合不全（VPI）患者发音的影响。方法选择经咽腔造影检查显示的腭咽部间隙为1～5 mm并且经语音评估诊断为轻度VPI的患者30例设为VPI组,均为在四川大学华西口腔医院唇腭裂外科行腭帆提肌重建术的非综合征型腭裂复诊患者,均于术后进行了3～6个月的语音训练。采用VS-99语音频谱分析系统测定患者在语音训练前和训练后发［i］音时第2、3共振峰的数值F2、F3,并与30例对照组（C组）的测定结果进行比较。结果VPI组语音训练前的F2、F3分别为（1 958.95±431.40）、（3 059.84±330.09）Hz,训练后分别为（2 322.95±213.02）、（3 293.84±215.08）Hz;C组的F2、F3分别为（2 430.47±223.05）、（3 345.97±180.83）Hz。VPI组语音训练前与C组的差异有统计学意义（P<0.05）,语音训练后与C组的差异无统计学意义（P＞0.05）;语音训练前后VPI组组内比较的差异有统计学意义（P<0.05）,语音训练后高于训练前。结论对于年龄很大才进行腭裂修复的患者,建议术后先实施语音训练,能显著改善腭咽闭合不全,有可能避免再次手术。     

鼠半胱氨酸蛋白酶抑制物cystatin S 对人口腔牙龈卟啉菌生长的抑制

目的：观察鼠半胱氨酸蛋白酶抑制物ｃｙｓｔａｔｉｎＳ对人口腔牙龈卟啉菌（Ｐｏｒｐｈｙｒｏｍｏｎａｓｇｉｎｇｉｖａｌｉｓ）生长的影响。方法：用琼脂扩散法检查了ｃｙｓｔａｔｉｎＳ对人口腔数种牙龈卟啉菌生长的抑制情况。结果：虽然对不同菌株其影响程度略有差异，对实验用牙龈卟啉菌３８１，３８１Ｐ，ＡＴＣＣＷ５０，Ｗ８３，３３２７７，ＮＣＴＣ１１８３４，ＶＰＩ１４０１８生长均有抑制作用，并且具有药物浓度依赖性。结论：鼠半胱氨酸蛋白酶抑制物ｃｙｓｔａｔｉｎＳ对人口腔牙龈卟啉菌生长有抑制作用。     

Speech adaptation: an aerodynamic study of adults with a childhood history of articulation defects

Three groups of subjects were studied; former lispers, persons with a history of /l/ or /r/ distortion, and normal subjects with no history of speech defects. All were normal-sounding adult speakers of English at the time of participation. Subjects were asked to wear an experimental removable dental prosthesis that provided 4 mm of thickness in the alveolar region. Measurements of oral air flow and intraoral pressure during the reading of sentence material were made, with the focus on the consonants /s/ and /t/. The sibilant /s/ was experienced as the greatest problem for speech adaptation, regardless of the type of former articulation defect. Both groups of subjects with a history of articulation defects showed evidence of slower adaptation and use of compensatory strategies for /s/. They tended as a group to have the same minimum airflow values for /s/ after 2 weeks of practice speaking with the prosthesis as after 1 day of practice. Aerodynamic calculation of the size of the constriction for /s/ also showed little or no change for most of the former speech-defective subjects. Evidence based on intraoral pressure indicated that particular effort was expended for /s/ even after 2 weeks of practice in speaking with the prosthesis.     

22例先天性腭咽闭合功能不全患儿智力情况初探

目的：对22例先天性腭咽闭合功能不全（CVPI）患儿进行智商测定，探讨CVPI患儿智力发育情况，为治疗提供依据。方法：用韦氏智商测试（WPSSI，WISC－R）法对22例CVPI患儿进行智商检查，并与33例健康学生进行对照。结果：22例CVPI患儿的智商范围为44－109分，平均67．46分；其中智商正常（IQ＞70）者10例，占45．5％，异常（IQ＜70）12例，占54．5％。智能障碍中大多数为轻度障碍，未见严重障碍。结论：CVPI中许多患儿存在不同程度的智能障碍，有必要对患儿进行智商测试，并尽早进行干预治疗，从而提高其语音治疗效果。     

Pressure-flow measurements for selected nasal sound segments produced by normal children and adolescents.

OBJECTIVE: The purpose of this prospective study was to: (1) report simultaneous oral-nasal pressures, nasal airflow rates, and velopharyngeal orifice areas for nasal sounds produced by children and adolescents; (2) determine whether data could be statistically classified by age, sex, or utterance type; and (3) provide guidelines for determining typical from atypical productions. PARTICIPANTS: The study involved 56 subjects, with two boys and two girls representing each age from 5 to 18 years. Subjects had no history of speech therapy, were judged as having normal speech and resonance at the time of testing, and had no upper respiratory tract infections or allergies at the time of testing. METHODS: All subjects repeated /mphaaa;/ and "hamper" at normal pitch and loudness after an examiner model. Mean oral-nasal pressures, nasal airflow rates, and velopharyngeal orifice areas were calculated for each subject's utterances. A discriminate function analysis determined whether data could be grouped by age and sex. RESULTS: Significant differences in mean data for age groups of 5 to 9 years, 10 to 13 years, and 14 to 18 years were observed. Data showed decreases in pressures and increases in nasal airflow and orifice areas with age. Variability in pressure stayed consistent or decreased with age, but variability in nasal airflow and orifice areas increased with age. CONCLUSION: We propose a scheme for categorizing velopharyngeal function for oral and nasal sound production to be used in clinical testing.     

Anterior open bite and oral port constriction.

Intraoral air pressure and rate of oral airflow were measured simultaneously during fricative sound production in ten subjects with anterior open bite and ten subjects with normal occlusion and speech. From these measurements the area of oral port constriction was calculated and the values compared within and between the two groups. Findings revealed that: (1) The area of oral port constriction was very consistent and reproducible in subjects with normal speech production and normal occlusion. (2) The area of oral port constriction was significantly larger in open-bite subjects compared with control subjects for all sounds. (3) Severe anterior open-bite subjects with a vertical defect over five millimeters were found to produce significantly larger oral port openings than those with only moderate open bite (3-5 mm) for most sounds. (4) A direct correlation between the degree of open bite and the area of oral port constriction was found. As the amount of open bite increased, the area of the oral port increased, especially in the severe open-bite group (5 mm and over).     

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。     

Quantitative study of velopharyngeal function post-palatoplasty]

The computer of nasopharyngeal fiberscope(NPF) for quantitative analysis was carried out to assess the palate articulation of 43 subjects,and normal articulation of 60 subjects.The rest,/a/,/s/and /m/ articulation of NPF pictures were calculated for veloparyngreal function via computer.     

Perceptual and videofluoroscopic analyses of relation between backed articulation and velopharyngeal closure following cleft palate repair

PurposePerceptual and videofluoroscopic (VF) analyses were performed to analyze velopharyngeal (VP) closure motions and tongue backing movement in subjects with postalveolar, palatal, and velar backed articulation (BA).Materials and methodsFor perceptual analysis, the timing of the appearance of BA and the VP closure level of 22 children with BA following palatal repair were compared to those of 17 subjects with normal articulation, 17 subjects with lateral articulation, and 11 subjects with glottal stop. For VF analysis, 16 subjects with BA and two healthy adult males as references were enrolled. On VF images, the proportions of the time required to complete VP closure and the duration of articulation (VPC/DA) were recorded and then analyzed based on the various degrees of tongue backing movement.ResultsThe appearance of BA was recognized just after the acquisition of VP closure, and it was later than that of glottal stop and earlier than lateral articulation. On VF images, VP closure was achieved before tongue movement in healthy individuals, but after tongue movement in BA subjects. VPC/DA on articulation of both /ta/ and /sa/ were significantly smaller for healthy individuals than for BA subjects (P < 0.05). The timing of the complete VP closure approached that of articulation when the site of articulation shifted posteriorly (P < 0.01).ConclusionsBA may result from precedent tongue backing movement before the completion of VP closure, as a process that may assist the VP closure motion for articulation.     

Effect of jaw position on forced maximum inspiratory airflow in normal Japanese subjects and in Japanese patients with sleep apnea syndrome

PURPOSE: The purpose of this study was to evaluate whether maximum forced inspiratory airflow changes occur by changing the jaw position in Japanese normal subjects and patients with obstructive sleep apnea (OSA) classified by their craniofacial features. MATERIALS AND METHODS: The subjects included 8 male non-OSA subjects and 15 male patients with OSA whose conditions had been diagnosed with a polysomnographic recording. The OSA subjects were divided into 2 groups by means of a craniofacial (CF) score based on cephalometric variables: a high-score group (CF score > or = 4) and a low-score group (CF score < or = 3). A case-control design was utilized to assess group differences (control and 2 patient groups). Airflow changes were determined using a spirometer that assessed the velocity of airflow during forced inspiration. Maximum forced inspiratory airflow was measured in 4 positions in all patients. RESULTS: All 3 groups had a significant decrease in their maximum forced inspiratory airflow upon reclining, and there were no significant group differences regarding the magnitude of this change. The OSA subjects returned to baseline measurements more than controls when the jaw was positioned forward, as the jaw was progressively advanced in high CF score subjects. CONCLUSION: This study suggested that a protrusive jaw position allows more inspiratory airflow to occur in OSA patients compared to controls, and this was significant in the patients with a high CF score.     

The aerodynamic characteristics of speech produced by normal speakers and cleft palate speakers with adequate velopharyngeal function

Pressure-flow data were obtained on 20 noncleft adults with normal speech and 26 adults with repaired cleft palate. All subjects had adequate velopharyngeal function as determined by preliminary aerodynamic assessment. Subjects were considered to have adequate closure if they had velopharyngeal areas no greater than 0.049 cm2 during production of /p/ in the word "hamper." Although the subjects in both groups demonstrated velopharyngeal adequacy, the subjects with cleft palate produced speech with significantly less nasal airflow. In addition, their intra-oral pressure curve was shifted forward in time. These differences suggest that speakers with cleft palate and adequate velopharyngeal function make certain compensatory adjustments that may be necessary because of differences in velopharyngeal movement capabilities. The potential significance of this for treatment planning is discussed.     

Influence of tooth contact on the path of condylar movements.

The correlation between condylar inclination and tooth guidance was tested by comparison of recordings of condylar movement in right and left parasagittal planes during lateral excursion, opening, and protrusive movements in 13 subjects with temporomandibular joint (TMJ) clicks and 15 subjects without TMJ clicks. The characteristic tracing of mandibular movements at the condyle with tooth-guided versus non-tooth-guided conditions were investigated by use of a computerized Axiograph graph. The generated tracings of each subject were graphed and analyzed to calculate the horizontal condylar inclinations as related to the axis orbital reference plane. Information from a standardized questionnaire provided evidence of a definite correlation between the presence of TMJ clicking and a specific prior medical event (tonsillectomy). The data from computerized tracings of all subjects revealed no significant difference (p 0.05) in the mean angles of condylar guidance at any of the millimeter intervals examined regardless of whether the craniomandibular contact was an articulation of natural teeth or an articulation of maxillary natural teeth against a tray clutch. These results do not suggest that dynamic interarch tooth guidance or the change in vertical dimension reflect a significant alteration in the recordings of condylar guidance in clicking or nonclicking groups.