不同舌重建术后患者语音功能的评价

目的:评价不同舌重建术式对舌癌患者术后语音功能恢复的影响。方法:32例舌癌患者据重建术式分组:带蒂胸大肌肌皮瓣修复组5人,除1例外舌切除缘范围均过中线;前臂游离皮瓣修复组和邻近组织瓣修复组分别为16人和11人,除1例外舌切除缘范围均不过中线。采用汉语语音清晰度测试和短句测试方法,对患者手术前后语音清晰度变化情况进行分析,并对前臂游离皮瓣修复组和邻近组织瓣修复组的评价结果进行团体t检验。结果:带蒂胸大肌肌皮瓣修复组、前臂游离皮瓣修复组和邻近组织瓣修复组术后的语音清晰度平均下降值分别为26.60、7.84和4.18分,短句测试得分下降值分别为1.60、0.50和0.27分;t检验结果显示,前臂皮瓣和邻近组织瓣修复组的语音清晰度和短句测试得分下降值间无显著性差异(P>0.05)。结论:舌癌手术切除后运用前臂游离皮瓣或邻近组织瓣进行舌重建均能较好地恢复患者术后的语音功能,且两者间没有显著差异;对于舌缺损范围较大尤其是超过半侧舌的患者,采用带蒂胸大肌皮瓣也能够在一定程度上改善患者术后的语音功能。     

舌癌患者语音研究进展

舌癌患者术后难免造成包括语音功能在内的一些功能障碍,随着当今功能性外科的推进,语音功能的保存和重建为各国学者所关注。本文阐述了一些相关的语音学基础、语音评价方法,并对目前舌癌患者术前术后的语音学特征的研究现状和语音重建、恢复、治疗的进展作一综述。     

游离皮瓣修复舌癌术后缺损联合语音训练的语音功能评价

目的探讨舌癌术后缺损经游离皮瓣同期修复并结合语音训练后的语音功能恢复情况。方法舌癌患者15例,其中男8例,女7例,平均年龄54岁,T2期13例,T3期2例。均行舌癌扩大切除及患侧颈淋巴清扫术,根据舌体缺损大小制备游离前臂皮瓣或股前外侧皮瓣,完成舌体缺损重建,术后1个月行语音训练,术后6个月后行语音清晰度检查,分析患者术后语音功能恢复情况。结果15例患者皮瓣均完全成活,均获得创口一期愈合。重建后的舌均具有良好的活动度,15例患者的语音清晰度为90％—100％,平均语音清晰度为94.5％。结论游离皮瓣同期修复舌癌术后缺损结合术后语音训练,能够较好地恢复患者的语音功能。     

舌癌患者语音研究进展

舌癌患者术后难免造成包括语音功能在内的一些功能障碍，随着当今功能性外科的推进，语音功能的保存和重建为各网学者所关注。本文阐述了一些相关的语音学基础、语音评价方法。并对目前舌癌患者术前术后的语音学特征的研究现状和语音重建、恢复、治疗的进展作一综述。     

舌癌患者术后语音康复训练的护理

目的探讨舌癌患者手术后,通过有针对性的护理指导训练的患者的语言功能,使患者在术后达到正常发音的目的。方法收集2005年1月—2011年1月因舌恶性肿瘤在我院行手术的100例患者(观察组)资料,从分析舌癌对患者口腔系统的影响及手术对口腔组织结构的影响入手,采用有针对性的护理方法,对比观察此组患者与舌癌术后未进行语音康复训练的100例患者(对照组)的术后发音对比观察。结果对照组患者的语言功能恢复率为64%;观察组患者的语言功能恢复率为87%。两组患者的语言功能恢复率存在统计学差异(P<0.05)。结论在维持患者术生命体征较为平稳的基础上,对患者进行从唇训练、张口训练到舌功能训练,能够有效改善患者因疾病及手术照成的对发音的影响。舌癌患者术后,采取有针对性的护理措施后,能够显著提高患者的术后发音情况。     

舌癌术后吞咽功能的研究

舌癌的治疗主要采取以手术为主的综合序列治疗,治疗的原则已由根治为主上升到了根治和功能保存及重建并重的新层面,目前研究主要集中在舌形态和体积的修复上,关于吞咽功能恢复的研究不多。本文就舌癌术后吞咽功能的研究作一综述。     

前臂游离皮瓣在舌癌术后组织缺损修复与功能重建中的应用

目的:总结前臂游离皮瓣在舌癌术后组织缺损修复与功能重建中的临床效果。方法:选择舌癌联合根治术+同期前臂游离皮瓣移植修复术治疗的患者39例,对临床治疗效果进行随访观察。结果:随访6个月～4年,全部病例供、受区创口均一期愈合,患者语言、吞咽等功能均满意。结论:前臂游离皮瓣修复是舌癌术后组织缺损修复与功能重建较为理想的选择。     

舌癌术后远期生存质量影响因素的评价

目的：探讨舌癌术后无瘤生存5-15a患者的生存质量（quality of life，QoL）及其临床影响因素。方法：选择1991-2001年期间在我科治疗的无瘤生存至今的舌癌患者，54例自主完成华盛顿大学生存质量问卷第4版（University of Washington Quality of Life version 4，UW—QoL^v4），分析结果中可能的临床影响因素，结果利用SPSS11．0软件的非参数检验方法进行分析。结果：60岁以下的长期无瘤生存的舌癌患者，QoL显著高于60岁以上的患者（P〈0．05），早期、未行下颌骨骨段切除或未放疗的长期生存的舌癌患者QoL聪显高于进展期、下颌骨骨段切除或放疗的舌癌患者（P〈0．05），手术、年龄、临床分期、下颌骨骨段切除和放疗明显影响患者的QoL。结论：UW—QoL^v4是有效的舌癌患者QoL评价工具，可为舌癌治疗方案设计提供参考建议。     

Total glossectomy with preservation of the larynx: oncological and functional results

Our aim was to analyse the overall and disease-free survival (DFS), time to recovery of oral feeding, and morbidity, in a consecutive series of patients who had total glossectomy with preservation of the larynx for advanced cancer of the tongue at the European institute of Oncology (Milan). From June 2002 to April 2011, 37 patients who were treated for advanced cancer of the tongue had total glossectomy, bilateral neck dissection, and preservation of the larynx. Various flaps were used for reconstruction. Overall and disease-free survival were assessed from the day of operation to the latest outpatient examination. Postoperative morbidity and rehabilitation of feeding were also assessed. Six patients had major complications, four of whom had a second operation for necrosis of the flap. Actuarial five-year overall survival (OS) and disease-free survival were 54% and 47%. Twenty-four patients (65%) were operated on as their first treatment, and had 79% five-year overall survival and 61% 5-year disease-free survival. Twenty-six patients were eventually able to feed orally postoperatively. Although this retrospective study include a limited number of patients, the results support the validity of total glossectomy as a safe procedure for advanced cancer of the tongue. Pretreated patient were previously treated with surgery, radiotherapy or chemoradiotherapy with curative purposes. Nevertheless, the long period required for recovery of oral feeding indicates that total glossectomy should be reserved for highly motivated patients.     

Gender difference in speech intelligibility using speech intelligibility tests and acoustic analyses

PURPOSE

The purpose of this study was to compare men with women in terms of speech intelligibility, to investigate the validity of objective acoustic parameters related with speech intelligibility, and to try to set up the standard data for the future study in various field in prosthodontics.

MATERIALS AND METHODS

Twenty men and women were served as subjects in the present study. After recording of sample sounds, speech intelligibility tests by three speech pathologists and acoustic analyses were performed. Comparison of the speech intelligibility test scores and acoustic parameters such as fundamental frequency, fundamental frequency range, formant frequency, formant ranges, vowel working space area, and vowel dispersion were done between men and women. In addition, the correlations between the speech intelligibility values and acoustic variables were analyzed.

RESULTS

Women showed significantly higher speech intelligibility scores than men and there were significant difference between men and women in most of acoustic parameters used in the present study. However, the correlations between the speech intelligibility scores and acoustic parameters were low.

CONCLUSION

Speech intelligibility test and acoustic parameters used in the present study were effective in differentiating male voice from female voice and their values might be used in the future studies related patients involved with maxillofacial prosthodontics. However, further studies are needed on the correlation between speech intelligibility tests and objective acoustic parameters.     

Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients

To analyze objective and subjective progression of speech intelligibility in oral cancer patients undergoing high-frequency speech therapy during early rehabilitation.Oral cancer patients in the Department of Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany, participated in the study from March 2016 to November 2017. Speech intelligibility was analyzed preoperatively (t1), post radiation (t2), and post speech therapy (t3). Objective measures were the Munich Intelligibility Profile (Online) and the Frenchay Dysarthria Assessment-2 (FDA-2). Subjective measures were the Speech Handicap Index (SHI), the speech subscale of the EORTC QLQ-C30&HN35, and the WHO-5 Index II.For nine patients with complete data, progression analyses showed a non-existent-to-low intelligibility impairment at t1 (means/SDs: e.g. FDA-2: 8.96/0.11, SHI: 17.5/15.15), increasing towards t2 (means/SDs/p-values for difference from t1: e.g. FDA-2: 7.40/0.80/0.000, SHI: 21.7/14.24/0.213), and then decreasing towards t3, without ever reaching the initial level (means/SDs/p-values for difference from t1: e.g. FDA-2: 8.22/0.60/0.005, SHI: 23.5/15.85/0.481). The objective changes in intelligibility were significant; the subjective changes were not.Overall, the ability to speak intelligibly after oral cancer treatment follows a typical pattern. Therefore, high-frequency speech therapy in the early rehabilitation phase might be recommendable. It might help patients to adapt to their situation after surgery, and facilitates compensating for possible functional deficits.     

不同舌重建术患者语音功能的声学分析

目的评价不同舌重建术式的舌癌患者手术前后语音功能。方法30例舌癌患者据重建术式分组:前臂皮瓣修复组,直接拉拢缝合组,胸大肌皮瓣修复组,对患者手术前后语音清晰度及6个汉语单元音前3个共振峰频率(F1、F2、F3)进行分析比较,并对各个组的评价结果进行团体t检验。结果前臂皮瓣修复组患者元音/o/F1、/i/F1、/u/F1、//F1、//F2变化与直接拉拢缝合组相比,其变化值有统计学差异;语音清晰度下降值两者间无统计学差异。前臂皮瓣修复组/a/f3,/o/f3,/e/f2,/e/f3,/i/f2,/i/f3、/u/f2、/u/f3、//f2、//f3;直接拉拢缝合组/a/f3、/e/f3、/i/f3、/u/f1、/u/f3、//f2、//f3,带蒂胸大肌皮瓣修复组/i/f2与清晰度变化相关性较好。结论半舌以内进行舌切除的舌癌患者,不同的修复方式之间语音功能无差异,手术前后语音清晰度变化与频谱分析结果两者之间有较好的相关性。     

上颌骨缺损的语音清晰度及影响因素的评价

目的：评价上颌骨切除术后，患者的语音清晰度情况以及影响语音清晰度的相关因素。方法：选择因肿瘤行上颌骨切除的36例患者为研究对象，采用中空上颌赝复体修复缺损部分，用主观语音清晰度测试法，测试患者戴赝复体前后的语音清晰度值SI，并分析下列因素对其语音清晰度的影响：（1）口腔与鼻腔相通情况；（2）硬腭切除范围；（3）软腭缺损情况；（4）口内余留基牙。结果：36例患者未戴入赝复体时的SI均值为41．3±10．6％，戴入赝复体的SI均值为89．6±7．7％，两者具有显著性差异。多元回归分析结果显示，在各因素的综合作用下，口鼻腔穿通情况对未戴用赝复体患者的SI值有显著的影响（P〈0．01）；软腭缺损对戴用赝复体后的SI值有显著影响（P〈0．01）。结论：口鼻腔穿通是影响戴赝复体前语音清晰度的因素之一，软腭缺损是影响戴赝复体后语音清晰度的因素之一。     

The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects

The aim of this study was to evaluate the functional outcomes of dynamic tongue reconstruction in various types of glossectomy defects. A retrospective review of patients who underwent tongue reconstruction following cancer resection was performed. Patients were divided into two groups by the type of procedure: dynamic reconstruction using motor-innervated free flaps and conventional reconstruction with fasciocutaneous free flaps. Demographics, including patient and tumor characteristics, and surgical factors, including the type of glossectomy and flap, were investigated. Functional outcomes were compared through quantitative assessment of tongue movement, speech capacity, videofluoroscopic barium swallow, and percutaneous endoscopic gastrostomy (PEG) tube dependency. 94 patients were enrolled in this study. The conventional reconstruction was performed in 52 patients and dynamic reconstruction was performed in 42 patients. Overall, the dynamic group showed improved swallowing capacity (videofluoroscopic swallowing scale, mean ± standard deviation, dynamic group, 3.24 ± 0.79, versus conventional group, 2.88 ± 1.08; p = 0.07). No significant differences in tongue motion and speech outcomes were noted between the groups. In multivariate logistic analysis controlling of various confounders, the dynamic reconstruction was significantly related to improved swallowing outcomes (adjusted odds ratio, 0.148; 95% confidence interval 0.03–0.725; p = 0.018). Dynamic reconstruction was not significantly related to the rate of PEG tube dependency. Within the limitations of the study, it seems that the dynamic tongue reconstruction using motor innervated free flaps can improve swallowing outcome by reproducing the original sling action of tongue musculature and preserving the tongue volume.     

Long Term Rehabilitation of a Total Glossectomy Patient

Malignant tumours of the oral cavity that require resection of the tongue result in severe deficiencies in speech and deglutition. Speech misarticulation leads to loss of speech intelligibility, which can prevent or limit communication. Prosthodontic rehabilitation involves fabrication of a Palatal Augmentation Prosthesis (PAP) following partial glossectomy and a mandibular tongue prosthesis after total glossectomy [1]. Speech analysis of a total glossectmy patient rehabilitated with a tongue prosthesis was done with the help of Dr. Speech Software Version 4 (Tiger DRS, Inc., Seattle) twelve years after treatment. Speech therapy sessions along with a prosthesis helped him to correct the dental sounds by using the lower lip and upper dentures (labio-dentals). It was noticed that speech intelligibility, intonation pattern, speech articulation and overall loudness was noticeably improved.     

A precise glossectomy for tongue cancer adjacent to or crossing the midline: a novel anatomical unit resection surgery

Previous studies have lacked a clear anatomical and functional definition of glossectomy for tongue cancer adjacent to or crossing the midline (TCML). The aim of this study was to provide a novel surgical approach based on anatomical unit resection surgery to treat TCML. A total of 120 patients with TCML who had undergone radical surgery were recruited retrospectively into the study. The patients who were treated with compartment surgery formed the control group; those treated with anatomical unit resection surgery formed the experimental group. The TCML was classified into cancer adjacent to the midline, cancer invading but not breaching the contralateral musculus verticalis linguae–genioglossus complex (MGC), and cancer breaching the contralateral MGC. No significant difference in the overall survival rate was found between the experimental and control groups overall (P = 0.853) or by TCML classification. In patients with cancer adjacent to the midline, the swallowing score (P = 0.040) and cosmetic outcome (P = 0.015) were significantly better in the experimental group than in the control group. For patients with cancer invading but not breaching the contralateral MGC, the speech intelligibility score (P = 0.001), swallowing score (P = 0.002), and cosmetic outcome (P = 0.037) were significantly better in the experimental group than in the control group. Anatomical unit resection surgery was found to provide a precise surgical treatment to address tongue cancer adjacent to or crossing the midline and maximally maintain tongue tissue and function.     

下颌骨单侧节段性缺损及重建对语音清晰度的影响

目的：通过语音清晰度测试，探讨下颌骨单侧节段性缺损及不同修复方法对语音功能的影响。方法：以32例下颌骨单侧节段性缺损手术患者为研究对象，应用汉语语音清晰度字表，对其手术前、后的语音功能进行测试，对结果进行Wilcoxon秩和检验。结果：患者手术前、后的语音清晰度（SI）无显著差异，短句测试效果满意。不同下颌骨单侧节段性缺损之间以及不同修复方法之间比较，SI改变无统计学意义。下颌骨单侧节段性缺损连续性中断组（8例）与连续性恢复组（24例）之间，SI改变无统计学意义。结论：下颌骨单侧节段性缺损对患者的语音清晰度并无显著影响；不同重建方法（拉拢缝合、钛板重建、钛板＋骨瓣修复等）对患者语音清晰度的影响无统计学意义；语音清晰度测试可能无法精确反映下颌骨单侧节段性缺损患者的语音功能改变。     

Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification

The evaluation of speech outcomes after resection and reconstruction of the oral tongue remains largely unsystematic. A cross-sectional study was performed to analyse the speech outcomes of patients who underwent curative treatment with appropriate reconstruction. Sixty-nine patients were assessed for speech intelligibility and phonetics using a validated speech intelligibility assessment tool in the local language. Volume defects were classified as class I (less than one third), II (one third to half), III (half to two-thirds), or IV (two-thirds to total glossectomy). Defect location was defined as lateral, tip, or sulcus. The χ² test and Kruskal–Wallis test were used to test volume and location as predictors. Twenty-six patients had class I defects, 29 had class II defects, seven had class III defects, and seven had class IV defects. Twenty-two patients (31.9%) received adjuvant radiotherapy. Mean vowel, consonant, word, and paragraph intelligibility were 99.27%, 86.86%, 85.52%, and 88.72%, respectively. The incremental volume of the glossectomy defect was significantly correlated with speech intelligibility scores and phonatory alterations. In classes II and III, tip resection significantly affected interdental sounds. All patients in class III had affected alveolar and alveo-palatal sounds. The results positively corroborated the volume and location of the glossectomy defect to a classification system.