腭裂手术年龄对语音清晰度的影响

目的：通过回顾性调查,研究在不同年龄修复腭裂对术后语音清晰度的影响.方法：将102例年龄在10岁以上,腭裂术后2年以上的单侧完全性唇腭裂患者,根据接受腭裂手术的年龄分为3组,A组：0～3.00岁手术组（n=37）、B组：3.01～6.00岁手术组（n=36）和C组：6.01岁以上手术组（n=29）.随访时进行录音检查,对其语音清晰度进行判定,并对不同手术年龄组间语音清晰度的差异进行统计学检验.结果：3组患者的语音清晰度均值分别为91.7％、81.4％、和73.3％,统计学检验显示,术后语音清晰度在3组间的差异有显著性（P＜0.05）.结论：在不同年龄进行腭裂修复术,其术后语音清晰度的恢复不同.手术年龄越小,语音清晰度的恢复越好.     

腭裂术后语音训练的临床观察

目的:提高腭裂术后患者的汉语语音清晰度。方法:对30例腭裂术后患者进行系统的语音训练,包括训练前后语音清晰度测试、吹气训练及序列语音训练(单音→音节→词组→短句→短文)。结果:患者语音清晰度从训练前的49.2％提高到训练后的平均95.4％,平均提高了46.2％,经t检验,具有极显著差异。结论:语音训练能纠正腭裂术后患者的代偿性发音习惯,使语音清晰度提高到与正常人基本一致。     

腭裂儿童三位一体语音训练模式的构建

目的：评价家庭语音训练模式对腭裂术后患者语音康复的干预效果。方法：对16例患儿运用家庭-学校-医院三位一体的训练模式进行为期1年的家庭语音训练，通过语音清晰度评价疗效。结果：患儿语音清晰度平均提高36．06％，代偿性发音等腭裂音质明显改善。结论：家庭-学校-医院三位一体的训练模式对于校正腭裂术后患者的不良代偿性发音习惯有良好的效果。     

腭裂手术前后舌静止及动态的比较研究

目的　探讨舌的位置及动态对腭裂语音的影响。方法　应用标准头颅侧位Ｘ 线片及计算机图像扫描系统,对腭裂手术前后及正常人的舌静止及发／ａ：／ 时的位置及动态变化进行了比较研究。结果　静止时,术前组Ａ／Ｆ值小于术后及对照组（ Ｐ＜ ０ ．０１） ;术后组Ｃ／Ｈ值小于术前及对照组（ Ｐ＜０ ．０１） ;术后组Ｓ／Ｖ 值小于对照组（ Ｐ＜ ０．０１）。发／ａ：／ 时,术前组Ｄ／Ｆ、Ａ／Ｐ 及α／ｐ 均小于对照组,而Ｐ／Ｂ、Ｃ／Ｈ 大于对照组;术后组Ａ／Ｆ小于对照组（ Ｐ＜ ０ ．０５） ,Ｃ／Ｈ 大于对照组（Ｐ＜ ０．０１）;术前组Ｄ／Ｆ、Ａ／Ｐ、α／ｐ 小于术后组。结论　腭裂术前的舌位置及动态存在明显异常,术后虽可获得接近正常的一定变化,但仍存在某些异常,需经语音治疗,消除舌的不良因素,才能达到清晰发音     

影响腭裂术后语音功能的多因素研究进展

先天性腭裂是人类最常见的发育畸形之一,发病率较高,严重影响患者的语音功能。腭裂患者语音功能障碍,并不完全随着腭裂畸形的修复而消失,术后发音障碍仍然是一个普遍问题。导致腭裂术后语音障碍的因素很多,如:腭裂的严重程度、腭裂修复时机、腭裂修复方法及术后语音治疗等,本文就可能影响腭裂患者术后语音功能的因素进行归纳分析。     

早期与延迟腭帆形成术的语音效果比较

目的：探讨不同手术时期对腭裂术后语音效果的影响。方法：对78例早期腭帆形成术（手术时平均年龄为3．2个月）及43例延迟腭帆形成术（手术时平均年龄为15个月）的两组术后患儿,由2名有经验的专职语音师进行包括语音音色、音素、过高鼻音与过低鼻音的评估,观察其不良的语音习惯,如唇习惯、舌习惯及发音时的脸部异常表情动作等,从而作出语音效果评估。结果：两组术后患儿的语音评估结果差异有显著性意义（P＜0．05）,即早时期接受腭帆修复手术者,语音效果好。结论：腭帆形态术实施时间早,可为良好的语音发育创造正常的解剖生理条件,因而语音效果好;早期实施腭帆形态术,对腭裂患儿的语音功能正常发育有重要意义。     

改良兰氏+反向双Z法腭裂手术对患儿发音影响的临床研究

目的:探讨改良兰氏+反向双Z法腭裂手术对患儿发音的影响。方法:选取2013年2月-2016年1月行改良兰氏法+软腭双层"Z"形三角瓣修复法的30例腭裂患儿为观察组,选取既往予以兰氏两瓣法进行治疗的30例腭裂患儿为对照组。比较两组患儿手术前后腭咽闭合不全率、元音[i]的第二共振峰(F2)、第三共振峰(F3)、F1振幅能量值(A1)、辅音样本冲直条、擦音乱纹出现率以及语音清晰度。结果:两组患儿术后腭咽闭合不全率均低于术前(P0.05);观察组患儿术后腭咽闭合不全率低于对照组(P0.05)。与手术前相比,两组患儿术后F2、F3高于术前,A1低于术前,差异有统计学意义(P0.05);观察组患儿术后F2、F3高于对照组,A1低于对照组(P0.05)。观察组患儿术后辅音样本冲直条、擦音乱纹出现率高于对照组,差异有统计学意义(P0.05)。两组患儿术后语音清晰度均高于手术前(P0.05);观察组患儿术后语音清晰度优于对照组,差异有统计学意义(P0.05)。结论:腭裂手术软腭延长能有效改善腭裂患儿腭咽闭合功能,改善发音。     

咽后壁组织瓣转移在腭裂治疗中的应用

目的：探讨咽后壁组织瓣转移术对腭裂患儿语音清晰度的影响。方法：对23例6－12岁腭裂患儿实施咽后壁组织瓣转移术，术后4周开始接受语音训练，训练周期三个月。测试并记录训练前后的语音清晰度。结果：患儿的语音清晰度从术前的30％提高到92％，提高了62％，经t检验，具有极显的差异（P＜0．0001）。结论：咽后壁组织瓣转移术只要选择合适的适应症，方法得当，术后配合适当的语音训练，最终可使患儿的语音达到或接近正常效果，是成功治疗腭裂的一种良好的手术方法。     

大龄腭裂患者两种手术模式的临床评估

目的 探讨不同年龄腭裂患者的手术治疗模式,以提高大龄腭裂患者术后的腭咽闭合率和语音清晰度.方法 2010年5月至2012年4月,52例大龄腭裂患者按年龄不同分为A组(8～16岁,n=18)和B组(16岁以上,n=34),A组进行改良兰氏法同期腭咽肌瓣咽成形术,B组进行改良兰氏法同期咽后壁瓣咽成形术.所有患者术后随访10～18个月,观察创口愈合情况、语音清晰度、高低鼻音、鼻漏气及鼻咽纤维内镜检查情况.结果 语音评估显示,A组和B组患者高鼻音和鼻漏气程度均显著下降,语音清晰度提高;32例患者术后腭咽闭合完全,余20例患者术后虽仍有腭咽闭合不全,但在鼻咽纤维镜下腭咽闭合率达80％以上.结论 针对不同年龄的腭裂患者制定个体化手术方式,可显著提高腭裂患者术后腭咽闭合率和语音清晰度.     

舌癌术后患者的语音康复训练

目的 提高和改善舌癌患者术后的语音清晰度和生活质量.方法 将80例舌癌术后患者随机分为对照组和观察组各40例,术后两组均给予常规护理,同时实施发音训练.观察组在此基础上于术后第15天开始进行唇、齿和舌的功能训练及张口训练.术后90 d观察两组患者的语音清晰度和张口高度.结果 观察组张口高度≥3 cm者40例(100.0%),有效发音34例(85.0%);对照组分别为5例(12.5%)、16例(40.0%),两组比较,差异有显著性意义(均P＜0.01).结论 对舌癌术后患者进行早期、有针对性的语音康复训练,可提高患者残存舌体的功能,增加舌体的运动力度和速度,使舌体的活动恢复或接近正常,提高患者的语音清晰度,从而提高患者的生活质量.     

Unrepaired Clefts in the Hard Palate: Speech Deficits At the Ages of 5 and 7 Years and Their Relationship to Size of the Cleft

The purpose of the study was to investigate the relationship between the size of oronasal openings in the hard palate and speech deficits. Audiotape recordings and plaster casts were taken according to standard procedures at 5 and 7 years of age from 22 consecutive children born with complete unilateral cleft lip and palate treated at Sahlgrenska University Hospital, Göteborg, Sweden. The soft palate had been repaired before the age of 12 months, whereas the cleft in the hard palate was left unrepaired, to be closed later. Perceptual judgements of nine speech variables at 5 and 7 years of age were correlated with measures of the area of the residual cleft in the hard palate. "Retracted oral articulation" (to velar place) found in nine of the 22 children correlated significantly with the area of the cleft at the age of 5 years but not later. The establishment of this particular speech error seems to be related to the size of an oronasal opening.     

兰氏和双反Z法腭裂修复术后患儿语音清晰度对比

目的比较兰氏和双反Z法腭裂修复术后患儿的语音清晰度,寻找重建腭咽闭合的最佳手术方法。方法选取2009年至2013年在我院口腔颌面外科就诊的先天性软腭裂患儿69例,其中行双反Z法腭裂修复术35例(双反Z法组),行兰氏法腭裂修复术34例(兰氏法组)。患儿3.5岁后随访,由3名语音师进行单盲性审听,比较两组患儿术后语音清晰度。结果语音测评结果显示,双反Z法组患儿术后患者语音清晰度平均达到88.72%±6.05%,明显高于兰氏法组的71.31%±3.46%,语音改善明显。结论双反Z法能够充分缩小咽腔、延长软腭,重建软腭肌肉结构,更有利于恢复良好的腭咽闭合功能。     

先天性腭裂的手术修复及其疗效观察

目的：探讨腭裂修复术手术方法及技巧对腭裂患者治疗效果的影响。方法：对97例先天性腭裂患者进行手术治疗，根据腭裂的不同类型选择不同术式，对手术方法及技巧进行总结，探讨腭裂修复术式的选择和其术后并发症的防治方法。结果：97例先天性腭裂患者，92例伤口Ⅰ期愈合，2例软腭穿孔，3例悬雍垂不全裂开。术后复诊的68位患者，语音恢复效果满意者26例，明显改善14例，语音不良28例。结论：手术方法以两瓣法为首选，软硬腭交界处鼻腔粘膜均应切断，手术操做应轻柔，不仅要关闭裂隙，还应使软腭达到足够的长度和动度，重建良好”腭咽闭合”，术中止血应彻底，术后应预防伤口感染和加强护理。出院后应积极进行语音训练。     

小儿腭裂修复手术后早期低氧血症的临床观察

目的与方法：用脉搏氧饱和度义对比观察１２３例腭裂修复手术和后小儿，９０例非腭裂修复手术小儿的术后早期低氧血症发生率和血氧和度值的恢复情况，结果：两组病人的术后早期低氧血症的发生率分别为３３．６％和１３．１％，严重低氧血症发生率则分别为１６．７％和４．４％。低氧血症主要发生在３０ｍｉｎ以内，腭裂组的持续时间较且明显延长，术后ＳｐＯ２值的下降程度也明显低于对照组，恢复强度也相对较慢，结论：小儿腭裂手术     

单纯腭裂患儿心脏畸形的发生率与腭裂程度的关系

目的 研究单纯腭裂患儿合并先天性心脏病的特点,探讨腭裂的程度与心脏畸形发生率的关系.方法 收集2008年8月至2009年12月收治的416例单纯腭裂患儿的临床资料,对所有患儿进行心脏超声检查;将患儿分为完全性腭裂和不完全性腭裂组,每组再分为单侧和双侧亚组,不完全腭裂组进一步分为悬雍垂裂、软腭裂、软腭及部分硬腭裂3个亚组,统计各组患儿合并心脏畸形的例数和类型,计数资料用百分构成比表示,采用SPSS 13.0版软件包进行统计学处理,组间比较采用x2检验.结果 416例中共检出46例先天性心脏病,占11.1%;不完全性腭裂组心脏畸形检出率为9.9%(38/384),完全性腭裂组检出率为25%(8/32),明显高于不完全性腭裂组(F=6.852,P<0.05);在合并的心脏畸形中,房间隔缺损占52.2%(24/46),是最常见的心脏畸形.结论 与不完全性腭裂相比,完全性腭裂具有较高的发生心脏畸形的风险,应常规进行心脏超声检查,腭裂程度可作为腭裂合并先天性心脏病的预测因子之一.     

单纯腭裂患儿心脏畸形的发生率与腭裂程度的关系

目的 研究单纯腭裂患儿合并先天性心脏病的特点,探讨腭裂的程度与心脏畸形发生率的关系.方法 收集2008年8月至2009年12月收治的416例单纯腭裂患儿的临床资料,对所有患儿进行心脏超声检查;将患儿分为完全性腭裂和不完全性腭裂组,每组再分为单侧和双侧亚组,不完全腭裂组进一步分为悬雍垂裂、软腭裂、软腭及部分硬腭裂3个亚组,统计各组患儿合并心脏畸形的例数和类型,计数资料用百分构成比表示,采用SPSS 13.0版软件包进行统计学处理,组间比较采用x2检验.结果 416例中共检出46例先天性心脏病,占11.1%;不完全性腭裂组心脏畸形检出率为9.9%(38/384),完全性腭裂组检出率为25%(8/32),明显高于不完全性腭裂组(F=6.852,P<0.05);在合并的心脏畸形中,房间隔缺损占52.2%(24/46),是最常见的心脏畸形.结论 与不完全性腭裂相比,完全性腭裂具有较高的发生心脏畸形的风险,应常规进行心脏超声检查,腭裂程度可作为腭裂合并先天性心脏病的预测因子之一.     

单纯腭裂患儿心脏畸形的发生率与腭裂程度的关系

目的 研究单纯腭裂患儿合并先天性心脏病的特点,探讨腭裂的程度与心脏畸形发生率的关系.方法 收集2008年8月至2009年12月收治的416例单纯腭裂患儿的临床资料,对所有患儿进行心脏超声检查;将患儿分为完全性腭裂和不完全性腭裂组,每组再分为单侧和双侧亚组,不完全腭裂组进一步分为悬雍垂裂、软腭裂、软腭及部分硬腭裂3个亚组,统计各组患儿合并心脏畸形的例数和类型,计数资料用百分构成比表示,采用SPSS 13.0版软件包进行统计学处理,组间比较采用x2检验.结果 416例中共检出46例先天性心脏病,占11.1%;不完全性腭裂组心脏畸形检出率为9.9%(38/384),完全性腭裂组检出率为25%(8/32),明显高于不完全性腭裂组(F=6.852,P<0.05);在合并的心脏畸形中,房间隔缺损占52.2%(24/46),是最常见的心脏畸形.结论 与不完全性腭裂相比,完全性腭裂具有较高的发生心脏畸形的风险,应常规进行心脏超声检查,腭裂程度可作为腭裂合并先天性心脏病的预测因子之一.

Abstract：

Objective To analyze the relationship between cleft severity and incidence of associated heart defect in children with isolated cleft palate(CP), as well as the characteristics of the heart defect. Methods From Aug 2008 and Dec 2009, a total 416 children with CP underwent echocardiogram, and were divided into complete and incomplete CP groups. Then each group was further classified as unilateral or bilateral groups. Incomplete CP was subdivided into submucous cleft palate, soft palate cleft, hard and soft palate cleft. The associated heart defects were recorded and analyzed in each group. The data were analyzed statistically using SPSS 13.0. Chi-square test was used to compare the incidence between groups. Results In the series of 416 patients, 46 (11.1%) children were found to have an associated congenital heart disease. The incidence of heart defect was 9.9% (38/384) in the incomplete cleft group, and 25% (8/32) in the complete cleft group, showing a significant difference between the two groups (F = 6. 852, P < 0.05). Atrial septal defect was the most common heart defect,which accounted for 52.2% (24/46) of all associated heart malformations. Conclusions Compared to incomplete cleft palate, complete cleft palate has a higher risk of heart defect. Cleft severity may be a predictor for congential heart diseases in cleft palate. Routine echocardiogram should be considered in CP patients.     

Ambulatory surgery for cleft lip repair

Standard of care for cleft lip repair has included preadmission testing, surgical correction, and postoperative hospital care. Driven not by managed care economics but to speed the safe home care of infants by parents, the authors have gained experience in ambulatory cleft lip repair. In this retrospective study the authors evaluated the outcome of patients who underwent ambulatory cleft lip repair compared with those patients who were hospitalized after surgery. From 1989 to 1998, 24 cleft lip repairs in 24 patients performed by the senior author were evaluated. Two groups were treated. Group 1 (N = 11) consisted of ambulatory unilateral cleft lip repairs and group 2 (N = 13) consisted of inpatient unilateral cleft lip repairs. Important surgical factors considered were technique of cleft lip repair, performance of ancillary procedures, type of local anesthetic administered, and intravenous steroid administration. Time to first postoperative feeding and complications, including bleeding, spontaneous or traumatic wound dehiscence, and infection, were considered important outcome parameters. There were no differences in surgical technique or use of antibiotics and postoperative analgesics between the two groups. None of the patients in group 1 underwent ancillary procedures. Four patients underwent soft palate repair and 3 patients underwent insertion of myringotomy tubes among group 2 patients. The use of a 1:1 mixture of 1% lidocaine and 0.5% bupivacaine with epinephrine vs. 1% lidocaine with epinephrine as a local anesthetic and intravenous steroid administration was greater in group 1 (92%) than in group 2 (33%) patients. The average time to the first postoperative feeding was more than 1 hour sooner in the ambulatory group (p < 0.05) compared with the hospitalized group (excluding the 4 patients who underwent soft palate repair). There were no complications among patients with ambulatory cleft lip repair, and there were two cases of minor wound separation in patients who received postoperative hospital care. Although many variables factor into the outcome after cleft lip repair, these data support the safety and continued practice of ambulatory cleft lip repair.     

Results of two-flap palatoplasty with regard to speech production

Summary Forty-five children with unilateral cleft lip and palate, who underwent two-flap palatoplasty as described by Bardach [6], were examined primarily for speech patterns using a previously designed protocol. Results indicated that in 80% of patients, velopharyngeal function was within normal limits. However, more than half (62%) needed further dental treatment or speech therapy (51%) before normal speech production could be expected. These findings indicate that the two-flap method is highly satisfactory as a technique for primary palatoplasty.This study was supported in part by PHS Program-Project Grants DE-00853 and DE-08537, The National Institute for Dental Research