咽后壁瓣断蒂对腭咽闭合影响的探讨

目的 探讨咽后壁瓣成形术后腭咽闭合功能不全(velopharyngeal insufficiency,VPI)及其并发症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)治疗中咽后壁瓣断蒂的作用.方法 1993至2008年于北京大学口腔医学院·口腔医院唇腭裂治疗中心接受咽后壁瓣断蒂术患者20例(不完全腭裂11例、完全性唇腭裂9例),20例断蒂术前均行鼻咽纤维镜、头颅定位侧位X线片检查及语音录音,对有OSAHS主述者行睡眠呼吸监测.全部患者术后48 h后进行语音评价.术中单纯断蒂14例,断蒂后重新改变咽成形术式6例.结果 ①14例成形术后语音改善不明显,仍存在过高鼻音,咽后壁瓣断蒂术后语音改善明显;②3例成形术后虽发音正常但出现呼吸道阻塞症状,断蒂术后呼吸睡眠状况改善,语音仍正常;③3例成形术后发音正常,因正颌手术的麻醉需要断蒂,断蒂后的语音无明显改变.结论 咽后壁瓣成形术后出现OSAHS或仍存在VPI,需手术断蒂或其他类型咽成形术治疗;断蒂的时间应在咽后壁瓣成形术半年后.     

咽扩约肌成形术治疗腭裂临床效果评价

我科从 1993 0 1～ 1999 12采用咽扩约肌成形术治疗腭裂46例 ,经随访观察效果良好 ,现报告如下 :1　临床资料咽扩约肌成形术 (咽腭肌瓣 ) 46例中 ,男 2 8例 ,女 18例。一期手术 3 4例 ,二期手术 12例。年龄 6岁以下者 10例 ,7岁以上者 3 6例 ,最小年龄 4岁 ,最大 2 0岁。其中软腭裂 9例 ,单侧完全性腭裂 15例 ,双侧完全性腭裂 10例 ,腭咽闭合不全 12例。全部病例均在经口插管全麻下进行。2　手术方法2 .1　设计利用双侧咽腭弓的粘膜和咽腭肌组织形成蒂在上 (软腭部 )粘膜肌瓣 ,与咽后壁瓣联合 ,使咽后壁突起成嵴 ,并与软腭协调运动产生扩约…     

腭裂术后功能性语音不清分类的初步研究

腭裂修复术后恢复了正常腭咽闭合功能，仍有部分患者存在不同程度语音障碍，需行语音训练治疗，而语音治疗的方法需根据发音器官存在的不同问题来决定。我们对１１０例腭裂术后语音不清患者进行腭咽功能等主客观检查评价，选出其中５０例腭咽功能正常，语音清晰度在７０％以下患者进行汉语发音语音学、语音病理学分析研究，并将其分为三类发音异常，即Ｉ类：发音部位异常，占５０例患者的２０％；ＩＩ类：发音方式异常，占２４％；Ｉ     

成人腭裂腭咽成形术和语音治疗的效果评价

目的：探讨咽成形术和语音治疗对成人腭裂的效果。方法：21例未曾接受腭裂手术治疗的患者在接受一期腭裂修复术的同时行咽后瓣成形术,术后3个月开始语音训练,定期接受发音指导和语音测评,记录结果统计分析。结果：21例患者手术效果满意,未见严重并发症,通过语音治疗,发音改善明显。结论：咽成形术能在一定程度上改善患者的腭咽闭合状态,而要经过语音治疗才能提高语音效果。     

咽成形术后咽后壁瓣脱落语音治疗方法的探讨

采集腭裂术后VPI并行咽成形＋咽后壁瓣转移术后一个月进行复诊的患者12例[1-2]；其中咽后壁瓣固位良好患者6例、咽后壁瓣脱落患者6例，年龄在6—12岁、智力正常、能够讲普通话或由语音治疗师领读可以朗读语音清晰度字表[3]，分别进行语音清晰度测试、blowing试验、以及过度鼻音的声学检查。     

咽后壁瓣咽成形术对腭裂术后患者颌面部生长影响的初步研究

目的 通过对颌面部软、硬组织形态的测量分析,探讨咽后壁瓣咽成形术对腭裂术后患者颌面部生长的影响。方法 对56例腭裂术后腭咽闭合不全患者,采用病例对照研究：A组21例,为腭裂术后行咽后壁瓣咽成形术患者;B组（对照组1） 15例,为腭裂术后行Furlow腭再成形术患者;C组（对照组2） 20例,为腭裂术后未行二期手术患者。对所有患者随访1年以上的X线头影侧位片进行测量,硬组织测量包含颅底、上颌骨、面高3个方面,软组织包含10个面部轮廓指标,用SPSS 21.0软件进行统计学分析。结果 手术年龄4～7岁的咽瓣手术患者与同年龄行腭再成形术及腭裂术后未行二期手术患者相比较,在水平及垂直方向上,软、硬组织生长均未见明显差异。结论 咽后壁瓣咽成形术对腭裂术后患者的颌面部生长发育没有明显影响。     

腭裂咽成形术后患者异常语音的发音特点研究

目的：对腭裂咽成形术后患者的发音特点和发生机制进行探讨。方法：本组病例82例(男46，女36)，年龄4～31岁(平均13.44岁)。采用汉语语音清晰度测试表(包含音节、词、词组、短句)对患者录音，并对其语音清晰度、异常语音、代偿性发音进行分析比较。结果：在82例患者巾，以腭咽闭合不全型为持点的代偿性语音71例：声门塞音60例、咽摩擦音11例；以腭咽闭合良好型为特点的代偿性语音11例：腭化音6例、腭化 侧化音2例、侧化音3例．清晰度：声门塞音46.27％、咽摩擦音57.19％、腭化音67．17％、腭化 侧化音74．67％、侧化音77．50％．异常辅音多见于塞音、擦音、塞擦音，辅音的弱化以送气音p66．67％(8／12)、t78.95％(15／19)、s60％(39／64)、sh60％(39／64)、c66％(43／65)、ch66％(43／65)、x62％(39／63)、q67％(43／64)、k76％(31／41)、b73％(43／59)所占比例较多；辅音的脱落则以不送气音z81％(56／69)、zh81％(56／69)、i80％(56／70)、g84％(48／57)所占比例较多。结论：咽成形术后仍以腭咽闭合不全型为特点的代偿性语音为主，主要表现为辅音的脱落与弱化。产生弱化的辅音多见于送气音，产生脱落的辅音则多见于不送气音．     

腭咽—期成形术后语音效果初步分析

15例大年龄先天性腭裂患者采用腭咽一期成形术进行手术治疗，术后进行随访，并用频谱动态信号分析仪测量其汉语普通话元音／a／／i／／u／的频谱曲线特点，分析其术后语音效果。结果显示，大年龄腭裂患者行腭咽一期成形术后语音效果的优良率为46．67％。作者认为：腭咽一期成形术作为大年龄腭裂患者的一种治疗方法，其语音效果尚需进一步分析。     

管状咽后壁瓣在腭裂修复中的应用

管状咽后壁瓣在腭裂修复中的应用第二军医大学附属长征医院颌面外科孙弘腭裂修复术已有百余年的历史，修复技术不断改进和完善。为了提高腭咽闭合的程度和术后发音的能力，许多作者曾进行过有益的探索。咽后壁粘膜肌瓣移植术（简称咽后壁瓣）及其改良方法的提出和应用，对...     

72例腭隐裂修复方式的回顾分析

目的：通过回顾性分析8年的腭隐裂修复治疗，寻求较合适的修复方法及修复时机。方法：1999年9月至2007年1月行腭隐裂修复的患者72例，男37例，女35例，年龄1-35岁，平均11．2岁。术后1个月复诊，检查伤口愈合情况，并进行语音评估。同时将72例患者按所接受的手术方法分为三组：Ⅰ组（腭成形术），Ⅱ组（改良咽后壁组织瓣转移术），Ⅲ组（腭咽成形术）；按手术年龄将其分为：〈4周岁；t〉4周岁、〈8周岁；≥8周岁三组，统计各组的构成比，及比较各组术后的腭咽闭合及语音情况。结果：术后穿孔的患者为3例（4．2％），69例患者术后接受了语音评估，1例（兰氏术后）仍遗留VPI。10例患者语音检测为正常（96．15％±2．11％），余58例患者腭咽闭合功能改善，但仍伴代偿性发音，需语音治疗。手术方式分组：Ⅰ组13例（18．1％），Ⅱ组46例（63．89％），Ⅲ组13例（18．1％）；年龄分组：〈4周岁7例（9．72％），t≥4周岁、但〈8周岁25例（34．72％），≥8周岁40例（55．56％）。〈4周岁的患者采用腭成形术最多，占57．1％，≥4周岁、但〈8周岁及≥8周岁的患者采用改良咽后壁组织瓣转移术的最多，各占68％，和70％。语音评估发现〈4周岁组的患者术后正常语音的比例最高，占71．4％，其次是t〉4周岁、但〈8周岁组，正常语音的比例为该年龄组的19．2％，VP完全，有代偿性发音的占76．9％，而大年龄组（≥8周岁），均伴有代偿性发音而需语音治疗。结论：小年龄组（〈4周岁）的腭隐裂修复术后语音效果较好，大年龄组（≥8周岁）的腭隐裂修复可首选咽成形术或腭咽成形术，术后须辅以语音训练，t≥4周岁、但〈8周岁的患者修复方式的选择可根据具体情况选用。     

腭裂患者手术前后语音频谱特点的研究

目的分析腭裂语音的频谱特点,提示其语音缺陷,为腭裂患者的语音评价及治疗提供理论及临床支持。方法应用语音频谱分析系统分别对正常儿童、腭裂术前患者和腭裂术后患者的元音共振峰频率值和辅音嗓音起始时间(VOT)的频谱特点进行分析。结果发元音/a/时,正常组及腭裂患者手术前、后组的前3个共振峰频率值无显著性差异(P>0.05);发元音/i/时,腭裂术前组F2、F3低于正常组,差异有显著性(P<0.05),腭裂术后组F2、F3低于正常组,高于术前组,但差异无显著性(P>0.05);发元音/u/时,腭裂术前组F2低于正常组,但无显著性差异(P>0.05)。对照组VOT的出现率达100.0%,而腭裂术前组仅25.0%(9/36),腭裂术后组42.1%(16/38)。结论声学频谱分析技术有助于找出腭裂患者的不良发音习惯及判断腭咽闭合的完善与否,从而对腭裂患者的语音评价和治疗提供一定的理论和临床价值。     

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.     

Speech Outcome After Cranial-Based Pharyngeal Flap in Children Born With Total Cleft, Cleft Palate, or Primary Velopharyngeal Insufficiency

PURPOSE: The aim of this study was to compare the effect of a cranial-based pharyngeal flap on the speech of children born with a unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), cleft palate (CP), or primary velopharyngeal insufficiency (VPI) without cleft. PATIENTS AND METHODS: A total of 234 children born with clefts and 22 children born with primary VPI were evaluated. Children with associated abnormalities were excluded from this study. The Borel-Maisonny classification system was used to evaluate the velar insufficiency. The cranial-based pharyngeal flap was performed using the Sanvenero-Rosselli technique. RESULTS: Between 1984 and 2001, 74 children underwent pharyngeal flap for VPI. The mean follow-up period was 7 years. Borel-Maisonny scores after pharyngeal flap surgery were as follows: children with UCLP (n = 22), 59.1% type 1, 36.4% type 1/2, and 4.5% type 2; children with BCLP (n = 18), 44.4% type 1, 27.8% type 1/2, 16.7% type 2, and 11.1% type 2/3; children with CP (n = 17), 64.7% type 1, 23.5% type 1/2, and 11.8% type 2; children with primary VPI (n = 17), 29.4% type 1, 29.4% type 1/2, 29.4% type 2/3, and 11.8% type 3. There were significant differences in outcome among the 4 groups (P = .029; Fisher exact test). CONCLUSIONS: The positive effect on speech of a cranial-based pharyngeal flap is greater in children born with a UCLP or CP than in those born with a BCLP. In children born with primary VPI, this operation has only a slightly positive effect on speech that shows compensatory misarticulations; in such cases, alternative surgical choices or secondary procedures may be indicated. This information should be clearly conveyed to the parents in presurgical consultation so that they know what to expect from the procedure and postoperative adjuvant therapy.     

腭裂修复术前及术后发音时咽侧壁运动的对比研究

目的探讨腭裂修复术关闭腭部裂隙对发音时咽侧壁运动程度的影响。方法应用鼻咽纤维镜分别对15例腭裂患者发／a／和/i／音时腭裂修复术前与术后咽侧壁的运动程度进行评价、对比。结果发／a／和/i／时术后咽侧壁运动程度的均值均大于术前，发／a／时术前术后咽侧壁运动程度问的差别无显著性差异（P〉0．05），发/i／时术前术后差别有显著性（P〈0．01）。结论腭裂修复术关闭腭部裂隙可以改善发音时咽侧壁的运动程度，咽侧壁运动的改善程度与元音的性质有关，发高元音时咽侧壁运动的改善程度大于发低元音时。     

双Z形瓣修复腭裂的临床应用与改进

<正> 本文报告从88年以来应用双Z形瓣手术,修复62例腭裂。随访12例,多数满一年以上。语言优良率91.58％,其中正常率58.25％。认为双Z形瓣手术具有下列特点:(1)矫正了错位的腭提肌,既形成咽括约肌环,又长了软腭;(2)不需要硬腭的粘骨膜瓣后退,不在腭部做松驰切口没有马蹄形瘢痕形成。可能减少了对颌骨发育的影响;(3)腭部切口缝合后呈Z形,而不是直线,故不产生直线收缩。术后软腭形态近于常人,没有悬雍垂内陷现象;(4)口腔没有暴露创面,不需用碘纱填塞,减少了术后的组织水肿反应。所以术后病人的静脉输液及住院时间明显缩短。     

腭帆提肌重建联合咽后壁瓣术在先天性腭裂中的临床应用

目的　探讨腭帆提肌重建联合咽后壁瓣术在先天性腭裂中的临床应用。方法　采用腭帆提肌重建联合咽后壁瓣术,共修补47例先天性腭裂患者,其中单侧完全性腭裂21例,不完全性腭裂26例。结果　所有患者均一期愈合,未出现腭瘘,随诊1~3年,语音清晰度满意。结论　腭帆提肌重建联合咽后壁瓣术较好地恢复了腭帆提肌正常的解剖结构和位置,获得了良好的腭咽闭合,并有效地降低了术后腭瘘的发生率,是一种值得推荐的功能性腭裂修复方法。     

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。     

Speech intelligibility of patients with cleft lip and palate after placement of speech prosthesis.

OBJECTIVE: To evaluate the speech intelligibility of patients with clefts before and after placement of a speech prosthesis. DESIGN: Cross-sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of S?o Paulo (HRAC/USP), Bauru, Brazil. PATIENTS: Twenty-seven patients with unoperated cleft palate or operated cleft palate presenting with velopharyngeal insufficiency (VPI) after primary palatoplasty, treated with speech prosthesis, aged 8 to 63 years. INTERVENTIONS: Patients were fitted with palatopharyngeal obturators or pharyngeal bulbs, suitable to their dental needs. Five speech-language pathologists blindly evaluated speech samples of the patients with and without the prosthesis. MAIN OUTCOME MEASURES: Classification of speech samples according to a scoring system developed for speech intelligibility problems: 1 (normal), 2 (mild), 3 (mild to moderate), 4 (moderate), 5 (moderate to severe), and 6 (severe). Results were evaluated by the calculation of means of all judges for each patient in both situations. RESULTS: The judges presented significant agreement (W=.789, p<.01). Speech intelligibility was significantly better after placement of the prosthesis for both unoperated patients (Z=1.93, p=.02) and operated patients with VPI after primary palatoplasty (Z=1.78, p=.03). CONCLUSIONS: Speech intelligibility may be improved by rehabilitation of patients with cleft palate using a speech prosthesis. Speech therapy is needed to eliminate any compensatory articulation productions developed prior to prosthetic management.     

Clinical outcomes of the furlow z-plasty for primary cleft palate repair

Objective: To review the clinical outcomes following the Furlow Z-plasty for primary cleft palate repair. The primary objective was to determine if the presence of an associated sequence or syndrome (i.e., Pierre Robin sequence), age at palate repair, cleft type, or surgeon experience influenced speech outcomes after a Furlow Z-plasty. Design: The outcomes of 140 patients who underwent palate repair were analyzed retrospectively. Speech evaluations were performed to score the severity of hypernasality, nasal escape, articulation errors, and velopharyngeal insufficiency. Results: The mean age at latest evaluation was 4 years 9 months (age range 2 years old to 12 years old and 4 months). Of the 140 patients, 83% had no evidence of hypernasality, 91% had no presence of nasal escape, and 69% had no articulation errors. Overall, 84% of patients had no evidence of velopharyngeal insufficiency. Secondary posterior pharyngeal flap to correct velopharyngeal insufficiency was required in only 2.1% of patients. The formation of an oronasal fistula occurred in only 3.6% of patients. Nonsyndromic patients with Pierre Robin sequence and syndromic patients did just as well as purely nonsyndromic patients in terms of velopharyngeal insufficiency, hypernasality, and nasal escape. Syndromic patients were more likely to make mild-to-moderate articulation errors. In addition, age at palate repair, cleft type, and surgeon experience had no statistically significant effect on speech results. Conclusions: The Furlow Z-plasty yielded excellent speech results in our patient population with minimal and acceptable rates of fistula formation, velopharyngeal insufficiency, and the need for additional corrective surgery.