上颌骨缺损赝复体修复语音效果评价

目的:评价上颌骨缺损赝复体修复的语音康复效果。方法:测量21例上颌骨缺损患者不戴赝复体和戴赝复体1月后的语音清晰度和元音声学特点。结果:患者不戴赝复体时的语音清晰度平均为(23.2±7.4)%,戴赝复体1月后上升至(81.8±9.4)%(P<0.0001),戴赝复体与不戴赝复体相比,元音共振峰频率值有变化,其中发元音/i/时第二共振峰(F2)显著升高。结论:赝复体能明显改善上颌骨缺损患者的语音功能。     

赝复体修复Ⅴ类上颌骨缺损的临床效果

目的 探讨金属卡环与弹性卡环联合固位式赝复体在上颌骨肿瘤术后Ⅴ类骨缺损修复的临床效果.方法 对2012年1月~2015年12月中山大学孙逸仙纪念医院口腔科23例患者,共24副金属卡环与弹性卡环联合固位式上颌骨赝复体进行6个月~2年的跟踪随访.结果 佩戴赝复体后,23例患者颌面外形均明显改善,其中,21例洼田饮水试验从Ⅳ级或Ⅴ级改善至Ⅰ级或Ⅱ级,差异有统计学意义(P<0.05);15例可使用患侧咀嚼软食或中等硬度食物;佩戴赝复体前后语音清晰度分别为(36.6±5.6)%和(83.2±7.3)%,差异有统计学意义(P<0.05);18例口腔及赝复体卫生状况维持良好.结论 金属卡环与弹性卡环联合固位式赝复体修复上颌骨肿瘤术后Ⅴ类骨缺损可取得良好临床效果,有利于提高患者术后生活质量和心理健康.     

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。     

软衬式赝复体修复单侧上颌骨缺损的疗效分析

目的探讨应用软衬式赝复体修复单侧上颌骨缺损的临床效果。 方法以2010年9月至2014年9月北京大学深圳医院口腔科收治的16例单侧上颌骨缺损的患者为研究对象,制作软衬式赝复体修复上颌骨缺损部分。分别测量患者术后戴入赝复体前和戴入赝复体1个月后的咀嚼效率和语音清晰度值。 结果单侧上颌骨缺损应用赝复体修复1个月后,咀嚼效率与语音清晰度值差异有统计学意义(t_咀嚼效率=-2.33,P_咀嚼效率=0.034;t_{语音清晰度}=-2.49,P_{语音清晰度}=0.029)。 结论软衬式赝复体修复单侧上颌骨缺损可以取得良好的修复效果。     

上颌骨缺损手术重建与赝复体修复的语音功能评价

目的:评价上颌骨切除后手术重建和赝复体修复2种方法对患者术后语音功能的影响。方法:选择因肿瘤行上颌骨切除的20例患者为研究对象,根据上颌骨切除术后修复的方式,分成2组:(1)手术重建组10例,即在手术切除上颌骨同期或二期,运用CAD/CAM个体化钛网支架结合前臂游离皮瓣或串联腓骨瓣行上颌骨缺损重建修复;(2)赝复体修复组10例,上颌骨切除术后未行手术重建,术后配戴修复体。采用主观语音清晰度测试法,评价患者术后语音清晰度;采用客观语音频谱分析法,比较2组发4个单元音[a]、[i]、[e]、[u]时第一、第二、第三共振峰频率的平均值和病理性鼻共振峰出现的频数。另选10例正常人作为对照组,对所收集资料进行单因素方差分析。结果:手术重建组、赝复组和正常对照组的语音清晰度平均测定值分别为97.0%、83.8%和99.0%。单因素两两比较显示,赝复组语音清晰度显著低于手术重建组和正常对照组(P<0.01),而手术重建组和对照组间语音清晰度无显著性差异(P>0.05)。语音频谱显示,手术重建组和赝复组的元音共振峰频率变化较为相似:即发[a]、[u]时,F2频率升高;发[i]时F2、F3频率下降;手术重建组和赝复组两者间在鼻共振峰出现频数上存在显著差异,在发[a]、[i]、[e]、[u]时,鼻共振峰在赝复组中出现的频数最高,在对照组中则无1例     

数字化赝复体术中修复BrownⅡ类缺损后的功能评价

目的探讨数字化赝复体术中修复BrownⅡ类缺损后的功能及面容恢复程度。方法 2016年8月至2017年8月收治10例因肿瘤致BrownⅡ类缺损患者;对其行术中赝复体修复。术后1、3、6个月分析语音清晰度、吞咽功能、咀嚼功能、面容对称性。结果赝复体修复后1、3、6个月语音清晰度显著提高(P=0.004、0.015、0.001,P<0.05);吞咽功能提高1～2级,有效率25%(2/8),显效率75%(6/8);口角偏斜角度、双侧唇部高度差、最大偏差距离、变化区域体积显著减小(P=0.007、0.044、0.039,0.042,P<0.05);患侧牙合力比值(20.45±2.55)%,健侧牙合力比值(79.55±2.55)%,牙合力不对称指数(59.10±5.09)%,患侧牙合力恢复指数范围(25.82±4.04)%。结论数字化赝复体术中修复BrownⅡ类缺损可获得良好的面容及功能恢复。     

上颌骨缺损赝复体修复的临床效果评价

目的:评价上颌骨缺损赝复体修复的临床效果。方法:测量21例上颌骨缺损患者不戴赝复体和戴赝复体1个月后的咀嚼效率和语音清晰度。结果:患者不戴赝复体时的咀嚼效率在32.5%~75.0%之间,平均为56.0%±12.5%,戴修复体1个月后的咀嚼效率在49.0%~85.0%之间,平均为69.0%±11.3%,经配对t检验表明两者间有显著性差异(P<0.0001);不戴修复体时的语音清晰度在14.3%~41.0%之间,平均为23.2%±7.4%,戴赝复体1个月后语音清晰度在62.5%~98.7%之间,平均为81.8%±9.4%,两者相比差异有显著性(P<0.0001)。结论:赝复体能明显改善上颌骨缺损患者的语音功能和咀嚼功能。     

赝复体式放射性粒子布源器治疗11例腭部腺源性恶性肿瘤的疗效观察

目的:评价赝复体式放射性粒子布源器用于腭部腺源性恶性肿瘤患者的术后放射治疗效果。方法:11例腭部恶性肿瘤患者,经常规手术切除治疗后2周,根据上颌骨缺损的赝复体设计原则,分别制作铸造支架式赝复体。按照放射性粒子植入治疗计划系统的靶区照射剂量设计要求,在近瘤腔的赝复体基托树脂组织面均匀埋植数枚¹²⁵I放射性粒子。术后随访观察患者的治疗效果及不良反应。采用SPSS 21.0软件包对数据进行统计学分析。结果:11例患者均能坚持配戴赝复体式放射性粒子布源器,无粒子脱落或移位。随访6~24个月,未见肿瘤复发或远处转移。经赝复体修复后,患者语音清晰度、咀嚼效率、生活质量等均显著改善,自我评估全优。结论:采用赝复体式放射性粒子布源器对腭部腺源性恶性肿瘤患者进行术后近距离靶向照射治疗,可以取得较好的临床疗效,改善患者的生活质量,值得推广应用。     

上颌骨缺损伴张口受限的磁性附着体分段式赝复体修复

目的探讨上颌骨缺损伴张口受限患者应用磁性附着体连接分段式赝复体修复的临床特点和疗效。方法选择15例上颌骨缺损患者,其中8例伴有张口受限。依据术后修复时间及张口情况分别选择磁附着体连接分段式赝复体和一体式中空赝复体进行修复,测定咀嚼效率、进行语音清晰度评价和临床效果评价。结果使用磁性附着体连接分段式赝复体可使上颌骨缺损伴张口受限病人提前进行修复,而且分段式赝复体摘戴方便,固位稳定,发音得到良好的改善,美观也有一定恢复。磁性附着体连接分段式赝复体咀嚼效率高于一体式中空赝复体(P<0.05),两类赝复体和语音清晰度评价没有差别(P>0.05)。结论上颌骨缺损伴张口受限患者,应用磁性附着体连接分段式赝复体修复能达到比较满意的效果。     

赝复体修复上颌骨缺损语音效果的评价

目的采用患者自我评价和主观判听的主观评价方法 ,评价赝复体修复上颌骨缺损的语音效果,并比较开放式赝复体和封闭式赝复体语音效果的差异。方法对9例单侧上颌骨缺损患者的录音资料进行患者自我评价;由判听者进行过高鼻音程度及语音清晰度的判听。对评价结果进行单因素方差分析。结果戴用开放式赝复体或封闭式赝复体时,患者对语音效果的自我评价明显高于未戴赝复体时,过高鼻音判听分数明显降低,语音清晰度明显升高,差异具有统计学意义（P〈0.01）。戴用开放式赝复体与封闭式赝复体时,患者对语音效果的自我评价、过高鼻音判听分数以及语音清晰度的差异无统计学意义（P〉0.01）。结论赝复体可显著降低上颌骨部分缺损患者的过高鼻音程度,改善患者的语音清晰度,患者的满意度较高,且开放式赝复体与封闭式赝复体的效果相近。     

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目的    探讨中腭板式和中空式连接体可摘局部义齿修复对语音功能的影响。方法    选择2007年1月至2009年2月南阳市口腔医院收治的上颌肯氏I类牙列缺损患者16例，均分别制作中空式和中腭板式连接体义齿。初戴不同义齿时，统计患者的语音清晰度，并进行对比分析。结果    戴中腭板式义齿时，患者的语音清晰度为（87.5±6.1）%，明显高于戴前、后腭杆组成的中空式连接体义齿时的语音清晰度（25.0±4.3）%（P < 0.05）。结论    与中空式连接体义齿相比，采用中腭板式义齿可较快恢复患者发音功能，发音清晰度明显改善并接近正常。     

舌癌患者术后语音功能的影响因素分析

目的：评价舌癌患者手术前、后的语音功能,探讨患者术后语音功能的影响因素。方法：收集2001年10月—2004年6月在上海交通大学医学院附属第九人民医院口腔颌面外科I病区接受手术的舌癌患者27例,所有患者的舌切除范围均在半舌内。根据重建术式分为前臂游离皮瓣修复组（16例）、邻近舌组织瓣修复组（11例）;根据肿瘤大小和分期分为T1组（9例）、T2组（13例）及T3组（5例）;根据肿瘤切除后缺损的部位分为舌前部切除组（5例）、舌中部切除组（6例）、舌后部切除组（12例）和半舌切除组（4例）;根据术后舌活动度分为I度受限（14例）、Ⅱ度受限（7例）和Ⅲ度受限（6例）。采用100个具有代表性的汉字组成的汉语语音清晰度测试字表作为检测手段,对每例患者手术前、后语音清晰度变化情况进行采样,利用SPSS11.5软件包对所获资料进行方差分析,评价原发灶大小、手术切除部位、修复术式、邻近结构保存以及术后舌活动度等因素对患者术后语音清晰度的影响。结果：前臂游离皮瓣组和邻近舌组织瓣修复组间,术后语音清晰度比较无显著性差异（P〉0.05）;对原发灶大小不同的舌癌患者术后语音清晰度的比较表明,T1和T3组间有显著性差异（P〈0.05）;舌前份切除者的语音清晰度显著低于后份切除者（P〈0.05）,保存舌尖和口底组术后的语音清晰度明显高于未保存组（P〈0.05）,保存舌根组和未保存组间的语音清晰度改变无显著差异（P〉0.05）;不同程度伸舌受限者,术后语音清晰度下降有显著差异（P〈0.01）。结论：对半舌范围内行舌切除的舌癌患者,手术切除部位和邻近结构以及舌活动度的保存与否是影响术后语音功能的敏感因素,原发灶大小在一定程度上决定术后语音清晰度的高低,而选择何种修复手段并不是其主要影响因素。     

Speech intelligibility following maxillectomy with and without a prosthesis: an analysis of 54 cases

To statistically evaluate the factors that influenced speech following maxillectomy, the speech intelligibility (SI) in 54 patients was measured with and without a prosthesis. The mean SI score without a prosthesis in all patients was 35.7 ± 22.7% and that with a prosthesis was 84.9 ± 12.7%. The results of the postmaxillectomy SI statistical analysis revealed that an oro–nasal communication was one of the factors that influenced SI without a prosthesis. The resection of the anterior portion of the soft palate was one of the factors that influenced SI with a prosthesis, which suggested that for some of these patients we should consider specific surgical treatment, aimed at the reconstruction in the deep defect extending to the intratemporal fossa. A new classification of maxillary defects has been proposed which will help to predict the grade of postmaxillectomy speech disorder following surgery.     

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。     

The effects of a maxillary speech-aid prosthesis for the combined tongue and mandibular resection patient

The purpose of this investigation was to develop a protocol for the fabrication of a prosthesis that would improve speech in individuals who have undergone complete removal of the tongue and mandible. A 60-year-old man was suffering from severe xerostomia and was unable to produce intelligible speech. Speech analysis without the prosthesis revealed a profound articulatory disorder. With the prosthesis, xerostomia was eliminated and the subject had fewer articulatory errors of severity. Improvement in speech intelligibility was significant at p less than 0.001.     

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.     

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.     

Oral rehabilitation by prosthetic restoration after maxillectomy for malignant tumors.

In maxillectomy patients, speech intelligibility between before and after insertion of prostheses has been reviewed by many investigators. Speech intelligibility was not related to the size of the defect, but rather to the defect region. Speech intelligibility was considerably improved by the use of prostheses. A great difference could not be found in escape rate from the nasal cavity between before and after insertion of prostheses, but there was a remarkable change in the spirometer. Postmaxillectomy functions are also easily restored by prosthetic oral rehabilitation, necessary to aid surgical procedure.