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.     

阻塞性睡眠呼吸暂停综合征的外科治疗--腭帆成型与口咽气道扩大

手术在保留口咽腔正常解剖形态与功能的前提下，解除阻塞、重建并扩大口咽气道。术前经上气道Muller试验证实Fujita Ⅰ型56／62例。对62例OSAS施行CO2激光辅助腭贝成型，保留悬雍垂大部或全部，切开舌腭弓与咽腭弓，松解悬雍垂。术后无鼻咽部粘连及鼻腔反流发生。鼾声基本消失29／62例，明显减轻30／62例，近期总有效率95．2％。本术式基于口咽与腭帆肌群的解剖特点进行设计与重建，避免了软腭组织的过多切除，可达到明显提升腭帆、扩大口咽气道的目的。     

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。     

牙槽裂植骨改善唇腭裂患者鼻底塌陷畸形

分析唇腭裂患者牙槽裂植骨与改善鼻底塌陷畸形的关系。方法：对同一术者所行牙槽裂植骨术的单侧唇腭裂患者48例进行临床研究，结合X线片及面部正侧位照片探讨植骨成功与否与鼻底塌陷畸形改善的关系。结果：植骨成功组的患侧鼻底塌陷畸形的改善较未成功组有明显差异，明显高于未成功组。结论：牙槽裂植骨成功后患侧鼻底塌陷畸形可以得到明显改善。     

Craniofacial cephalometric morphology in 6-year-old children with isolated cleft lip,isolated submucous cleft palate,and combined cleft lip and submucous cleft palate

One hundred and twenty-one cleft children (67 with isolated cleft lip (CL), 32 with isolated submucous cleft palate (SMCP), and 22 with combined cleft lip and submucous cleft palate (CL + SMCP)) were compared retrospectively from lateral cephalograms taken at a mean age of 6.2 years (range 5.5–7.9). None of the children had had their palates repaired or been operated on to treat velopharyngeal insufficiency (VPI). The children with CL + SMCP and CL had similar morphology. They had greater maxillary length, greater maxillary and mandibular prominence, less vertical growth pattern, less deep nasopharyngeal airways, and thinner upper lips than those with isolated SMCP. After 6 years of age one patient with CL + SMCP, none with CL, and 16 with SMCP needed operations for VPI. This small series suggests that children with CL + SMCP and SMCP have different morphology. Although CL + SMCP is a combination of two types of clefts, it seems to be associated with similar morphology to CL.     

牙槽嵴裂隙间固定对腭裂上颌复合体内置式牵引成骨生物力学的影响

目的 探讨裂隙间固定对唇腭裂上颌复合体牵引成骨生物力学的影响.方法 采用三维有限元方法,建立唇腭裂上颌复合体LeFort Ⅰ型截骨骨块及相应软组织有限元模型,在保留牙槽嵴裂隙与裂隙两侧钛板固定两种情况下,模拟临床上内置式牵引方式,使截骨块上牵引器固位点沿牵引方向前移10 mm,比较分析其生物力学变化.结果 唇腭裂上颌复合体LeFort Ⅰ型截骨内置式牵引下,腭部出现压缩现象,而裂隙两侧钛板固定腭部压缩现象不明显.矢向位移与垂直向位移在两种工况下比较,位移方向及大小与保留裂隙的前牵引无明显差异.结论 裂隙间固定后唇腭裂上颌复合体内置式牵引成骨,可以避免腭部出现压缩现象,有生物力学指导意义.     

正颌联合术后正畸矫治唇腭裂术后的牙颌面畸形

目的探讨应用正颌手术联合术后正畸矫治唇腭裂术后牙颌面畸形的方法。方法2002年1月至2010年8月,共收治25例唇腭裂术后颌骨畸形患者。男11例,女14例;年龄16～33岁;单侧唇腭裂19例,双侧6例。所有患者术前均未接受过正畸治疗。本组患者均联合应用正颌手术和术后正畸建牙合矫治唇腭裂术后颌骨畸形。结果25例患者经过3~12个月的术后正畸治疗,均建立了良好的咬牙合关系,恢复正常咬合功能。随访6个月至3年,术后疗效稳定。结论唇腭裂术后颌骨畸形采用正颌手术联合术后正畸能够有效矫治牙颌面畸形。     

正颌联合正畸矫治唇腭裂术后牙颌面畸形

目的以正颌外科手术联合正畸治疗的方法矫治唇腭裂术后牙颌面畸形。方法1996年以来共矫治此类畸形2l例，采用手术方法如下：Le FortⅠ型截骨术7例；多片段Le FortⅠ型截骨术5例；Le FortⅠ型截骨术加双侧下颌升支矢状劈开术（BSSRO）4例；BSSRO加颏成形术2例：Le FortⅠ型截骨术加下颌体部截骨术2例；BSSRO1例。结果2l例术后均达到模型外科设计要求，术后随访14例，平均25．6个月，九严重并发症及明显复发。12例行术前后正畸治疗者希关系及面部外形均满意，另2例个别牙齿矛台关系欠佳。结论以正颌外科手术联合正畸治疗的方法矫治成年期唇腭裂术后牙颌面畸形可取得满意结果。     

大龄腭裂患者的手术治疗方法与语音治疗效果的对比研究

目的 对单纯行裂隙关闭术和同期行咽后壁咽成形术的大龄腭裂患者,术前、术后发音效果进行检测分析和对比研究,评定手术的治疗效果.方法 对24例同期行腭裂关闭术及咽后壁组织瓣咽成形术治疗和12例单纯行裂隙关闭术的大龄腭裂患者,术前、术后用鼻咽纤维镜检测其腭咽闭合情况,应用通用音频谱分析系统,对本组术后患者腭裂语音进行声学分析.结果 所有腭裂修复术后,创口均达到临床Ⅰ期愈合,语音也有不同程度改善.大龄腭裂患者采用腭裂关闭及同期咽成形术的修复组,术后发音明显优于单纯行裂隙关闭组.结论 大龄腭裂患者,采用腭裂关闭及同期咽成形术,是提高腭咽闭合和改善发音较好的手术方法.     

Efficacy of speech aid prostheses for acquired defects of the soft palate and velopharyngeal inadequacy--clinical assessments and cephalometric analysis: a Memorial Sloan-Kettering Study

BACKGROUND: Restoration of speech after surgical resection for oropharyngeal cancer traditionally includes maxillofacial prosthetic intervention. Relatively few publications with objective speech outcomes exist. The purpose of this study was to evaluate speech outcome relative to the size of the surgical defect, the type of speech prosthesis, and the height and position of the speech bulb in relation to the posterior pharyngeal wall in the nasopharynx. METHODS: Fifty-five patients treated at the Memorial Sloan-Kettering Cancer Center Dental Service who underwent ablative cancer therapy were evaluated. All patients were 4 months or longer after surgery and were using a speech aid or obturator prosthesis at the time of the study. Speech samples for percent intelligibility and perceptual evaluation were collected and analyzed, in addition to aeromechanical measurements of palatopharyngeal function. Lateral cephalograms were taken while wearing the prosthesis using a radiopaque marker placed on the posterior aspect of the prosthesis for evaluating the height and position of the prosthesis obturator-speech bulb component. RESULTS: After adjustment for the differences between listeners, findings revealed that as the percentage of resection of palate or tongue increased, the intelligibility of speech decreased. Aeromechanical assessment of speech was the only outcome measure sensitive to the type of speech prosthesis. The position of the speech bulb component, as well as the angle measured, was correlated with the percent intelligibility. The amount of the prosthesis physically contacting the posterior pharyngeal wall was not significantly associated with any of the functional outcome measures. CONCLUSIONS: Speech aid and obturator prostheses contribute to a higher percentage of intelligible speech. A difference in intelligibility exists in relationship to the position of the prosthesis and the anterior tubercle of the atlas vertebrae (C1), both statistically and clinically. The position for optimal speech could not be specifically located mathematically (ie, 3 mm or 3 degrees inferior to the anterior tubercle of the atlas vertebrae) from the analysis. Subjective ratings of the efficacy of the obturator-speech bulbs by the clinicians did not correspond to the percent intelligibility. A strong statistical and clinical correlation exists supporting the efficacy of speech bulb-obturator intervention after velopharyngeal insufficiency for improved intelligibility of both words and sentences.