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

Articulatory function after maxillectomy: a comparison between surgical rehabilitation and prosthodontic rehabilitation

PURPOSE: To evaluate the articulatory function of the maxillectomized patients with surgical rehabilitation or prosthodontic rehabilitation. METHODS: Since September of 1999, 20 patients who had undergone maxillectomies were investigated in our study. According to the rehabilitative methods for maxillary defects, patients were divided into two groups. One was the surgical rehabilitation group(10) in which the maxillary defects were reconstructed with individualized titanium mesh and forearm free flap or combined with fibular flap. The other was the prosthodontic rehabilitation group (10) in which the defects were covered with the traditional prothesis. Speech intelligibility test and the computerized acoustic analysis of , , , were conducted to evaluate the postoperative articulatory function. 10 normal people were also involved in our study as the control group. ANOVA was used for statistictical analysis. RESULTS: The speech intelligibility test showed that the mean speech intelligibility(SI) score in surgical rehabilitation group, prosthodontic rehabilitation group and control group were 97.0%, 83.8%, 99.0% respectively. The SI scores of the prosthodontic group were significantly lower than those of the surgical group and the control group. The computerized acoustic analysis indicated, compared with the control group, the second formant frequencies of , were increased and the second and third formant frequencies of were decreased both in the surgical and prosthodontic rehabilitation group. Nasal resonances were significantly more frequent in the prosthetic restored patients than those in the surgical reconstructed patients. CONCLUSION: Surgical reconstruction with titanium mesh and composite flap can better restore the articulatory function than the prosthodontic rehabilitation for the maxillectomized patients.