唇腭裂患者上颌骨牵引成骨术后口鼻腔共鸣的变化

Oral-nasal resonance changes in cleft lip and palate patients after maxillary distraction osteogenesis

目的:通过研究行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)的唇腭裂患者前后过度鼻音、过低鼻音的变化,并结合腭咽部结构功能变化、上颌骨前移幅度等因素,综合分析上颌骨RED对口鼻腔共鸣的影响。方法:1999年至2001年行RED治疗的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED手术前后语音测听、拍摄静止位及[i]位头颅定位片测量腭咽闭合功能,对检测结果行非参数检验。结果:RED术后患者过度鼻音程度显著加重。RED前61.9%患者存在过度鼻音,RED术后增至90.5%,所有患者均未出现过低鼻音。上颌骨前移幅度对患者术后过度鼻音加重程度有显著影响。患者腭咽闭合冠状收缩不全率(RVCR)和RED前的过度鼻音程度也直接影响术后的过度鼻音程度。结论:唇腭裂患者经RED前移上颌骨后,鼻腔共鸣增加,过度鼻音加重。

PURPOSE: This study was conducted to evaluate the oral-nasal resonance changes after maxillary distraction osteogenesis by using a rigid external distraction device (RED) in cleft lip and palate patients with maxillary dysplasia.METHODS:Twenty-one cleft lip and palate patients with maxillary dysplasia were included in this study. There were 13 male and 8 female patients, with an average age of 15.05 years. All the patients underwent maxillary advancement with rigid external distraction after a high Le Fort Ⅰ osteotomy. Perceptual assessment of speech and lateral cephalograms at rest and position before and after RED were compared. RESULTS: Hypernasality deteriorated significantly after RED. Hypernasality existed in 61.9% patients pre-RED, while 90.5% post-RED, but hyponasality were not found in all patients. The deterioration of hypernasality was influenced by the degree of maxillary advancement.The severity of hypernasality post-RED was caused by RVCR and the severity of hypernasality pre-RED.CONCLUSION:Oral-nasal resonance is worse after RED in cleft patients, which leads to deterioration in hypernasality.