大龄腭裂患者咽后壁组织瓣咽成形术后语音特征(英文)

Articulatory characteristics of cleft palate patients over eight years old after pharyngoplasty with posterior pharyngeal flap

背景:根据唇腭裂序列治疗的现代概念,腭裂修复应在语音发育开始前即出生后9～12个月左右进行,但由于诸多因素延误了就诊和手术时机,仍存在一些大于8岁而未手术的腭裂患者。选择合适的手术方法进行治疗,使发音功能及腭部外形得以改善显得更为重要。目的:探讨对大龄(8岁以上)腭裂患者的特点,同期行腭裂关闭术和咽后壁组织瓣转移术对语音的影响,以提高修复效果。设计:以患者为观察对象,对照观察。单位:解放军第四军医大学口腔医学院的颌面外科。对象:选择2000-01/2003-12第四军医大学口腔医学院颌面外科收治大龄腭裂患者24例,男14例,女10例;年龄8～20岁,平均13.8岁;双侧完全性腭裂3例,单侧完全性腭裂12例,不完全性腭裂9例。方法:全部腭裂均采用常规的两瓣后推术和蒂在上的咽后壁组织瓣转移术。术后30d在安静的语音实验室内,麦克风距受试者唇10cm,由医生领读,患者随读,录音。由5名从事语音病理研究的医师进行主观判听。主要结局观察:术前术后用鼻咽纤维镜检测其腭咽闭合情况,评价患者鼻漏气及过重鼻音改善情况。结果:24例腭裂修复术后创口均达到Ⅰ期愈合,软腭后退良好,腭咽闭合改善明显,为发音创造了条件,语音也有不同程度改善。同期行腭裂关闭术和咽后壁组织瓣转移术前过重鼻音、鼻漏气4级患者24例,术后过重鼻音、鼻漏气1级患者3例,2级患者7例,3级患者6例,4级患者8例。结论:大龄腭裂患者同时采用腭裂关闭术及咽成形术的方法修复,有利于改善软腭的形态和发音。

BACKGROUND： According to up-to-date development, the best timing to repair cleft palate is at 9-12 months old after birth when the articulation does not begin to develop. However. there are many over-eight-year-old children who still suffer from unrepaired cleft palate. Therefore, it is very important to adopt proper surgery for these patients to improve palate form and articulatory function. OBJECTIVE： To study the characteristics of the cleft palate in patients of over 8 years old and the effects of palate repair and posterior pharyngeal flap transplantation （PPFT） on articulation. DESIGN：A controlled study with children patients as subjects. SETTING：Department of Maxillofacial Surgery, Medical College of Stomatology, Fourth Military Medical University of Chinese PLA. PARTICIPANTS： Twenty-four children patients of cleft palate who were treated in the Department of Maxillofacial Surgery . Medical College of Stomatology, Fourth Military Medical University of Chinese PLA from January 2000 through December 2003 were enrolled in the study. Fourteen were male and ten female. Their ages varied from 8 to 20 years old （mean 13.8 years）. Three cases were bilateral complete cleft palate and twelve cases were unilateral complete cleft palate. Nine were incomplete cleft palate. METHODS：Two flap palatoplasty and upper pediele PPFT were conducted in all the patients. In thirty days after surgical treatment, the patients were asked to repeat the words of a doctor in the phonetic lab with his or her lips 10 cm away from microphone. The words of the patients were recorded and evaluated subjectively by 5 doctors specialized in pathologic phones. MAIN OUTCOME MEASURES：The palatopharynx was observed with nasopharyngoseope before and after operation. And the improvement of nasal gas leakage and enhanced rhinophonia were also evaluated. RESULTS： The repaired cleft palate was healed in the first intention in all the patients. The soft palate retreated satisfactorily and the palatopharynx was apparently closed, which created good preconditions for artieulalion. The patients＇ articulation was also improved in different degrees. All he 24 patients had the fourth grade of enhanced rhinophonia and nasal gas leakage before repairing. After palate repair and PPFT, the enhanced rhinophonia and nasal gas leakage of grade 1 was in 3 patients, grade 2 in seven, grade 3 in six and grade 4 in eight patients. CONCLUSION： The combination of palate repair and pharyngoplasty is able to improve the form of soft palate and the articulation of over-elght-year-old patients with cleft palate.