黏膜下腭裂的腭咽闭合状态及语音表现分析

Velopharyngeal closure pattern and speech performance among submucous cleft palate patients

目的通过分析黏膜下腭裂患者腭咽闭合模式、腭咽口各部分的收缩运动状况和语音表现,进一步探究黏膜下腭裂的病理特征规律。方法回顾2008—2016年于四川大学华西口腔医院唇腭裂外科就诊的黏膜下腭裂患者的病历资料,分析其术前腭咽功能、辅音构音表现,采用鼻咽内镜观察腭咽闭合模式以及软腭、咽侧壁和咽后壁的运动情况。结果共纳入353例黏膜下腭裂患者,其中术前腭咽闭合完全(VPC)者138例(39.09%),腭咽闭合不全(VPI)者176例(49.86%),边缘性腭咽闭合不全(MVPI)者39例(11.05%);268例患者接受了鼻咽内镜检查,167例(62.31%)为环状闭合,89例(33.21%)为冠状闭合,12例(4.48%)为矢状闭合;派氏嵴参与了45.51%(76/167)的环状闭合和13.48%(12/89)的冠状闭合。353例患者中137例(38.81%)构音正常,124例(35.13%)表现为辅音省略,51例(14.45%)有代偿性构音,36例(10.20%)有辅音弱化,25例(7.08%)有辅音替代,36例(10.20%)有2种以上的构音错误。结论环状闭合是黏膜下腭裂患者最主要的腭咽闭合模式,压力辅音省略是最常见的构音障碍。随着腭咽闭合程度的降低,发生2种以上构音错误的患者明显增加。

Objective To characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients. Methods Patients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed. Results A total of 353 cases were retrieved in this study, among which 138 （39.09%） demonstrated velopharyngeal competence, 176 （49.86%） velopharyngeal incompetence, and 39 （11.05%） marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 （62.31%） demonstrated circular closure pattern, 89 （33.21%） coronal pattem, and 12 （4.48%） sagittal pattern. Passavant＇s ridge existed in 45.51% （76/167） patients with circular closure and 13.48% （12/89） patients with coronal closure. Among the 353 patients included in this study, 137 （38.81%） presented normal articulation, 124 （35.13%） consonant elimination, 51 （14.45%） compensatory articulation, 36 （10.20%） consonant weakening, 25 （7.08%） consonant replacement, and 36 （10.20%） multiple articulation errors. Conclusion Circular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.