黏膜下腭裂的语音评估与治疗建议

Speech evaluation and treatment of patients with submucosal cleft palate

黏膜下腭裂是一类特殊腭裂,其特殊性表现在:腭部没有明显裂隙,部分患者出现高鼻音和鼻漏气等腭咽闭合不全的症状,另有30%~50%的患者可以终身不表现出任何腭咽闭合不全的语音症状,不需手术治疗。黏膜下腭裂患者有可能不完全具备Calnan三联征,存在不同的形态分类,其腭咽闭合率也不相同。目前黏膜下腭裂的手术治疗指征和手术方案存在争议,部分学者认为应尽早手术,部分学者认为应根据患者具体的腭咽功能状态决定手术。本文通过文献回顾和近10年来对黏膜下腭裂的临床观察,分析其不同形态及腭咽闭合功能评估方法,探讨手术指征和术后语音治疗原则。为避免过度医疗和贻误手术时机,笔者提出了黏膜下腭裂的腭咽功能评估的时机与手术治疗建议:1)手术仅适用于有确切的腭咽闭合不全症状的黏膜下腭裂患者;2)术前须经专科言语治疗师进行评估;3)结合儿童语音语言发展的规律,通常在患儿2岁左右能进行有效的语音及腭咽闭合功能评估,因此适宜的手术时间不宜早于2岁。

Submucosal cleft palate(SMCP) is a special type of cleft palate. Velopharyngeal insufficiency(VPI) such as hypernasal speech and nasal emission occurs in some patients, but about 30%-50% of patients do not show any speech symptoms of VPI and do not need surgical treatment. Patients with SMCP do not have the typical Calnan triad, and their clefts have different morphological classifications and show different velopharyngeal closure rates. The surgery indications and surgical design for SMCP are controversial. Some scholars believed surgery should be determined based on the patients specific velopharyngeal function, whereas other scholars believed that surgery should be performed as early as possible. On the basis of literature review and clinical observation of SMCP for the past 10 years, this study analyzed the different types of SMCP and evaluations of velopharyngeal function, surgical indications, and speech therapy. To avoid excessive medical treatment and delayed surgery, we present the following suggestions for the timing of speech evaluation and surgical treatment of SMCP. First, surgery is only suitable for SMCP patients with VPI. Second,preoperative speech evaluation is required. Third, the appropriate operation time should not be earlier than 2 years old,considering that effective speech assessment can usually be performed around 2 years old in accordance with the rules of children’s speech and language development.