上颌骨牵引成骨对腭咽闭合功能的影响

Effects of maxillary DO on velopharyngeal function

目的:探讨牵引成骨技术(Distraction Osteogenesis,DO)前移上颌骨后对腭咽闭合功能的影响。方法:应用DO矫治14例上颌骨发育不足病例,牵引前后分别拍摄正中(牙合)位及发ⅰ位X线头颅侧位定位片,通过头影测量分析腭咽部组织的变化;同时采用吹气试验及语音清晰度测听比较牵引前后腭咽闭合功能的变化。结果:上颌骨平均前移11.39±7.15 mm。X线片测量结果显示:软腭厚度明显小于术前;咽腔深度较术前明显增大;而软硬腭夹角、静止位软腭长度及发音位有效软腭长度均明显高于术前;软腭上抬高度无明显降低;牵引前7例腭咽闭合者有2例引起腭咽闭合不全。7例腭咽闭合不全者牵引后腭咽最短距离平均增大2.5 mm。不捏鼻及捏鼻吹气试验持续时间牵引前后无显著性差异。语音测听显示语音清晰度牵引前后改变无显著性差异。对Crouzon综合征患者牵引后腭咽闭合变得更具生理性,且语音清晰度得到提高。结论:上颌骨牵引成骨在一定范围内不会引起腭咽闭合功能障碍,但牵引超过一定限度则会引起腭咽闭合不全。对Crouzon综合征患者牵引后腭咽闭合功能得以改善。

Objective:To study velopharyngeal function after maxillary advancement with DO. Method: 14 patients with maxillary hypoplasia who underwent DO, Lateral cephalograms were obtained with all patient at centric occlusion and during phonating i,Combined with blowing test and evaluation of speech. Result;The average maxillary advancement was 11.39 ± 7.15mm. Cephalometric analysis showed: The velar thickness was decreased following maxillary advancements; The angel formed by the soft and hard palate was increased; The pharyngeal depth showed an increase; Similarly, there were increase in effective velar length and velar length; There was no significant change in the postoperative elevated height of soft palate; Two of seven patients showed evidence of induced velopharyngeal incompetence, The shortest length of pharynx average increased 2. 5 mm in the seven patients who had velopharyngeal incompetence preoperatively. On phonating cephalogram, The velopharyngeal contact became more physiological after the maxillary advancement in Crouzon's disease; There were no significant difference in blowing test with tweak and untweak nose; The results of speech evaluation showed no significant change. Conclusion: the velopharyngeal adequacy is maintained in some degree of maxillary advancement, and velopharyngeal tissue had adapted change; But if exceed this, some patients may result in disturbance of velopharyngeal function. The velopharyngeal function increased after the maxillary advancement with DO in Crouzon' s disease.