腭裂术后腭咽闭合不全的评估
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摘要
腭裂治疗的主要目的在于达到完善的腭咽闭合,获得正常的语音功能。但限于目前的手术方式及技术水平,许多患者腭裂术后仍存在腭咽闭合不全,使口腔内不能形成足够的压力,鼻漏气、异常的鼻腔共鸣导致语音清晰度降低。因此,在手术关闭腭部裂隙之后,仍需对患者的腭咽闭合情况进行评估,对腭咽闭合不全者要采取进一步的治疗措施。目前临床上关于腭咽闭合不全的评估方法有很多,可以分为主观评价和客观评价,客观评价又可以进一步分为直接评价和间接评价。本文将目前的评估方法进行归纳总结、分类对比,阐明其各自的评估原理、方法和优缺点,并对近年来的研究热点及应用前景进行综述。
One of the main purposes of cleft palate repair is to achieve perfect velopharyngeal and acquire normal speech function. However, limited to the current surgical methods and the ability of the operators, many patients with cleft palate still have velopharyngeal insufficiency, which can not form enough pressure in the mouth. Nasal leak and abnormal nasal resonance lead to reduction of speech articulation. Therefore, it is necessary to evaluate the velopharyngeal closure after cleft palate surgery. Further treatment should be taken on the patients with velopharyngeal insufficiency. At present, there are many clinical evaluation methods for velopharyngeal insufficiency, which can be divided into subjective and objective methods. And objective methods include direct methods and indirect methods. In this paper, these methods were summarized,classified and compared, and the principles, methods, advantages and disadvantages of which were clarified. The research hotspots and prospects in recent years were indicated.
One of the main purposes of cleft palate repair is to achieve perfect velopharyngeal and acquire normal speech function. However, limited to the current surgical methods and the ability of the operators, many patients with cleft palate still have velopharyngeal insufficiency, which can not form enough pressure in the mouth. Nasal leak and abnormal nasal resonance lead to reduction of speech articulation. Therefore, it is necessary to evaluate the velopharyngeal closure after cleft palate surgery. Further treatment should be taken on the patients with velopharyngeal insufficiency. At present, there are many clinical evaluation methods for velopharyngeal insufficiency, which can be divided into subjective and objective methods. And objective methods include direct methods and indirect methods. In this paper, these methods were summarized,classified and compared, and the principles, methods, advantages and disadvantages of which were clarified. The research hotspots and prospects in recent years were indicated.
引文
[1]Agrawal K.Cleft palate repair and variations[J].Indian J Plast Surg,2009,42(3):102-109.
[2]Nishio J,Yamanishi T,Kohara H,et al.Early two-stage palatoplasty using modified Furlow's veloplasty[J].Cleft Palate Craniofac J,2010,47(1):73-81.
[3]Kummer AW.Disorders of resonance and airflow secondary to cleft palate and/or velopharyngeal dysfunction[J].Semin Speech Lang,2011,32(2):141-149.
[4]de Blacam C,Smith S,Orr D.Surgery for velopharyngeal dysfunction:A systematic review of interventions and outcomes[J].Cleft Palate Craniofac J,2018,55(3):405-422.
[5]王国民,朱川,袁文化,等.汉语语音清晰度测试字表的建立和临床应用研究[J].上海口腔医学杂志,1995,4(3):125-128.
[6]申铁兵,孟秀英.腭裂患儿术前术后腭咽闭合功能对比研究[J].现代中西医结合杂志,2010,19(3):319-320.
[7]Shprintzen RJ,Marrinan E.Velopharyngeal insuf?ciency:Diagnosis and management[J].Curr Opin Otolaryngol Head Neck Surg,2009,17(4):302-307.
[8]Dalston RM,Warren DW,Dalston ET.Use of nasometry as a diagnostic tool for identifying patients with velopharyngeal impairment[J].Cleft Palate Craniofac J,1991,28(2):184-188.
[9]杨增杰,陈仁吉,穆玥.应用语图分析评价腭裂术后腭咽闭合状况的临床研究[J].北京口腔医学,2010,18(1):36-38.
[10]封兴华,吴炜,魏建华,等.运用声学技术分析腭裂患者术后的辅音特点[J].中国美容医学杂志,2003,12(6):611-613.
[11]Skolnick ML,McCALL GN,Barnes M.The sphincteric mechanism of velopharyngeal closure[J].Cleft Palate J,1973,10(3):286-305.
[12]尹恒,郭春丽,石冰,等.黏膜下腭裂的腭咽闭合状态及语音表现分析[J].华西口腔医学杂志,2017,35(3):296-300.
[13]Abdel-Aziz M,El-Hoshy H,Ghandour H.Treatment of velopharyngeal insufficiency after cleft palate repair depending on the velopharyngeal closure pattern[J].J Craniofac Surg,2011,22(3):813-817.
[14]Armour A,Fischbach S,Klaiman P,et al.Does velopharyngeal closure pattern affect the success of pharyngeal flap pharyngoplasty[J]?Plast Reconstr Surg,2005,115(1):45-52.
[15]Vadodaria S,Goodacre TE,Anslow P.Does MRI contribute to the investigation of palatal function[J]?Br J Plast Surg,2000,53(3):191-199.
[16]Perry JL,Kuehn DP,Sutton BP,et al.Velopharyngeal structural and functional assessment of speech in young children using dynamic magnetic resonance imaging[J].Cleft Palate Craniofac J,2017,54(4):408-422.
[17]Perry JL,Sutton BP,Kuehn DP,et al.Using MRI for assessing velopharyngeal structures and function[J].Cleft Palate Craniofac J,2014,51(4):476-485.
[18]Silver AL,Nimkin K,Ashland JE,et al.Cine magnetic resonance imaging with simultaneous audio to evaluate pediatric velopharyngeal insufficiency[J].Arch Otolaryngol Head Neck Surg,2011,137(3):258-263.
[19]Scott AD,Wylezinska M,Birch MJ,et al.Speech MRI:morphology and function[J].Phys Med,2014,30(6):604-618.
[20]Fu M,Bo Z,Shosted RK,et al.High-resolution dynamic speech imaging with joint low-rank and sparsity constraints[J].Magn Reson Med,2015,73(5):1820-1832.
[21]Fu M,Barlaz MS,Holtrop JL,et al.High-resolution full-vocal-tract3D dynamic speech imaging[J].Magn Reson Med,2017,77(4):1619-1629.
[2]Nishio J,Yamanishi T,Kohara H,et al.Early two-stage palatoplasty using modified Furlow's veloplasty[J].Cleft Palate Craniofac J,2010,47(1):73-81.
[3]Kummer AW.Disorders of resonance and airflow secondary to cleft palate and/or velopharyngeal dysfunction[J].Semin Speech Lang,2011,32(2):141-149.
[4]de Blacam C,Smith S,Orr D.Surgery for velopharyngeal dysfunction:A systematic review of interventions and outcomes[J].Cleft Palate Craniofac J,2018,55(3):405-422.
[5]王国民,朱川,袁文化,等.汉语语音清晰度测试字表的建立和临床应用研究[J].上海口腔医学杂志,1995,4(3):125-128.
[6]申铁兵,孟秀英.腭裂患儿术前术后腭咽闭合功能对比研究[J].现代中西医结合杂志,2010,19(3):319-320.
[7]Shprintzen RJ,Marrinan E.Velopharyngeal insuf?ciency:Diagnosis and management[J].Curr Opin Otolaryngol Head Neck Surg,2009,17(4):302-307.
[8]Dalston RM,Warren DW,Dalston ET.Use of nasometry as a diagnostic tool for identifying patients with velopharyngeal impairment[J].Cleft Palate Craniofac J,1991,28(2):184-188.
[9]杨增杰,陈仁吉,穆玥.应用语图分析评价腭裂术后腭咽闭合状况的临床研究[J].北京口腔医学,2010,18(1):36-38.
[10]封兴华,吴炜,魏建华,等.运用声学技术分析腭裂患者术后的辅音特点[J].中国美容医学杂志,2003,12(6):611-613.
[11]Skolnick ML,McCALL GN,Barnes M.The sphincteric mechanism of velopharyngeal closure[J].Cleft Palate J,1973,10(3):286-305.
[12]尹恒,郭春丽,石冰,等.黏膜下腭裂的腭咽闭合状态及语音表现分析[J].华西口腔医学杂志,2017,35(3):296-300.
[13]Abdel-Aziz M,El-Hoshy H,Ghandour H.Treatment of velopharyngeal insufficiency after cleft palate repair depending on the velopharyngeal closure pattern[J].J Craniofac Surg,2011,22(3):813-817.
[14]Armour A,Fischbach S,Klaiman P,et al.Does velopharyngeal closure pattern affect the success of pharyngeal flap pharyngoplasty[J]?Plast Reconstr Surg,2005,115(1):45-52.
[15]Vadodaria S,Goodacre TE,Anslow P.Does MRI contribute to the investigation of palatal function[J]?Br J Plast Surg,2000,53(3):191-199.
[16]Perry JL,Kuehn DP,Sutton BP,et al.Velopharyngeal structural and functional assessment of speech in young children using dynamic magnetic resonance imaging[J].Cleft Palate Craniofac J,2017,54(4):408-422.
[17]Perry JL,Sutton BP,Kuehn DP,et al.Using MRI for assessing velopharyngeal structures and function[J].Cleft Palate Craniofac J,2014,51(4):476-485.
[18]Silver AL,Nimkin K,Ashland JE,et al.Cine magnetic resonance imaging with simultaneous audio to evaluate pediatric velopharyngeal insufficiency[J].Arch Otolaryngol Head Neck Surg,2011,137(3):258-263.
[19]Scott AD,Wylezinska M,Birch MJ,et al.Speech MRI:morphology and function[J].Phys Med,2014,30(6):604-618.
[20]Fu M,Bo Z,Shosted RK,et al.High-resolution dynamic speech imaging with joint low-rank and sparsity constraints[J].Magn Reson Med,2015,73(5):1820-1832.
[21]Fu M,Barlaz MS,Holtrop JL,et al.High-resolution full-vocal-tract3D dynamic speech imaging[J].Magn Reson Med,2017,77(4):1619-1629.