Rudnick Emily F, Sie Kathleen C
Department of Otolaryngology, Head, and Neck Surgery, The University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
Curr Opin Otolaryngol Head Neck Surg. 2008 Dec;16(6):530-5. doi: 10.1097/MOO.0b013e328316bd68.
To discuss principles of evaluation and treatment of children with velopharyngeal insufficiency, and to review recent reports of surgical outcomes.
Velopharyngeal insufficiency significantly impacts both quality-of-life and speech intelligibility in children. Diagnosis is made through history and physical, perceptual speech assessment, and instrumental measures including nasendoscopy and radiographic multiplanar videofluoroscopy. Treatment options for velopharyngeal insufficiency consist of prosthetic management or surgery, supplemented with speech therapy when appropriate. Surgical interventions are palatal, palatopharyngeal or pharyngeal in nature. Despite some controversy, most recent reports identify no significant difference in outcomes following pharyngeal flap or sphincter pharyngoplasty. Complications of surgical therapy relate to postoperative obstructive breathing or persistent velopharyngeal insufficiency.
Although there is no universally accepted measure to assess velopharyngeal insufficiency severity, nasendoscopy and multiplanar videofluoroscopy are most commonly used for clinical diagnosis. A speech pathologist is an integral member of the velopharyngeal insufficiency team, and momentum toward a standardized reporting system of perceptual speech measurements is increasing. Treatment of velopharyngeal insufficiency should be tailored to the specific needs of the child and family. Surgical therapy may improve velopharyngeal function but may negatively impact upper airway patency and respiration during sleep. The otolaryngologist should be familiar with strengths and limitations of different surgical options for velopharyngeal insufficiency.
探讨腭咽功能不全患儿的评估和治疗原则，并回顾近期手术治疗结果的报告。
腭咽功能不全对儿童的生活质量和言语清晰度均有显著影响。通过病史和体格检查、言语感知评估以及包括鼻内镜检查和放射学多平面电视荧光透视在内的仪器测量进行诊断。腭咽功能不全的治疗选择包括假体治疗或手术治疗，并在适当时辅以言语治疗。手术干预包括腭部、腭咽或咽部手术。尽管存在一些争议，但最近的报告表明，咽瓣手术或括约肌咽成形术后的结果没有显著差异。手术治疗的并发症与术后阻塞性呼吸或持续性腭咽功能不全有关。
虽然目前尚无普遍接受的评估腭咽功能不全严重程度的方法，但鼻内镜检查和多平面电视荧光透视是最常用于临床诊断的方法。言语病理学家是腭咽功能不全治疗团队不可或缺的成员，建立标准化言语感知测量报告系统的趋势正在增强。腭咽功能不全的治疗应根据患儿及其家庭的具体需求进行调整。手术治疗可能改善腭咽功能，但可能对睡眠期间的上呼吸道通畅和呼吸产生负面影响。耳鼻喉科医生应熟悉腭咽功能不全不同手术选择的优缺点。
