Department of Speech Pathology and Audiology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB.
J Otolaryngol Head Neck Surg. 2011 Feb;40(1):40-7.
Two options exist for restoring structure and function after maxillectomy. Prosthodontic rehabilitation requires that an obturator be constructed to address the oronasal communication that exists after resection of the maxilla. Surgical reconstruction of the defect is another option, often accomplished with the use of bone-containing flaps.
To determine whether prosthetic rehabilitation or surgical reconstruction of the maxilla provides better speech and facial aesthetic outcomes after maxillectomy.
DESIGN, PARTICIPANTS, AND MEASURES: Fifty-nine patients in three groups were included: 23 patients with maxillary obturators, 16 patients with maxillary reconstruction, and 20 patients without any maxillary defects but who were diagnosed with nasopharyngeal cancer and who served as a control group. Using digitized photographs, facial attractiveness was rated on a 10-point scale by eight judges who were blinded to treatment group. Speech outcomes included nasalance, velopharyngeal orifice opening, and speech intelligibility.
There were no significant between-group differences found for facial attractiveness ratings. However, patients in either group who had involvement of the orbital rim or the orbital rim and zygoma were rated as significantly less attractive than those without such involvement. With respect to speech outcomes, the control group (ie, nasopharynx) had smaller velopharyngeal orifice areas than the obturator group; however, this was not clinically significant as scores in both groups were within normal limits. In conclusion, this study found no differences between surgical reconstruction or prosthodontic intervention of maxillary defects when facial attractiveness was assessed by naive raters and speech outcomes were assessed using objective measurements.
上颌骨切除术后有两种选择来恢复结构和功能。修复体修复需要制作阻塞器来解决上颌骨切除后存在的口鼻相通问题。另一种选择是进行缺陷的手术重建，通常使用含骨瓣来完成。
确定在上颌骨切除术后，修复体修复还是上颌骨重建能提供更好的语音和面部美学效果。
设计、参与者和措施：将 59 名患者分为三组：23 名上颌骨阻塞器患者、16 名上颌骨重建患者和 20 名无上颌骨缺陷但被诊断为鼻咽癌的对照组患者。8 名评判员使用数字化照片对 10 分制的面部吸引力进行评分，评判员对治疗组不知情。语音结果包括鼻共鸣、腭咽孔开口和言语清晰度。
在面部吸引力评分方面，三组之间没有显著差异。然而，眶缘或眶缘和颧骨受累的患者组在吸引力方面的评分明显低于无此类受累的患者组。就语音结果而言，对照组（即鼻咽部）的腭咽孔面积小于阻塞器组；然而，这在临床上并不重要，因为两组的评分均在正常范围内。总之，本研究发现，在上颌骨缺损的修复体修复或手术重建方面，当由无经验的评判员评估面部吸引力，以及使用客观测量评估语音结果时，两者之间没有差异。
