Ayliffe Brett W, Bressmann Tim, Al Mardini Majd, Jokstad Asbjørn
Postgraduate student, Department of Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada.
Associate Professor, Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada.
J Prosthet Dent. 2014 Sep;112(3):663-71. doi: 10.1016/j.prosdent.2013.12.014. Epub 2014 Mar 24.
Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client.
The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression.
Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1.
Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis.
This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.
语音球和腭托假体用于改善因腭咽功能障碍导致鼻音过重的说话者的口鼻平衡。制作此类语音假体通常是一个漫长的过程，而且鼻咽印模可能会让患者感到不适。
本研究的目的是开发并测试一种带有硅胶软腭薄片的模块化腭托假体，该假体无需鼻咽印模即可制作。
六名病因不同的成年参与者分别使用传统腭托假体和新型假体进行治疗。结果指标包括鼻漏气分数、语音可接受性评分以及参与者在问卷上的反馈。采用非参数Friedman检验和双尾配对Wilcoxon符号秩检验进行推断性统计分析。设定概率为P<0.1。
在三种说话条件（无假体、丙烯酸树脂假体、模块化硅胶腭托假体）下，口腔刺激的鼻漏气分数未发现差异。对于鼻音句子，硅胶假体的数值降低幅度比丙烯酸树脂假体更大。模块化硅胶腭托假体（z=2.032，P<0.05）和丙烯酸树脂假体（z=1.753，P<0.1）的语音可接受性均优于无假体。问卷显示，丙烯酸树脂假体（z=1.706，P<0.05）和模块化硅胶腭托假体（z=1.706，P<0.05）的主观语音可接受性均优于无假体。丙烯酸树脂假体的吞咽舒适度在数值上也优于模块化硅胶腭托假体。
本研究证明了一种灵活的模块化腭托假体新设计的可行性。功能结果与传统设计相当。尽管本研究的总体结果更倾向于传统假体，但新设计对于需要替代治疗方案的患者可能是可行的。
