Hortis-Dzierzbicka M, Radkowska E, Stecko E, Dudzinski L, Fudalej P S
Laboratory of Speech Pathology and Upper Airway Endoscopy, Institute of Mother and Child, Warsaw, Poland; Department of Otolaryngology and Maxillofacial Surgery, Universitary Clinical Hospital, Olsztyn, Poland.
J Oral Rehabil. 2014 Nov;41(11):809-15. doi: 10.1111/joor.12204. Epub 2014 Jun 23.
The aim of this study was to compare the speech in subjects with cleft lip and palate, in whom three methods of the hard palate closure were used. One hundred and thirty-seven children (96 boys, 41 girls; mean age = 12 years, SD = 1·2) with complete unilateral cleft lip and palate (CUCLP) operated by a single surgeon with a one-stage method were evaluated. The management of the cleft lip and soft palate was comparable in all subjects; for hard palate repair, three different methods were used: bilateral von Langenbeck closure (b-vL group, n = 39), unilateral von Langenbeck closure (u-vL group, n = 56) and vomerplasty (v-p group, n = 42). Speech was assessed: (i) perceptually for the presence of a) hypernasality, b) compensatory articulations (CAs), c) audible nasal air emissions (ANE) and d) speech intelligibility; (ii) for the presence of compensatory facial grimacing, (iii) with clinical intra-oral evaluation and (iv) with videonasendoscopy. A total rate of hypernasality requiring pharyngoplasty was 5·1%; total incidence post-oral compensatory articulations (CAs) was 2·2%. The overall speech intelligibility was good in 84·7% of cases. Oronasal fistulas (ONFs) occurred in 15·7% b-vL subjects, 7·1% u-vL subjects and 50% v-p subjects (P < 0·001). No statistically significant intergroup differences for hypernasality, CAs and intelligibility were found (P > 0·1). In conclusion, the speech after early one-stage repair of CUCLP was satisfactory. The method of hard palate repair affected the incidence of ONFs, which, however, caused relatively mild and inconsistent speech errors.
本研究的目的是比较采用三种硬腭关闭方法的唇腭裂患者的语音情况。对137例由单一外科医生采用一期手术方法治疗的单侧完全性唇腭裂（CUCLP）患儿（96例男孩，41例女孩；平均年龄12岁，标准差1.2）进行了评估。所有受试者唇裂和软腭的处理方式相似；硬腭修复采用了三种不同方法：双侧冯·朗根贝克法关闭（b-vL组，n = 39）、单侧冯·朗根贝克法关闭（u-vL组，n = 56）和犁骨成形术（v-p组，n = 42）。对语音进行了评估：（i）通过感知评估是否存在a）高鼻音、b）代偿性发音（CAs）、c）可闻及的鼻腔漏气（ANE）和d）语音清晰度；（ii）评估是否存在代偿性面部表情；（iii）进行临床口腔内评估；（iv）进行鼻内镜检查。需要进行咽成形术的高鼻音总发生率为5.1%；口腔后代偿性发音（CAs）的总发生率为2.2%。84.7%的病例总体语音清晰度良好。b-vL组患者口鼻瘘（ONF）发生率为15.7%，u-vL组为7.1%，v-p组为50%（P < 0.001）。在高鼻音、CAs和清晰度方面未发现组间有统计学意义的差异（P > 0.1）。总之，CUCLP早期一期修复后的语音情况令人满意。硬腭修复方法影响了口鼻瘘的发生率，然而，口鼻瘘导致的语音错误相对较轻且不一致。
