Dinsever Eliküçük Çağla, Kulak Kayıkcı Maviş Emel, Esen Aydınlı Fatma, Çalış Mert, Özgür Fatma Figen, Öztürk Mehtap, Günaydın Rıza Önder
Department of Audiology and Speech Pathology, Audiologist and Speech Pathologist, Hacettepe University Health Sciences Institute, Ankara, Turkiye; Numune Education and Research Hospital, ENT Clinic, Center of Hearing, Speech and Balance, Ankara, Turkiye.
Speech and Language Therapy, Hacettepe University Health Science Faculty, Hacettepe University Faculty of Health Sciences Vice Dean, Bologna Coordinator, Sıhhiye, Ankara, Turkiye.
J Craniomaxillofac Surg. 2017 Jun;45(6):891-896. doi: 10.1016/j.jcms.2017.02.024. Epub 2017 Mar 6.
The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy.
This is a prospective case-control study. The study involved 87 cleft palate ± cleft lip patients with velopharyngeal insufficiency (VPI) who has been treated with PPWA. Patients were separated into two groups according to age; the first group consisted of 49 pediatric participants between 6 and 12 years of age and the second group consisted of 38 adolescent participants between 13 and 18 years of age. Preoperative velopharyngeal function and articulation were compared postoperatively at the following time points: the 3rd month, 12th month, 18th month and 24th month. The velopharyngeal function was evaluated with regards to the velopharyngeal closure type and velopharyngeal closure amount, by using the pediatric flexible nasoendoscopy and the nasometer methods. In the nasometer evaluation, nasalance sores were measured by using nonsense syllables and meaningful sentences. The Ankara Articulation Test (AAT) (Ege et al., 2004) was used to detect compensatory articulation products secondary to VPI. Consonant production error types and frequencies were determined according the guidelines stated in the study of Hardin-Jones et al. (2009). These were Pharyngeal Fricatives - Posterior Nasal Fricatives/Stop Production, Glottal Stop Production, Middorsum Palatal Stop Production, Nasal Frictional Production, Posterior Nasal Frictional Production/Phoneme Specific Nasal Emission, use of Nasal Consonants for Oral Consonants, and Replacement of Trills. All the participants received concurrent speech therapy four times, twice in the post-operative period between 1 and 3 months and twice between 3 and 6 months.
PPWA improved the speech performance from the 18th month to 24th month of the postoperative period. AAT assessment of the first group after 24 months comparing the post-PPWA with the preoperative data showed a highly significant decrease with regard to compensatory production errors and hypernasality; however, in the second group, the same comparison revealed a highly significant decrease in regard to the degree of hypernasality and a significant difference in terms of glottal articulation and pharyngealization of fricatives. A circular closure pattern was observed in 17 individuals with cleft palate at a rate of 70.6%.
PPWA with concurrent speech therapy is an acceptable surgical method to correct VPI and to improve speech performance.
本研究旨在评估咽后壁脂肪移植术在术后早期和晚期的语音效果，并阐明该手术与言语治疗相结合的影响。
这是一项前瞻性病例对照研究。该研究纳入了87例患有腭咽闭合不全（VPI）的腭裂±唇裂患者，这些患者均接受了咽后壁脂肪移植术治疗。患者根据年龄分为两组；第一组由49名6至12岁的儿童参与者组成，第二组由38名13至18岁的青少年参与者组成。在以下时间点对术前腭咽功能和发音进行术后比较：第3个月、第12个月、第18个月和第24个月。通过小儿软性鼻内镜检查和鼻音计方法，从腭咽闭合类型和腭咽闭合量方面评估腭咽功能。在鼻音计评估中，使用无意义音节和有意义的句子测量鼻漏气情况。采用安卡拉发音测试（AAT）（Ege等人，2004年）来检测继发于VPI的代偿性发音产物。根据Hardin-Jones等人（2009年）研究中所述的指南确定辅音发音错误类型和频率。这些错误类型包括咽擦音 - 后鼻音擦音/塞音发音、声门塞音发音、中腭背塞音发音、鼻擦音发音、后鼻音擦音发音/音素特异性鼻漏气、用鼻辅音替代口腔辅音以及颤音替代。所有参与者均同时接受了4次言语治疗，术后1至3个月进行2次，3至6个月进行2次。
咽后壁脂肪移植术在术后第18个月至24个月期间改善了语音表现。24个月后对第一组进行AAT评估，将咽后壁脂肪移植术后与术前数据进行比较，结果显示代偿性发音错误和鼻音过重方面有极显著下降；然而，在第二组中，相同比较显示鼻音过重程度有极显著下降，声门发音和擦音咽化方面有显著差异。在17例腭裂患者中观察到圆形闭合模式，发生率为70.6%。
咽后壁脂肪移植术联合言语治疗是一种可接受的手术方法，用于纠正腭咽闭合不全并改善语音表现。
