Naran Sanjay, Ford Matthew, Losee Joseph E
Pittsburgh, Pa.
From the Department of Plastic Surgery, Division of Pediatric Plastic Surgery, University of Pittsburgh.
Plast Reconstr Surg. 2017 Jun;139(6):1343e-1355e. doi: 10.1097/PRS.0000000000003335.
After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for velopharyngeal dysfunction founded on objective considerations.
Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the velopharyngeal sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.
在学习本文后，参与者应能够：1. 清楚了解腭咽功能障碍概念的演变，尤其是与腭裂患者相关的情况。2. 解释腭咽功能障碍儿童言语的主观和客观评估。3. 根据这些诊断结果，能够对腭咽功能障碍的类型进行分类。4. 基于客观考虑，制定一个针对腭咽功能障碍的安全、循证、个性化的治疗方案。
腭咽功能障碍是控制腭咽括约肌的动态结构的功能异常。大约30%接受腭裂修复手术的患者因腭咽功能障碍需要二次手术。应由一个使用多模式仪器评估腭咽功能和言语的多学科团队来管理这些患者。仪器可能包括感知语音分析、视频鼻咽内窥镜检查、多视角语音视频荧光检查、鼻测量法、压力-流量测量以及磁共振成像。腭咽功能障碍可能适合手术或非手术治疗方法，或两者结合。非手术治疗可能包括言语治疗或修复装置。手术干预可能包括腭部再次修复并重新定位腭帆提肌、咽后壁瓣、括约肌咽成形术，或软腭或后壁增厚术。治疗干预应基于对咽侧壁和后壁以及腭部运动的客观评估和分级，以优化言语效果。治疗应根据特定的解剖和生理发现以及患者的总体需求进行定制。
