Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Prosthodont. 2019 Mar;28(3):234-238. doi: 10.1111/jopr.12990. Epub 2018 Nov 15.
This clinical report describes the prosthetic rehabilitation of a 25-year-old man with a history of grade II chondrosarcoma at the skull base who had undergone surgical resection and thereafter developed velopharyngeal incompetency (VPI), dysarthria, and dysphagia. Upon baseline fiberoptic endoscopic evaluation of swallowing (FEES), the patient had an atypical pattern of VPI with minimal to no velar lift during speech, blow, or suck tasks, but near complete velar lift and seal during swallowing. A palatal augmentation prosthesis combined with a resilient palatal lift extension was fabricated to enhance speech by displacing the soft palate and to decrease hypernasality, while avoiding interference with bolus transport. A resilient wrought wire extension was necessary to accommodate the velar movement upon swallowing while keeping the integrity of the velar lift during speech. In conclusion, this unique combination prosthesis was able to help the patient's atypical pattern of VPI by improving speech and preserving swallowing function, which was confirmed during a post-endoscopic evaluation.
本临床报告描述了一位 25 岁男性的义齿修复情况，该患者曾患有 II 级颅骨底软骨肉瘤，接受了手术切除，此后出现了咽腔闭合不全（VPI）、构音障碍和吞咽困难。在行基线纤维内镜吞咽评估（FEES）时，患者表现出非典型的 VPI 模式，在说话、吹气或吸吮时软腭几乎没有抬高，但在吞咽时软腭几乎完全抬高并封闭。制作了一种腭部增强假体结合弹性腭提升延伸装置，以通过移位软腭来改善语音，减少鼻音，同时避免干扰食团的输送。需要使用弹性锻造线延伸装置来适应吞咽时的软腭运动，同时在说话时保持软腭提升的完整性。总之，这种独特的组合假体通过改善语音和保留吞咽功能，帮助患者克服了非典型的咽腔闭合不全模式，这在内镜评估后得到了证实。
