Huang Xinyi, Mao Qirong, Yin Heng, Wu Min, Shi Bing, Zheng Qian, Li Jingtao
State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041 China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2025 Jun 1;43(3):376-382. doi: 10.7518/hxkq.2025.2024425.
A stable, reliable, and easily implementable clinical diagnostic method for marginal velopharyngeal insufficiency (MVPI) was established on the basis of the subjective hearing judgement of hypernasality and objective examination of velopharyngeal closure to address the lack of unified diagnostic criteria for MVPI.
Nasopharyngeal fiberscopy and speech assessment results were collected from postoperative patients with cleft palate. These results were used to analyze the differences in the distribution of nasal resonance in patients with different velopharyngeal closure ratios and the correlation between velopharyngeal closure ratios and nasal resonance status. Mild-to-moderate hypernasality with its corresponding elopharyngeal closure ratio was employed to establish the diagnostic criteria of MVPI. The reproducibility of the criteria and whether the patients with MVPI diagnosed by using the criteria exhibited significantly different speech characteristics compared with other patients were verified.
A strong correlation was found between velopharyngeal closure ratios and nasal resonance (<0.001). Mild-to-moderate hypernasality mainly corresponded to velopharyngeal closure ratios ranging from 90% to 99%, and the combination of the two characteristics as the diagnostic criteria for MVPI demonstrated good consistency (Kappa value=0.789, <0.001). Moreover, under the diagnostic criteria, significant differences in nasal resonance (<0.001), nasal emission (=0.007), and misarticulation (<0.001) were found between patients with velopharyngeal insufficiency and those with MVPI.
Combining the subjective hearing judgement of mild-to-moderate hypernasality with velopharyngeal closure ratios over 90% under nasopharyngeal fiberscopy provides a reliable and effective clinical method for diagnosing MVPI.
基于对高鼻音的主观听觉判断和腭咽闭合的客观检查，建立一种稳定、可靠且易于实施的边缘性腭咽闭合不全（MVPI）临床诊断方法，以解决MVPI缺乏统一诊断标准的问题。
收集腭裂术后患者的鼻纤维镜检查和语音评估结果。这些结果用于分析不同腭咽闭合率患者鼻共鸣分布的差异以及腭咽闭合率与鼻共鸣状态之间的相关性。采用轻至中度高鼻音及其相应的腭咽闭合率来建立MVPI的诊断标准。验证了该标准的可重复性以及使用该标准诊断为MVPI的患者与其他患者相比是否表现出明显不同的语音特征。
发现腭咽闭合率与鼻共鸣之间存在强相关性（<0.001）。轻至中度高鼻音主要对应腭咽闭合率在90%至99%之间，将这两个特征结合作为MVPI的诊断标准显示出良好的一致性（Kappa值 = 0.789，<0.001）。此外，在该诊断标准下，腭咽功能不全患者与MVPI患者在鼻共鸣（<0.001）、鼻漏气（=0.007）和语音清晰度错误（<0.001）方面存在显著差异。
将轻至中度高鼻音的主观听觉判断与鼻纤维镜检查下腭咽闭合率超过90%相结合，为诊断MVPI提供了一种可靠且有效的临床方法。
