Yoshida H, Michi K, Yamashita Y, Ohno K
Department of Stomatology, University of Tsukuba, Ibaragiken, Japan.
J Oral Maxillofac Surg. 1993 Apr;51(4):361-5. doi: 10.1016/s0278-2391(10)80345-3.
Surgical and prosthetic treatments for speech disorders attributable to surgically acquired soft palate defects were investigated. Ten patients who had undergone soft palate resection for extensive cancer served as the subjects. In four patients, the resected portion of the soft palate was confined to the anterior or middle segments, with an intact posterior band, whereas in the remaining six patients the resected portion extended into the posterior edge. An obturator with or without a speech appliance was adapted to all patients in the former group and to one patient in the latter group. The remaining five patients in the latter group underwent surgical reconstruction using a free radial forearm flap immediately after resection of the soft palate. The speech of each patient was evaluated either before and after surgery in those treated only surgically or with and without the obturator in the other patients using a standard intelligibility test of 100 Japanese syllables. These tests showed that two of the four patients with a posterior band of soft palate remaining postsurgically achieved excellent restoration of speech and improvement of velopharyngeal function following placement of a special prosthesis. The patients who had resection extending into the posterior edge of the soft palate obtained better restoration of speech and function from surgical reconstruction rather than prosthetic management. All three patients who had surgical reconstruction, in whom the special obturator was applied achieved a slight increase in speech intelligibility scores resulting from the improvement of velopharyngeal function. These results suggest that surgical reconstruction and prosthetic management may best be applied selectively based on the extent of resection of the soft palate.
对因手术导致软腭缺损引起的言语障碍的手术和修复治疗进行了研究。10名因广泛癌症接受软腭切除术的患者作为研究对象。4名患者软腭切除部分局限于前部或中部，后带完整，而其余6名患者切除部分延伸至后缘。前一组的所有患者以及后一组的1名患者适配了带或不带言语矫治器的腭托。后一组其余5名患者在软腭切除后立即使用游离桡骨前臂皮瓣进行手术重建。对于仅接受手术治疗的患者，在手术前后评估其言语情况；对于其他患者，在使用或不使用腭托的情况下，使用100个日语音节的标准可懂度测试评估其言语情况。这些测试表明，术后软腭后带保留的4名患者中有2名在佩戴特殊假体后实现了言语的出色恢复和腭咽功能的改善。软腭切除延伸至后缘的患者从手术重建而非修复治疗中获得了更好的言语和功能恢复。所有3名接受手术重建并应用特殊腭托的患者，由于腭咽功能的改善，言语可懂度得分略有提高。这些结果表明，手术重建和修复治疗可能最好根据软腭切除的范围进行选择性应用。
