Maegawa J, Sells R K, David D J
Australian Cranio-Facial Unit, Women's and Children's Hospital, North Adelaide, South Australia.
J Craniofac Surg. 1998 Mar;9(2):177-82; discussion 183-4. doi: 10.1097/00001665-199803000-00017.
In this study, we retrospectively investigated speech intelligibility changes in 40 patients at the Australian Cranio-Facial Unit who underwent Le Fort I maxillary advancement between 1978 and 1995. Resonance, articulation, and velopharyngeal sphincteric function, which were assessed before and after surgery, were analyzed in conjunction with details of the surgery in an attempt to identify the factors affecting speech intelligibility. Of the 40 patients, 10 experienced improved speech (improved intelligibility group), 18 demonstrated no detectable changes in speech (unchanged intelligibility group), and 12 presented with worsened speech intelligibility (deteriorated intelligibility group). The average amount of advancement was 9.4 mm in the improved and unchanged intelligibility groups and 12.2 mm in the deteriorated intelligibility group. There was a statistically significant difference in the average amount of advancement between the improved and unchanged groups and the deteriorated intelligibility group. In the improved intelligibility group, 9 patients demonstrated improved articulation and 7 had reduced hyponasality. Conversely, in the deteriorated intelligibility group, 10 patients demonstrated increased hypernasality. Intelligibility ratings appeared to depend on the balance between the benefits of amelioration of hyponasality and misarticulations and the debit of increased hypernasality. The amount of maxillary advancement has a direct bearing on speech intelligibility. The amelioration of speech intelligibility improves if the amelioration of distorted articulation and hyponasality overrides any increase in hypernasality.
在本研究中，我们回顾性调查了1978年至1995年间在澳大利亚颅面科接受Le Fort I型上颌骨前移手术的40例患者的言语可懂度变化。对手术前后评估的共鸣、发音和腭咽括约肌功能，结合手术细节进行分析，试图确定影响言语可懂度的因素。40例患者中，10例言语改善（言语可懂度改善组），18例言语无明显变化（言语可懂度无变化组），12例言语可懂度恶化（言语可懂度恶化组）。言语可懂度改善组和无变化组的平均前移量为9.4毫米，言语可懂度恶化组为12.2毫米。言语可懂度改善组和无变化组与言语可懂度恶化组之间的平均前移量存在统计学显著差异。在言语可懂度改善组中，9例患者发音改善，7例鼻音减轻。相反，在言语可懂度恶化组中，10例患者鼻音过重加重。言语可懂度评分似乎取决于减轻鼻音过重和发音错误的益处与鼻音过重增加的弊端之间的平衡。上颌骨前移量对言语可懂度有直接影响。如果发音扭曲和鼻音过重的改善超过鼻音过重的任何增加，言语可懂度的改善就会提高。
