二段階口蓋形成術における言語成績 : 一段階口蓋形成術との比較 Speech Results with Delayed Hard-Palate Closure In Children with Cleft Lip and Palate

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著者

    • 今井 智子 IMAI Satoko
    • 国際医療福祉大学保健学部言語聴覚障害学科 Department of Speech-Language Pathology and Audiology, International University of Health and Welfare
    • 鈴木 規子 SUZUKI Noriko
    • 昭和大学歯学部第一口腔外科教室 First Department of Oral and Maxillofacial Sugery, School of Dentistry, Showa University
    • 道 健一 MICHI Ken-ich
    • 昭和大学歯学部第一口腔外科教室 First Department of Oral and Maxillofacial Sugery, School of Dentistry, Showa University

抄録

二段階口蓋形成術 (二段階法) を施行した口唇口蓋裂症例18例の言語成績を, 粘膜骨膜弁による口蓋後方移動術 (一段階法) 施行例22例と比較検討した.二段階法はPerko法に準じて行い, 1次手術後硬口蓋閉鎖までの間, 全例口蓋閉鎖床を装着した.硬口蓋閉鎖後7歳時の鼻咽腔閉鎖機能 (VPC) は良好17例, ほぼ良好1例であった.異常構音の発現頻度は二段階法88.9%, 一段階法59.1%であり, 二段階法では声門破裂音, 側音化構音が多かったが, 声門破裂音はVPCが改善するに従い, 消失する傾向が認められた.一段階法では口蓋化構音が多かった.以上の結果から, 二段階法は異常構音の出現頻度は高いが, 最終的には一段階法と同程度のVPCが得られ, 一段階法に劣らない言語成績が得られる方法と考えられた.適切な言語管理を行うことによって, 異常構音の予防や自然治癒の促進を図り, 言語成績をさらに向上させていくことができるものと考える.

The purpose of this study was to compare speech results in 18 patients who had undergone delayed hard-palate closure (two-stage operation, TSO) with those in 22 patients who had undergone early complete closure (one-stage operation, OSO) . The average age of the TSO was 1 year 8 months at closure of the soft palate and 5 years 8 months at closure of the hard palate. The TSO patients had worn a palatal plate between the first and second operation to cover the hard palate openings as well as to improve their speech.<BR>At 4 years old, before hardpalate closure, slight nasal escape was observed in many patients. However, at 7 years old, after hardpalate closure, all patients except one exhibited good velopharyngeal function. This finding suggests the nasal escape may be due to leakage of air through clefts in spite of wearing a palatal appliance.<BR>The incidence of articulation disorders in patients undergoing the TSO was 88.9%, whereas that of those undergoing the OSO was 59.1%. Eleven patients of the TSO group had glottal stops, 7 had Japanese lateral misarticulation, 4 had Japanese palatalized misarticulation, and 2 had pharyngeal fricatives. Glottal stops were found to disappear gradually without any speech therapy in tandem with improvement in velopharyngeal function. Eleven patients of the TSO group (61.1%) received speech therapy for articulation disorders.<BR>Good velopharyngeal function was ultimately achieved after hard-palate closure, although the incidence of articulation disorders was high. Thus, the TSO method was seemed to yield the satisfactory speech results.

収録刊行物

  • 音声言語医学

    音声言語医学 42(2), 145-155, 2001-04-20

    The Japan Society of Logopedics and Phoniatrics

参考文献:  24件中 1-24件 を表示

被引用文献:  5件中 1-5件 を表示

各種コード

  • NII論文ID(NAID)
    10008579096
  • NII書誌ID(NCID)
    AN00034826
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00302813
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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