咽頭弁手術による鼻咽腔機能と形態の変化に関する研究

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  • A Study of the Changes in Velopharyngeal Function and Shape by Pharyngeal Flap Surgery
  • イントウベン シュジュツ ニヨル ビインコウ キノウ ト ケイタイ ノ ヘンカ

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A follow-up research, before and during 2 years after pharyngeal flap surgery, of 30 patients was undertaken in order to investigate the auditory changes, nasal air escape and the roentgenographical changes in velopharyngeal function and shape. The results were as follows ; 1. Both nasality and nasal air escape disappeared during about the same period. 50% of the subjects showed disappearance of nasality and nasal air escape at 2 months after operation, and 83.7% of them showed disappearance within a year after operation. All of the other subjects, with the exception of those who could not accept the follow-up research, also showed disappearance of nasality and nasal air escape within 18 months after operation, indicating remarkable improvement. The effectiveness of pharyngeal flap surgery was reaffirmed from this. 2. After the pharyngeal flap surgery, the velar length showed an increase but the tendency to constriction was not recognized. However, the velar elevational angle on phonation showed relatively lower degree until 3 months after operation than before operation. 3. The greatest change in the velopharyngeal function and shape, before and after pharyngeal flap surgery, was the reduction of the minimal velopharyngeal distance at the time of rest and phonation. 4. Within a month after operation, the depth of the posterior pharyngeal wall revealed the maximum constriction (forward protrusion) in the area of middle and lower pharynx, and later, within 6 months after operation, revealed the tendency to returning to the pre-operative shape. Coincident with this period of extention, nasality, nasal air escape and "snore" after operation disappeared or reduced, though the upper pharynx above the level of the palatal plane showed no change or a tendency to constriction, which was supposed to be the change caused by existence and growth of adenoid. 5. Pharyngeal flap base showed a tendency to descending until 9 months after operation. The average distance of descending was about 5 mm. The area of flap attached to soft palate also showed much the same tendency to descending until 6 months after operation. 6. Contrary to the descending of the flap base, the elevational mobility of the flap base showed an increase until 9 months after operation, but no striking change was recognized after that. This elevational movement was closely connected with the velar elevation. The coopertive movement between M. constrictor pharyngis superior and M. levator veli palatini was considered with much importance. 7. It seems proper that judgement of results after operation should be done later than 9 months after operation, since, as mentioned above, the velopharyngeal function and shape revealed considerable changes until 9 months after pharyngeal flap surgery. These changes in function and shape are considered to be affected most by the scar tissue. 8. Analysis of the manner of velopharyngeal closure and the improvement after pharyngeal flap surgery showed that pharyngeal flap base should be placed at the level of the palatal plane and in the area containing Passavant's ridge, and that it is difficult to expect successful results if the pharyngeal flap base is placed above the palatal plane. 9. Age, speech training, function of velopharyngeal muscle and shape of upper pharynx were pointed out as factors on improvement of results after pharyngeal flap surgery. In other words, successful results will be obtained regardless of surgical technique in younger patients with pre-operative speech training, Passavant's ridge as well as fairly good function of palatopharyngeal muscle, smaller palatopharyngeal distance, parallel type of nasal air escape and smaller velopharyngeal area as well as "non box-shaped" upper pharynx.

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