咽頭弁手術を行った口蓋裂患者の鼻咽腔閉鎖運動に関する研究 Study of Velopharyngeal Movement in Cleft Palate Patients Following Pharyngeal Flap Surgery

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著者

    • 園田 隆紹 SONODA Takaaki
    • 鹿児島大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Kagoshima University Dental School

抄録

本研究は咽頭弁手術によって口蓋裂患者の鼻咽腔閉鎖機能および発語にいかなる変化が生じるかを明らかにしたものである.対象は鼻咽腔閉鎖不全を呈し二次的に咽頭弁手術を行った口蓋裂術後患者5名および口蓋形成一次手術に咽頭弁を併用した年長の粘膜下口蓋裂患者1名の計6名(咽頭弁群)である.正常人7名(正常対照群),鼻咽腔閉鎖機能良好な口蓋形成術後患者7名(口蓋裂対照群)を対照とした.<BR>発音時・blowing・嚥下時の口蓋帆挙筋筋電図,鼻咽腔閉鎖圧,口腔内呼気圧の測定を全3群に行い,鼻腔気流量測定を咽頭弁群に,発語明瞭度検査は咽頭弁群,口蓋裂対照群に行った.咽頭弁群の測定を術前,術後3ヵ月,6ヵ月,1年に行なった.<BR>結果は以下のとおりである.<BR>1.咽頭弁群の術前では破裂音発音時およびblowing時の口蓋帆挙筋筋電図,鼻咽腔閉鎖圧,口腔内呼気圧は対照2群に比べ低値であったが,術後は上昇し対照2群に近い値となった.鼻呼気流量は術後著明に減少した.<BR>2.術前の鼻音発音時における口蓋帆挙筋筋電図および鼻咽腔閉鎖圧は全動作中最低値を示し,嚥下時における値は最高値を示し,ともに口蓋裂対照群の値と近似していた.術後も変化は認めなかった.<BR>3.口蓋帆挙筋筋電図と口腔内呼気圧は,術前には相関関係はなかったが,術後は両者間に有意の相関関係を認めた.<BR>4.以上の結果,咽頭弁手術後は鼻咽腔閉鎖運動が増強され,口蓋裂対照群と同様の閉鎖運動を営んでいることが確認された.<BR>5.発語明瞭度は術後,著明に改善された.特に破裂音が著しかったが,術後1年では口蓋裂対照群と比べ低い値にとどまった.

This study investigated the change in velopharyngeal movement following pharyngeal flap surgery. The subjects were six patients who underwent pharyngeal flap surgery because of velopharyngeal incompetence (the pharyngeal flap group). Seven normal adults (the normal group), and seven surgically treated cleft palate patients with normal speech (the recovered cleft group), were selected as control groups.<BR>EMG of m. levator veli palatini, and the strength of velopharyngeal closure and intraoral air pressure during phonation, blowing, and swallowing, were measured preoperatively, and at 3 months,6 months, and 1 year postoperatively. Nasal air flow rates were analyzed in the pharyngeal flap group as well. Speech intelligibility testing was carried out on the pharyngeal flap group and the recovered cleft palate group.<BR>Results were as follows:<BR>1. prepearatively, EMG activities, strength of velopharyngeal closure and intraoral air pressure during blowing and pressure consonants were significantly lower than in the normal group and the recovered cleft palate group. Following pharyngeal flap surgery, those values increased significantly, becoming close to the level in the recovered cleft palate group.<BR>2. The preoperative value of EMG activities and strength of velopharyngeal closure were the lowest during phonation of nasal consonant sounds. These parameters were as low as those of the two control groups, and no remarkable changes were observed until 1 year postoperatively.<BR>Preoperative values of EMG activity and strength of velopharyngel closure during swallowing were as high as those of the recovered cleft palate group, and there were no remarkable postoperative changes.<BR>3. There was no correlation between EMG activity and intraoral air pressure preoperatively, but these parameters were correlated postoperatively.<BR>4. Speech intelligibility improved remarkably following pharyngeal flap surgery. Still, at one-year postoperatively, it remained lower than that in the recovered cleft palate group.

収録刊行物

  • 日本口蓋裂学会雑誌

    日本口蓋裂学会雑誌 26(1), 68-87, 2001-04-30

    Japanese Cleft Palate Association

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被引用文献:  4件中 1-4件 を表示

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