Velopharyngeal closure pattern and speech performance among submucous cleft palate patients

doi:10.7518/hxkq.2017.03.013

Abstract

Abstract:

Objective To characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients. Methods Patients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed. Results A total of 353 cases were retrieved in this study, among which 138 (39.09%) demonstrated velopharyngeal competence, 176 (49.86%) velopharyngeal incompetence, and 39 (11.05%) marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 (62.31%) demonstrated circular closure pattern, 89 (33.21%) coronal pattern, and 12 (4.48%) sagittal pattern. Passavant’s ridge existed in 45.51% (76/167) patients with circular closure and 13.48% (12/89) patients with coronal closure. Among the 353 patients included in this study, 137 (38.81%) presented normal articulation, 124 (35.13%) consonant elimination, 51 (14.45%) compensatory articulation, 36 (10.20%) consonant weakening, 25 (7.08%) consonant replacement, and 36 (10.20%) multiple articulation errors. Conclusion Circular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.

Key words: submucous cleft palate, velopharyngeal closure pattern, cleft palate speech

CLC Number:

R 782.2⁺2

Heng Yin, Chunli Guo, Bing Shi, Yang Li, Jingtao. Li. Velopharyngeal closure pattern and speech performance among submucous cleft palate patients[J]. West China Journal of Stomatology, 2017, 35(3): 296-300.

Figures/Tables 5

Fig 1

Tab 1

Tab 2

Tab 3

Tab 4

References 14

[1]	Roux JP.Memoires sur staphylorrhaphie[M].Paris: J. S. Chaude, 1825:84.
[2]	Calnan J.Submucous cleft palate[J]. Br J Plast Surg, 1954, 6(4):264-282.
[3]	Croft CB, Shprintzen RJ, Daniller A, et al.The occult sub-mucous cleft palate and the musculus uvulae[J]. Cleft Palate J, 1978, 15(2):150-154.
[4]	尹恒, 马利, 石冰, 等. 主观判听在腭咽闭合功能诊断中的应用价值[J]. 华西口腔医学杂志, 2012, 30(2): 197-200.
	Yin H, Ma L, Shi B, et al.A study on the application of the perceptual assessment in the diagnosis of the velopharyn-geal function[J]. West Chin J Stomatol, 2012, 30(2):197-200.
[5]	Skolnick ML, Shprintzen RJ, McCall GN, et al. Patterns of velopharyngeal closure in subjects with repaired cleft palate and normal speech: a multi-view videofluoroscopic analysis[J]. Cleft Palate J, 1975,12:369-376.
[6]	Croft CB, Shprintzen RJ, Rakoff SJ.Patterns of velopharyn-geal valving in normal and cleft palate subjects: a multi-view videofluoroscopic and nasendoscopic study[J]. Laryngos-cope, 1981, 91(2):265-271.
[7]	程宁新, 赵敏, 邓慧, 等. 腭裂修复术腭咽肌肉重建与否的鼻咽内窥镜的比较观察[J]. 中华整形外科杂志, 2007, 23(1):16-18.
	Cheng NX, Zhao M, Deng H, et al.Nasendoscopic com-parison for cleft palate repair after velopharyngeal muscle reconstruction[J]. Chin J Plast Surg, 2007, 23(1):16-18.
[8]	姚隆浩, 袁文化, 夏炯, 等. 大年龄腭裂患者术后腭咽闭合功能的研究——纤维鼻咽内窥镜及微电脑图像分析[J]. 上海口腔医学, 1994, 3(2):65-67.
	Yao LH, Yuan WH, Xia J, et al.Evaluation of velopharyn-geal function after later surgical repair of cleft palate[J]. Shanghai J Stomatol, 1994, 3(2):65-67.
[9]	尹恒, 郭春丽, 石冰, 等. 黏膜下腭裂的形态分类与腭咽功能分析[J]. 华西口腔医学杂志, 2016, 34(5):488-492.
	Yin H, Guo CL, Shi B, et al.Morphological classification and velopharyngeal function analysis of submucous cleft palate patients[J]. West Chin J Stomatol, 2016, 34(5):488-492.
[10]	Lewin ML, Croft CB, Shprintzen RJ.Velopharyngeal in-sufficiency due to hypoplasia of the musculus uvulae and occult submucous cleft palate[J]. Plast Reconstr Surg, 1980, 65(5):585-591.
[11]	Peterson-Falzone SJ.The clinician’s guide to treating cleft-palate speech[M]. Philadelphia: Mosby Elsever, 2006:27.
[12]	尹恒, 郭春丽, 石冰, 等. 大龄腭裂患者术前辅音构音特点的初步研究[J]. 华西口腔医学杂志, 2013, 31(2):182-185.
	Yin H, Guo CL, Shi B, et al.A preliminary study on the consonant articulation of older patients with cleft palate[J]. West Chin J Stomatol, 2013, 31(2):182-185.
[13]	李蓓, 石冰, 郑谦, 等. 腭裂畸形程度对腭裂语音影响的研究[J]. 华西口腔医学杂志, 2007, 25(1):55-57.
	Li B, Shi B, Zheng Q, et al.Study on the effects of diffe- rent extent of cleft malformation on speech in patients with cleft palate[J]. West Chin J Stomatol, 2007, 25(1):55-57.
[14]	郭春丽, 马利, 尹恒, 等. 腭裂患者错误构音的相关因素研究[J]. 华西口腔医学杂志, 2014, 32(5):432-435.
	Guo CL, Ma L, Yin H, et al.Correlative factors on the arti-culation disorder of patients with cleft palate[J]. West Chin J Stomatol, 2014, 32(5):432-435.

闭合模式	VPC（n=101）		VPI（n=131）		MVPI（n=36）
闭合模式	例数	构成比/%	例数	构成比/%	例数	构成比/%
环状闭合	66	65.35	75	57.25	26	72.22
冠状闭合	28	27.72	52	39.69	9	25.00
矢状闭合	7	6.93	4	3.05	1	2.78

闭合模式	透明带型（n=44）		悬雍垂裂型（n=36）		凹陷型（n=90）		透明带+悬雍垂裂型（n=87）		腭瘘型（n=11）
闭合模式	例数	构成比/%	例数	构成比/%	例数	构成比/%	例数	构成比/%	例数	构成比/%
环状闭合	30	66.18	20	55.56	53	58.89	58	66.67	6	54.55
冠状闭合	13	29.55	13	36.11	37	41.11	24	27.59	2	18.18
矢状闭合	1	2.27	3	8.33	0	0	5	5.75	3	27.27

辅音构音表现	VPC（n=138）		VPI（n=176）		MVPI（n=39）
辅音构音表现	例数	发生率/%	例数	发生率/%	例数	发生率/%
正常	88	63.77	30	17.05	19	48.72
省略	11	7.97	103	58.52	10	25.64
替代	13	9.42	7	3.98	5	12.82
弱化	0	0	36	20.45	0	0
代偿	14	10.14	29	16.48	8	20.51
发展中	13	9.42	2	1.14	0	0
多种错误	2	1.45	31	17.61	3	7.69