Morphological Evaluation of Changes in Velopharyngeal Function following Maxillary Distraction in Patients with Repaired Cleft Palate during Mixed Dentition
Morphological Evaluation of Changes in Velopharyngeal Function following Maxillary Distraction in Patients with Repaired Cleft Palate during Mixed Dentition
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DOI：
10.1597/02-153.1
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发表时间：
2004-07
期刊：
影响因子：
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通讯作者：
K. Satoh;J. Nagata;K. Shomura;T. Wada;T. Tachimura;J. Fukuda;R. Shiba
中科院分区：
文献类型：
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作者：
K. Satoh;J. Nagata;K. Shomura;T. Wada;T. Tachimura;J. Fukuda;R. Shiba
目的描述上颌骨牵张后鼻咽各成分的形态变化，探讨其形态特征与腭咽闭合功能(VPF)的关系。设计治疗前后分别进行鼻腔隆起和鼻内窥镜检查。拍摄头颅侧位片描述其形态变化。单位：日本宫崎市宫崎市医科大学口腔颌面外科。研究对象9例混合期腭裂修复术患者，使用口罩和口内固定矫治器系统进行上颌骨牵张。结果：评估上鼻音、腭咽闭合功能不全的严重程度，并测量咽部深度、腭帆长度和腭平面的旋转。结果咽部深度的增加并不总是与进展量成正比。它取决于咽后壁的姿势和腭平面的旋转。结论鼻咽部头影测量证实了手术前后VPF的变化。提示这些指标对预测未来的VPF有一定的参考价值。对混合期的腭裂患者实施上颌骨牵张时，如果发现腭咽闭合是通过与肥大的腺样体接触而发生的，患者应该在手术前咨询他们的语言能力进一步恶化的风险。
Objective To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to velopharyngeal function (VPF). Design Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. Setting Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. Participants Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. Outcome Measures The severity of hypernasality, velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. Results Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and the rotation of palatal plane. Conclusion Cephalometric measurements of the nasopharynx before and after surgery confirmed subsequent changes in VPF. These were suggested to be useful in predicting future VPF. When performing maxillary distraction in patients with cleft palate in the mixed dentition stage, and when velopharyngeal closure is found to occur by velar contact against the hypertrophied adenoid, patients should be counseled about risks of subsequent deterioration in their speech before surgery.