VELOPHARYNGEAL FUNCTION FOR SPEECH AFTER PALATAL SURGERY

唇腭裂的发病率为1/750，是最常见的先天性畸形之一。 腭裂修复术的主要目的是建立一个能正常发音的咽口。不能建立鼻咽功能会导致以鼻音过强、口内气压通过鼻子丧失和发音障碍为特征的言语。佛罗里达大学与巴西包鲁的圣保罗大学合作，提出了一项为期5年的连续前瞻性随机对照研究，以完成对352例单侧完全性唇腭裂受试者在腭裂术后（通过von Langenbeck手术联合行内软腭成形术和Furlow双反向Z形腭成形术）的发音功能评估。 冯兰根贝克程序已被选为时间测试的标准，根据该标准可以判断Furlow程序。据报道，Furlow手术产生的咽喉功能发生率高于大多数其他报道的系列，理论上也应该对面中部生长产生较少的干扰。在初始研究结束时，可供入组的患者比预期的要少（在正文中解释）（9/99），并且不到50例患者的年龄足以可靠地评估其咽后言语能力。研究的继续将允许入组所有352例患者，并比较9-12月龄手术患者和15-18月龄手术患者的结果。在拟议项目的五年时间范围内，将对所有患者进行语音和咽喉功能的感知和仪器测量。面部生长分析，虽然不是拟议研究的一部分，但将继续进行，直到所有患者达到成熟。圣保罗大学的临床病例目前超过29 000例，每年新增1 500多例唇腭裂病例。这个项目代表了一个独特的机会，获得大量的受试者的前瞻性数据，控制变量，传统上困扰腭裂研究。这项研究应明确回答的问题，这两种手术程序是上级在建立一个帆能够影响腭能力的发展正常的语言。 此外，这项研究可以作为国际前瞻性临床试验的模型，如在俄罗斯和乌克兰，腭裂的治疗是集中的。

The incidence of cleft lip/palate is 1/750, making it one of the most common congenital malformations. The primary goal in surgically repairing the palatal cleft is to construct a competent velopharyngeal port for the development of normal speech. Failure to establish velopharyngeal competency results in speech characterized by hypernasality, loss of intraoral air pressure through the nose, and articulation disorders. The University of Florida, in collaboration with the University of Sao Paulo, Bauru, Brazil, is proposing a five-year continuation prospective randomized, controlled study to complete the assessment of velopharyngeal function for speech following palatoplasty (by the von Langenbeck procedure with intravelar velar plasty, and the Furlow double opposing z-plasty palatoplasty) for 352 subjects with complete unilateral cleft lip and palate. The von Langenbeck procedure has been selected as the time tested standard against which the Furlow procedure can be judged. The Furlow procedure has been reported to yield higher rates of velopharyngeal competency than identified in most other reported series, which also theoretically should result in less disturbance to mid-facial growth. Fewer patients than projected (explained in the text), were available for enrollment by the end of the initial study (9/99), and less than 50 were old enough for reliable assessment of their velopharyngeal competency for speech. Continuation of the study will allow enrollment of all 352 patients and the comparison of results between patients operated between 9-12 months of age and patients 15-18 months of age. Perceptual and instrumental measures of speech and velopharyngeal function will be obtained on all patients within the five year time frame of the proposed project. Facial growth analysis, although not a part of the proposed study, will continue until all patients reach maturity. The clinical caseload at the University of Sao Paulo currently exceeds 29,000 and over 1,500 new cases of cleft lip/palate are added yearly. This project represents a unique opportunity to obtain prospective data with a large number of subjects, controlling the variables which have traditionally plagued cleft palate studies. This study should definitively answer the question of which of the two surgical procedures is superior in constructing a velum capable of effecting velopharyngeal competency for the development of normal speech. In addition, this study may serve as a model for international prospective clinical trials, such as in Russia and Ukraine where treatment of cleft palate is centralized.