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。手术修复腭裂的主要目的是为正常语音的发育构建一个合格的腭咽闭合口部。不能建立腭咽闭合能力会导致以鼻音过大、通过鼻子的口腔内气压下降和发音障碍为特征的语音。佛罗里达大学与巴西宝鲁的圣保罗大学合作，正在提议一项为期五年的前瞻性随机对照研究，以完成对352例单侧完全性唇腭裂患者腭咽闭合功能的评估。Von Langenbeck程序被选为判断Furlow程序的时间检验标准。据报道，Furlow手术比大多数其他报道的系列手术产生更高的腭咽闭合能力，理论上也应该导致对面部中部生长的较少干扰。在最初的研究结束时(9/99)，可供登记的患者比预计的(在正文中解释)要少，不到50岁的患者足够大，可以可靠地评估他们的腭咽闭合能力。继续这项研究将允许登记所有352名患者，并比较9-12个月大的患者和15-18个月大的患者之间的结果。在拟议项目的五年时间框架内，将对所有患者进行语音和腭咽闭合功能的感知和工具性测量。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。圣保罗大学目前的临床病例数量超过2.9万例，每年新增1500多例唇腭裂病例。这个项目代表着一个独特的机会，可以获得大量受试者的前瞻性数据，控制传统上困扰腭裂研究的变量。这项研究应该明确地回答这两种外科手术中哪一种在构建能够影响腭咽闭合能力以发展正常语音方面更好的问题。此外，这项研究可以作为国际前瞻性临床试验的模型，例如在俄罗斯和乌克兰，那里的腭裂治疗是集中的。

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.