VELOPHARYNGEAL FUNCTION FOR SPEECH AFTER PALATAL SURGERY

唇腭裂的发生率为1/750，是最常见的先天性畸形之一。腭裂外科修复的主要目标是为正常语言的发育建立一个合格的咽口。如果不能建立腭咽能力，就会导致以鼻音过高、通过鼻子的口内气压丧失和发音障碍为特征的言语。佛罗里达大学与巴西圣保罗大学合作，提出了一项为期五年的前瞻性随机对照研究，以完成352名完全性单侧唇腭裂患者腭成形术后腭咽功能的评估（通过von Langenbeck手术和行内腭成形术，以及Furlow双对立z形腭成形术）。冯·兰根贝克程序被选为经过时间检验的标准，而弗罗程序可以根据它来判断。据报道，与大多数其他报道的系列相比，Furlow程序产生了更高的腭咽能力率，这在理论上也应该减少对面部中部生长的干扰。在最初的研究结束（9/99）时，可登记的患者比预计的要少（在文中解释），而且年龄不足50人，足以可靠地评估他们的腭咽语言能力。该研究的继续将纳入所有352例患者，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，将获得所有患者的言语和腭咽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，直到所有患者成熟。目前，圣保罗大学的临床病例超过29,000例，每年新增的唇腭裂病例超过1,500例。这个项目代表了一个独特的机会，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正常言语发育的腭咽能力的腭膜方面更优越的问题。此外，本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，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.