摘要
目的针对边缘性腭咽闭合不全(MVPI)缺乏统一诊断标准的问题,探索较为可靠的临床诊断方法。方法收集腭裂术后患者的鼻咽纤维镜检查和语音评估结果,分析不同腭咽闭合度下鼻腔共鸣情况分布的差异及二者的相关性。以轻/中度高鼻音及对应的腭咽闭合度建立MVPI的诊断标准,并验证该标准的可重复性及有效性。结果腭咽闭合度与鼻腔共鸣情况较强相关(P<0.001)。轻/中度高鼻音主要对应的腭咽闭合度为90%~99%,二者结合作为MVPI诊断标准具备良好的一致性(Kappa值为0.789,P<0.001),且该标准下腭咽闭合不全与MVPI患者的鼻腔共鸣(P<0.001)、鼻漏气(P=0.007)及构音错误(P<0.001)分布差异均存在统计学意义。结论结合主观判听轻/中度高鼻音和鼻咽纤维镜下高于90%的腭咽闭合度是诊断MVPI可靠有效的临床方法。
Objective A stable,reliable,and easily implementable clinical diagnostic method for marginal velopharyngeal insufficiency(MVPI)was established on the basis of the subjective hearing judgement of hypernasality and objective examination of velopharyngeal closure to address the lack of unified diagnostic criteria for MVPI.Methods Nasopharyngeal fiberscopy and speech assessment results were collected from postoperative patients with cleft palate.These results were used to analyze the differences in the distribution of nasal resonance in patients with different velopharyngeal closure ratios and the correlation between velopharyngeal closure ratios and nasal resonance status.Mild-to-moderate hypernasality with its corresponding elopharyngeal closure ratio was employed to establish the diagnostic criteria of MVPI.The reproducibility of the criteria and whether the patients with MVPI diagnosed by using the criteria exhibited significantly different speech characteristics compared with other patients were verified.Results A strong correlation was found between velopharyngeal closure ratios and nasal resonance(P<0.001).Mild-tomoderate hypernasality mainly corresponded to velopharyngeal closure ratios ranging from 90%to 99%,and the combination of the two characteristics as the diagnostic criteria for MVPI demonstrated good consistency(Kappa value=0.789,P<0.001).Moreover,under the diagnostic criteria,significant differences in nasal resonance(P<0.001),nasal emission(P=0.007),and misarticulation(P<0.001)were found between patients with velopharyngeal insufficiency and those with MVPI.Conclusion Combining the subjective hearing judgement of mild-to-moderate hypernasality with velopharyngeal closure ratios over 90%under nasopharyngeal fiberscopy provides a reliable and effective clinical method for diagnosing MVPI.
作者
黄欣怡
毛奇蓉
尹恒
吴敏
石冰
郑谦
李精韬
Huang Xinyi;Mao Qirong;Yin Heng;Wu Min;Shi Bing;Zheng Qian;Li Jingtao(State Key Laboratory of Oral Diseases&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Dept.of Cleft Lip and Palate Surgery,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)
出处
《华西口腔医学杂志》
北大核心
2025年第3期376-382,共7页
West China Journal of Stomatology
基金
四川大学华西口腔医院探索与研发项目(LCYJ2022-YF-2)
四川省医学青年创新科研课题计划(Q23038)
四川省自然科学基金项目(2025ZNSFSC0769)。
关键词
腭咽闭合不全
诊断
腭裂
构音
velopharyngeal insufficiency
diagnosis
cleft palate
articulation
