国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (1): 116-124.doi: 10.7518/gjkq.2024017

• 综述 • 上一篇    

边缘性腭咽闭合不全临床诊疗研究进展

毛奇蓉(),尹恒,李精韬()   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心四川大学华西口腔医院唇腭裂外科 成都 610041
  • 收稿日期:2023-02-14 修回日期:2023-09-25 出版日期:2024-01-01 发布日期:2024-01-10
  • 通讯作者: 李精韬
  • 作者简介:毛奇蓉，硕士，Email：qirong.mao@outlook.com

Progress in the management of marginal velopharyngeal incompetence

Mao Qirong(),Yin Heng,Li Jingtao()   

  1. 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
  • Received:2023-02-14 Revised:2023-09-25 Online:2024-01-01 Published:2024-01-10
  • Contact: Jingtao Li

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摘要：

边缘性腭咽闭合不全（MVPI）是腭裂术后腭咽功能的一类特殊状态。MVPI患者的腭咽生理和语音特征同典型腭咽闭合不全存在显著差异。目前针对MVPI病理机制和诊断标准尚存争议，在手术与非手术治疗方式选择问题上循证依据有限，治疗模式也缺乏相应的公认标准。本文基于对相关文献的系统梳理，明确目前对MVPI诊疗认识不足的具体问题，为进一步探索更加规范合理的MVPI干预模式提供指引。

关键词: 腭裂, 腭咽闭合不全, 语音训练, 手术

Abstract:

Marginal velopharngeal inadequacy (MVPI) is a particular state of postoperative velopharyngeal function after cleft-palate repair. Patients with MVPI demonstrate a unique pattern in velopharyngeal closure and speech performance compared with more evident velopharyngeal insufficiency. Currently, researchers disagree over the pathological mechanism and diagnositic criteria for MVPI. Evidence suggesting the selection of surgical or nonsurgical intervention to MVPI is scarce, and no standard MVPI management protocol is available. By summarizing literature relevant to MVPI management, this review aims to identify aspects of MVPI requiring further investigation and to provide guidance to the exploration of rational evidence-based MVPI management protocol.

Key words: cleft palate, velopharyngeal incompetence, speech therapy, surgery

中图分类号: 

  • R782.2

表 1

2012—2022年文献报道MVPI诊断标准"

时间/年作者主观标准客观标准
2012Patel等[20]PWSS量表评分1~2无
2013马思维等[21]有轻度连续和不连续鼻音鼻咽纤维镜检闭合率>0.9
2013Ma等[22]轻度高鼻音和鼻漏气检查者主观判断
2013Jackson等[23]PWSS量表评分≤2无
2013Barbosa等[24]无闭合时腭咽口面积0.050~19.9 cm2
2014Basta等[25]PWSS量表评分为1~2无
2015Hsu等[26]存在轻到中度高鼻音鼻咽纤维镜检闭合率为0.7~0.95
2015Chim等[27]PSA量表评分3~6无
2015Scarmagnani等[28]无腭咽口闭合时面积为5.0~19.9 mm2
2016Yamaguchi等[29]无腭咽口大部分时间能关闭，鼻咽纤维镜检闭合率为0.7~0.95
2016尹恒等[30]存在构音错误和高鼻音症状闭合率在0.9以上
2017Denadai等[31]轻度高鼻音，轻到中度鼻漏气，正常的口内压力无
2018Elsherbiny等[32]PWSS量表每项评分均为1无
2019Vella等[33]存在短暂高鼻音或鼻漏气，语音正常或接近正常，压力性辅音不受影响无
2019Dempsey等[34]PWSS量表评分为1~2无
2019Alaluusua等[35]存在短暂高鼻音或鼻漏气，语音正常或接近正常无
2020杨艳艳等[36]存在持续或非持续轻度鼻音不同检查时闭合形式不稳定
2022Carr等[37]SLP-3量表评分3~7无

图 1

MVPI诊疗流程参考"

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