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題名 | 由鼻咽內視鏡檢查法分析正常者及唇侸裂患者之侸咽功能=Nasopharyngoscopic Analysis of the Velopharyngeal Function in Normal and Cleft Lip and Palate Patients |
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作者 | 吳咨杏; 羅慧夫; | 書刊名 | 長庚醫學 |
卷期 | 19:4 1996.12[民85.12] |
頁次 | 頁305-312 |
分類號 | 416.413 |
關鍵詞 | 唇侸裂語言; 鼻咽內視鏡檢查; 侸咽閉鎖功能檢查; Cleft palate speech; Hypernasality; Nasopharyngoscopy; Chinese cleft palate speech; Assessment of velopharyngeal function; |
語文 | 中文(Chinese) |
中文摘要 | 背景:唇[]裂患者的語言異常,主要原因為[]咽閉鎖功能不全,其臨床特徵為鼻息流失、鼻音過重,同時可能伴隨補救性構音異常。語言異常的主因有三:[]咽閉鎖功能不全,學習錯誤,或兩者相互影響。[]咽閉鎖功能健全與否會影響鼻音程度及構音的學習。唇[]裂患者在[]部重建術後,仍有25%左右[]咽閉鎖不全造成鼻音異常。了解正常者及患者?咽功能的差異將有助於提昇?部修補術的健全性。一般評估鼻音及[]咽功能的方法有主觀性──由語言治療師憑聽覺、視覺判斷,及客觀性──藉助特殊儀器量化[]咽閉鎖功能。目前鼻咽內視鏡檢查法為臨床上最普遍使用的方法。 方法:本研究使用主觀性的語言評估及客觀性的鼻咽內視鏡檢查法探討正常者與唇[]裂患者之[]咽閉鎖功能在軟[]提昇度、兩側咽壁活動率、[]咽閉鎖度及形狀之差異。受試者分四組:(1)正常者;(2)單純唇裂、語言正常者;(3)唇[]裂不具鼻息流失、語言正常者;(4)唇[]裂具鼻息流失、構音可能異常者。年齡範圍:6至47歲,共98名,男女人數無顯著差異。測試句共有十句,分鼻音句組、韻母組、塞音組、擦音/塞擦音組及連續數字組。 結果:唇[]裂語言異常者其?咽閉鎖功能顯著較其他三組為差,其最大差異在軟[]向後咽壁閉鎖之活動率;四組最常呈現的[]咽閉鎖形狀為冠狀閉鎖;四組之兩側咽肌活動率並無顯著差異。 討論:本研究結果提供整形外科醫師在[]部重建術時,深思如何重建軟[]之構造及活動率,以強化[]咽閉鎖功能,使患者有更健全的器官習得正常語言。 |
英文摘要 | The speech problem in patients born with cleft lip and palate is mainly due to the insufficiency of the velopharyngeal (VP) valving mechanism, manifested as in visually seen nasal emission, and auditorily perceived hypernasality and articulation disorders. Evaluations of reasonance and VP function can be conducted by: (1) perceptual rating scale based on speech pathologist's subjective judgement and (2) objective instrumental assessment, by the use of specific instrument. Nasopharyngoscopy has been commonly used clinically to diagnose VP function. The purpose of this study is : using nasopharyngoscopy to investigate the differences in VP mechanism between those with VP competence and VP incompetence in the dimension of velar displacement, lateral pharyngeal wall (LPW) displacement, degree of VP closure and pattern of VP closure. Ninty-eight subjects were studied from June 1990 to August 1991. They were divided into 4 groups: (1) group 1: normals with normal speech; (2)group 2: cleft of lip only, with normal speech; (3) group3: cleft palate without nasal emission, but normal articulation; (4) group 4: cleft palate with nasal emission, with or without articulation error. Age range was from 6-47 years old with equal sex distribution. Ten Chinese sentences were used for standard test sentences, and were grouped according to Mandarin phonological distinctive features into 5 categories: (1) nasals; (2)vowels; (3)plosives; (4) fricatives/affricates; (5)connectecd number counting. The result indicated that the insufficient velar displacement to contact posterior pharyngeal wall is a determining factor causing velopharyngeal insufficiency in group 4; however, the lateral pharyngeal wall movement is not significantly different among 4 groups. Coronal pattern of velopharyngeal closure is the most common pattern among 4 groups of speakers. |
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