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目的:探讨上颌骨Le Fort Ⅰ型截骨前徙术对唇腭裂患者腭咽结构及功能的影响。方法:选择2010~2016年行上颌Le Fort Ⅰ型截骨前徙术的上颌发育不足唇腭裂患者15例,男9例,女6例,平均年龄21.41岁。所有患者在术前、术后1月拍摄头颅定位侧位片及发“i”音位头颅定位侧位片,对腭咽部结构进行测量分析。同时采用喉动态频闪喉镜录像录音检查、吹气实验及语音清晰度测听比较手术前后腭咽闭合功能的变化。结果:上颌骨最大前移幅度为6 mm,最小为3 mm,平均前移(4.28±2.02)mm,术后咽腔深度明显增大(P<0.05),同时软腭长度及软硬腭夹角较术前明显增大(P<0.05),软腭厚度减小。结论:上颌骨Le Fort Ⅰ型截骨前徙术造成患者咽腔深度显著增加,对腭咽闭合功能可能有一定的不良影响;但术后腭咽部软组织代偿性改变会在一定程度上减轻腭咽闭合不全。
Objective: To investigate the effect of maxillary Le Fort Ⅰ osteotomy on the structure and function of velopharyngeal tissues in patients with cleft lip and palate. Methods: From 2010 to 2016, 15 patients with maxillary underdevelopment of cleft lip and palate, including 9 males and 6 females, with an average age of 21.41 years were enrolled in this study. All patients in the preoperative and postoperative January skull positioning lateral radiographs and “i ” phoneme cranial positioning flaps, palatal pharyngeal structure measurement and analysis. At the same time, the change of velopharyngeal closure function before and after operation was compared by using laryngeal dynamic laryngoscope recording and recording test, air blowing test and voice clarity audiometry. Results: The maximal forward maxillary width was 6 mm, the minimum was 3 mm, the mean advance was (4.28 ± 2.02) mm, and the depth of the pharynx was significantly increased (P <0.05). Meanwhile, the length of the soft palate and the angle between the soft palate and the soft palate Preoperative significantly increased (P <0.05), soft palate thickness decreased. CONCLUSION: The maxillary pharyngeal extirpation with Le Fort Ⅰ pre-osteotomy has significantly increased pharyngeal cavity depth and may have some adverse effects on velopharyngeal closure. However, the compensatory changes of velopharyngeal soft tissue may be alleviated to a certain extent Velopharyngeal closure incomplete.