Study On Facial Grimace Behavior With Nasal Air Emission And Speech Intelligibility In Patients After Cleft Palate Surgery

Objective: To study the relationship between compensatory facial grimace behavior with nasal air emission and speech intelligibility in patients after cleft palate surgery.Methods: Systematic reviewed the clinical medical records and audiovisual materials of two hundred patients had nasal air emission after cleft palate surgery,patients were ranked as facial grimace present and facial grimace absent.Based on the reason that patients had nasal air emission after surgery,patients were divided in three groups: velopharyngeal insufficiency group,palatal fistula group,velopharyngeal insufficiency combined with palatal fistula group,and compared the proportion of facial grimace in three groups.Nasal air emission was ranked as inaudible nasal air emission,audible nasal air emission and nasal turbulence;The impairment of speech intelligibility was ranked as mild,moderate,and severe.Compared the proportion of facial grimace behavior in different characteristics of nasal air emission groups and different speech intelligibility groups.Then analyzed nasopharyngeal fibroscope videos of sixty-eight patients with facial grimace,compared the difference of velopharyngeal closure in in patients with facial grimace and different characteristics of nasal air emission.Velopharyngeal closure ratios were divided into mild,moderate and severe.Results: The incidence of grimace in the velopharyngeal insufficiency group,palatal fistula group and velopharyngeal insufficiency combined palatal fistula group was 56.6%、51.9%、55.0%,respectively,there was no statistically significant(P>0.05);The incidence of facial grimace with inaudible nasal air emission,audible nasal air emission and nasal turbulence was 34.5%、84.1%、61.9%,respectively,comparisons showed statistically significant difference(P<0.05).Among patients with facial grimace and inaudible nasal air emission,the incidence of mild,moderate,severe velopharyngeal insufficiency was 15.8%、26.3%、57.9%,respectively;Among patients with facial grimace and audible nasal air emission,the incidence of mild,moderate,severe velopharyngeal insufficiency was 15.8%、68.4%、15.8%,respectively;Among patients with facial grimace and nasal turbulence,the incidence of mild,moderate,severe velopharyngeal insufficiency was 63.6%、27.3%、9.0%,respectively,comparisons showed statistically significant difference(P<0.05).The incidence of facial grimace with mild,moderate and severe impairment of speech intelligibility was 43.9%、74.0%、36.0%,respectively,comparisons showed statistically significant difference(P<0.05).Conclusion:Patients had combined diseases that can cause nasal air emission after cleft palate surgery didn’t add the incidence of facial grimace behavior.Patients who had audible and nasal air emission cleft palate surgery were prone to show facial grimace.Patient had facial grimace with inaudible nasal air emission,audible nasal air emission or nasal turbulence after cleft palate surgery may indicate that he had different velopharyngeal closure.Patient whose speech intelligibility was moderate impaired after cleft palate surgery was prone to show facial grimace.