Clinical Study On The Effection Of Velopharyngeal Closure And Speech After Palatoplasty

Objectives: The operation purpose of cleft-cleft is not only to closefissure to restore palatal anatomy structure, but also to form favourablevelopharyngeal competence(VPC) to improve physical function. In recentyears, the postoperative speech of patients with cleft palate have beensignificantly improved for early operation and surgical techniques. Tounderstand the velopharyengeal and speech improvement of patients with cleftpalate, four methods were used to evaluate the velopharyngeal and speech ofpatients with palatoplasty.Methods:1Clinical materials1.1One hundred and two patients were selected from Stomatology Hospital ofHebei Medical University from January2005to July2013. There were55male cases and47female cases. The minimum age was3year-old and themaximum age was35year-old. The shortest follow-up time was3montns andthe longest follow-up time was96months. The mean follow-up time was25.1months postoperation.1.2These patients included4cases of Ⅰ°cleft palate (cleft uvula),69cases ofⅡ°cleft palate (part of the cleft palate), and29cases of Ⅲ°cleft palate (cleftfrome uvula to alveolar).1.3The Furlow double opposing Z-plasty was performed in53cases of cleftpalate while two-flap palatoplasty was performed in49cases of cleft palate.2Evaluation Methods2.1Speech intelligibility testA sample of each subject’s correlative speech was recorded in a soundproof room. These samples were perceptually judged for intelligibility bythree speech pathologists experienced in judging resonance disorders. Speech intelligibility was expressed as a percentage.2.2Voice spectrum analysisVs-99speech analysis system was used to record the formants of/a/and/i/preoperation and postoperation. The formant frequencies include the firstthree formants (F1, F2and F3).2.3Cephalometric X-ray ExaminationThe ORTHOPHOS machine was used to take cephalometric lateralradiographs. Two cephalometric lateral radiographs were taken at rest and inphonation of/i/, respectively. The pharyngeal depth of the patients wasrecorded as velar-pharyngeal.2.4Nasopharyngeal fiber endoscopy (NPF)The Nasopharyngeal fiber endoscopy machine was appied to observe thestatus of velopharyngeal closure. The photos at rest and in phonation of/i/were recorded by computer. Computer software was used to measure the roteof velopharyngeal incompetence (RVPI).Results:1Speech intelligibility test1.1Six-seven point six percent of all patients had over70%speechintelligibility. The postoperation was better than preoperation(P<0.05).1.2In addition, the postoperation speech intelligibility of Furlow palatoplasty(77.4%) was better than that of two-flap palatoplasty (57.1%)(P<0.05).2Voice spectrum analysis2.1The frequency value of the first three formant (F1, F2, F3) in/a/had nosignificant difference among three groups (P>0.05).2.2The frequency value of the first formant (F1) in/i/had no significantdifference among three groups (P>0.05). The second formant values (F2) ofpreoperation and postoperation in/i/were lower than that of group control(P<0.05) while the second formant frequency of postoperation in/i/is higherthan that of preoperation (P<0.05). The third formant frequency (F3) ofpreoperation and postoperation in/i/were lower than that of group control(P<0.05) while there was no significant difference between preoperation and postoperation (P>0.05).3Voice spectrum analysis3.1Seventy-nine point two percent of all patients had formed favorable VPCaccording to the cephalometric lateral radiographs.3.2The incidence of favorable VPC of Furlow palatoplasty was92.9%whilethat of two-flap palatoplasty was60%.4Nasopharyngeal fiber endoscopy4.1Seventy-four point one percent of all patients had formed favorable VPCaccording to the NPF.4.2The incidence of favorable VPC of Furlow palatoplasty was86.7%whilethat of two-flap palatoplasty was58.3%.Conclusions:1After palatoplasty,67.6%patients’ speech intelligibility was improved. Inaddition, Furlow palatoplasty is more than effective than two-flap palatoplastyin obtaining superior speech.279.2%patients can form favorable VPC and improve obviously speechintelligibility. The result of VPC is better than speech intelligibility, sospeech training is expected to further improve the speech intelligibility ofpatients after palatoplasty.3Speech intelligibility test can reflect the speech of the patients afterpalatoplasty, but can not be evaluate their’ VPC. One the other hand,objective examination can reflect the VPC of the patients after palatoplasty,but can not be perfectly represent the speech. Not only the subjectiveevaluation but also the objective examination can we obtain accurate resultson clinical sudy.