口がい裂患者の鼻いんくう閉鎖機能診断への超音波の応用に関する研究 ＩＩ 口がい裂術後鼻いんくう閉鎖機能不全例について

Abstract

The mechanism of lateral pharyngeal wall (LPW) movement was studied in postoperative cleft palate patients by ultrasonic examination. The subjects for this study were 5 adults and 20 children with nasopharyngeal insufficiency and wearing speech aids.1. The head positioner used in this ultrasonic examination, which uses the bulb of speech aids as an index was useful to point out the LPW position in each subject and to aim the transducer at point this.2. The ultrasonic examination of LPW was practicable without troubles in young cleft palate children (3-9 years old).3. In the patients with nasopharyngeal insufficiency, the LPW movement during speech is obviously reduced and unstable as viewed by the real time ultrasound scan. As further examples, a peculiar movement and incongruous movement of right and left LPW were seen.4. In several subjects, blowing is different from pronunciation in LPW mobility. During swallowing in many subjects, the medial movement is as large as in the normal subjects, but in some subjects it differed from normal subjects in movement patterns.5. The M-mode echo curve of the LPW movement showed several patterns in speech, blowing and swallowing, and they differed from those of the normal subjects.6. In some subjects, there was a tendency for the moved distance of the LPW for swallowing > blowing > plosive consonants >/a/ vowel /i/ vowel and nasal consonants, and in other subjects for swallowing >/a/vowel and plosive consonants >/i/ vowel and nasal consonants > blowing.7. The starting point of the LPW movement occurs before the beginning of voice with larger time lag than that of the normal subjects, and the point of maximum movment is observed after the beginning of voice in many subjects.8. The speed of the medial movement of the LPW was obviously less than that of the normal subjects.9. The average time for swallowing was 1, 557 msec.10. It was proved that 20 cleft-palate children were able to be classified into three groups by mobility of LPW as a result of the analysis of the patterns of a series of M-mode echo curves, 11. This ultrasonic method proved to be useful in assessing the nasopharyngeal function for Cleft palate patients from an early age.