再建中咽頭の構音機能評価 前腕皮弁を用いた症例について

Abstract

Soft palate and tonsil (mesopharynx) play an important role on articulation and swallowing. We must take care not to restrict these physiological function when we reconstruct the mesopharyngeal defect after cancer ablation. In order not to restrict the postoperative function of mesopharynx, we take it the more important to preserve the function of the residual tissue rather than to rebuild the lost function. We took notice of pliable nature of the radial forearm flap and tried to reconstruct mesopharyngeal defect in five cases with this flap. We analyzed articulatory function and velopharyngeal closure in these cases, postoperatively. Articulatory function was assessed on the results of intelligibility test with 100 Japanese monosyllables. In four cases out of five, about 70% of syllables were accurately heard. According to the Hirose's standard of speech function after the operation of oral and/or oropharyngeal cancer, those four cases were evaluated also to be excellent. Whether the resection was done beyond the uvula or not, proved not to have anything to do with the postoperative speech intelligibility. Although speech intelligibility once went down immediately after the operation, it improved around six months later. The improvement might be due to the following facts; The forearm flap was cicatrized postoperatively, disturbing the mobility. After the softening of the cicatrix began, the flap gradually recovered flexibility, which enabled surrounding structure to move more smoothly. Articulatory dysfunction was characterized as plosives tend to be misunderstood as nasals or affricates. Concerning nasality, the velopharyngeal closure was examined by fiberscope. Perfect closure was seen in two cases, near-perfect in two cases, and insufficient in one case.(ABSTRACT TRUNCATED AT 250 WORDS)