上海口腔医学

上海口腔医学 ›› 2021, Vol. 30 ›› Issue (4): 394-401.doi: 10.19439/j.sjos.2021.04.011

• 论著 • 上一篇    下一篇

正颌手术对骨性Ⅲ类错畸形患者语音功能的影响

孟坤1,2, 孙健1,2,3, 李亚莉1, 刘延山1, 陈晨1, 徐泽先1,2, 孙鸣1,2, 张秀秀1,2, 周东阳1,2   

  1. 1.青岛大学附属医院 口腔颌面外科,山东 青岛 266000;
    2.青岛大学口腔医学院,山东 青岛 266000;
    3.青岛市口腔数字医学与3D打印工程实验室,山东 青岛 266000
  • 收稿日期:2020-09-03 修回日期:2020-11-16 出版日期:2021-08-25 发布日期:2021-09-23
  • 通讯作者: 孙健,E-mail:sunjianqy@126.com
  • 作者简介:孟坤（1993-）,女,硕士,住院医师,E-mail:501535326@qq.com
  • 基金资助:
    山东省科技发展计划项目（2014GSF118108）

The effect of orthognathic surgery on speech function in patients with skeletal Class Ⅲ malocclusion

MENG Kun1,2, SUN Jian1,2,3, LI Ya-li1, LIU Yan-shan1, CHEN Chen1, XU Ze-xian1,2, SUN Ming1,2, ZHANG Xiu-xiu1,2, ZHOU Dong-yang1,2   

  1. 1. Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Qingdao University. Qingdao 266000;
    2. School of Stomatology, Qingdao University. Qingdao 266000;
    3. Department of Operating Room, Affiliated Hospital of Qingdao University. Qingdao 266000, Shandong Province, China
  • Received:2020-09-03 Revised:2020-11-16 Online:2021-08-25 Published:2021-09-23

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摘要： 目的: 探讨正颌手术对骨性Ⅲ类错畸形患者术后语音功能的影响。方法: 选择 31例骨性Ⅲ类错畸形成人患者,分别在术前1周、术后 3个月采集颌面 CT 扫描数据、语音数据。将采集的CT数据导入Dolphin软件,对咽部解剖结构进行测量、分析及头颅X线头影测量分析;对语音数据进行主观和客观评价。采用SPSS 24.0软件包进行统计学分析。结果: 正颌手术后,软腭下缘到咽后壁的距离、会厌上缘到咽后壁的距离及其相应的横截面积和口咽、喉咽的体积较术前均有显著差异（P<0.01）。头颅X线片分析显示,术前和术后SNA、SNB、ANB、OJ、OBJ差异具有统计学意义（P<0.05）。正颌患者术后语音情况较术前发生改变,差异具有统计学意义（P<0.05）。正颌手术前、后,元音/a/B2、B3、B4,/i/B1、B2,/u/B1、B2、B4的差异具有统计学意义（P<0.05）,辅音/x/、/zh/、/s/下限频率及/zh/能量值的变化有统计学意义（P<0.05）,辅音/z/的语图形态变化有统计学意义（P<0.05）。上颌骨前移距离与△S1、△VOP、语音变化存在高度相关或显著相关。结论: 正颌手术对上、下颌骨的移动,引起咽腔解剖结构改变,导致术后语音改变。

关键词: 正颌外科, 骨性Ⅲ类错畸形, 咽腔解剖结构, 语音功能

Abstract: PURPOSE: To investigate the influence of the position of the upper and lower jaws on the anatomical structure of pharynx before and after orthognathic surgery in patients with skeletal Class Ⅲ malocclusion. METHODS: Craniofacial CT scan and speech data were collected from 31 patients with skeletal Class Ⅲ malocclusion before and 3 months after surgery. The collected CT data was imported into Dolphin imaging 11.95 software to establish a digital original model, and the anatomical structure of the pharynx was measured and analyzed. Speech data were analyzed objectively and subjectively by Computerized Speech Lab 4500b and professional speech specialists. Statistical analysis was performed using SPSS 24.0 software package. RESULTS: The distance from the lower edge of the soft palate to the posterior pharyngeal wall, the shortest distance from the posterior margin of the tongue to the posterior pharyngeal wall and its corresponding cross-sectional area were significantly different from those before surgery (P<0.05). The changes of SNA, SNB, ANB, OJ, and OBJ before and after surgery were significant in this series. Importantly, the speech intelligibility of orthognathic patients before and after surgery changed significantly subjectively (P<0.05). Objectively, the postoperative vowels /a/B2, B3, B4, /i/B1,B2, /u/B1,B2 and B4 of the patients were significantly different from those before surgery. There was no significant difference in the lower limit frequency of the consonants /x/, /zh/, /s/, the energy value of /zh/ and the grammatical form of /z/ before and after surgery. The maxillary advancement distance was highly correlated or significantly correlated with △S1, △VOP, and voice changes. CONCLUSIONS: Orthognathic surgery moves the upper and lower jaws to cause changes in the anatomy of the pharyngeal cavity, leading to changes of postoperative speech.

Key words: Orthognathic surgery, Skeletal Class Ⅲ malocclusion, Pharyngeal cavity anatomy, Speech function

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