| Objective: A cross-sectional study was conducted to evaluate the long-term effects of speech,hearing,masticatory function,maxillary development and psychological status of underage cleft lip and palate patients who had undergone the first cleft palate reduction for 5 years or more.To investigate the actual situation of cleft lip and palate sequence therapy,to establish and try out a complete,simple and effective procedure for lip and palate cleft maxillofacial malformation,to promote individual recovery after cleft palate surgery.Methods: Part one: A total of 30 minor patients with complete cleft lip and palate [CLP,excludes(1)cleft lip and(2)cleft palate] and their guardians(father / mother)who had undergone the first cleft palate surgery for 5 years or more were divided into two groups: palatine fistula group(n = 15)and non-palatal fistula group(n = 15).In addition,13 patients with complete labial and alveolar cleft [CLA,excludes(1)cleft lip,(2)cleft lip and palate,and(3)cleft palate ] were selected as control group and 15 healthy children as normal control group.To investigate the basic information of the three groups of minors and their guardians,to check the basic situation of the patients-undefined oral cavity,and to use Cool Edit Pro software to record the relevant data of patients voice,please make a speech assessment with two professional phonologists.VIEWGUM color analysis software was used to test the masticatory efficiency of the patients,and the same professional otolaryngologist was invited to use pure tone audiometer and acoustic conductance instrument to measure the pure tone and Eustachian tube function.The patients and their relatives filled out the psychological assessment form of cleft palate children and family members of cleft palate respectively in quiet rooms.Part two : The data of soft and hard maxillofacial tissue of CLP group were obtained by positive and lateral imaging and cone-beam computed tomography(CT).The CBCT data of 20 normal adolescents were selected as normal control group.Three-dimensional reconstruction and aesthetic analysis of maxillofacial region were performed with Photoshop,Mimics 15.0 and so on.Inform the guardian of all subjects of the risk of participating in the study before entering the referral procedure and sign an informed consent form(see Annex 1).The results of clinical data and software analysis were statistically analyzed by SPSS22.0 software(P < 0.05).Results : Part one:1)Speech articulation,hearing and Eustachian tube function in CLP group were significantly lower than that in and CLA group and normal control group(P < 0.001).2)The postoperative speech intelligibility of cleft palate in CLP group was affected by palatal fistula or not,operation time and care degree of guardian.(P < 0.05).3)The masticatory efficiency and mental state of CLP group were lower than that of normal control group(P < 0.05),butthere was no significant difference between CLP group and CLA group(P >0.05).4)There was no significant difference in the psychological assessment results between the CLP group and the normal group(P > 0.05).5)The diagnosis of Cleft palate,speech articulation,masticatory efficacy and parents-undefined psychology may be the important factors influencing the psychological status of patients with cleft lip and palate after cleft palate surgery(P < 0.05).Part two : 1)Z angle,nasal process angle and the angle of nasal column length in CLP group were smaller than those in N group,the angle of nasal tip and facial protrusion were higher than those in group N(P < 0.05).There was no significant difference in surface angle and nasolabial angle between CLP group,CLA group and N group(P > 0.05).The main difference in the angle of soft tissue profile between CLP group and CLA group was nasal process angle(P < 0.05).2)The 3D distance of hard palate in CLP group was shorter than that in CLA group(P < 0.05).There was significant difference between CLP group and CLA group with N group in the degree of deviation the anterior nasal crest point ANS and chin point Pt to the mid-facial line(P < 0.05).3)In UCLP group and UCLP group,the distance between zygomaticotemporal crevice midpoint Z and zygomatic process point J to PL1 was shorter than that of normal side(P < 0.05).Conclusion :The long-term speech,hearing,masticatory efficacy and psychological state of the minor cleft lip and palate patients were lower than those of the normal control group,among which,palatal fistula may be the main cause of the long-term speech articulation in the patients with CLP,and had a positive correlation with the postoperative years.It has nothing to do with the timing of surgery.Functional recovery is the key to affect the mental state of patients.Z angle,Nasal process angle,The skew degree of point ANS to themid-facial line can be used to detect the skew degree difference sensitively on soft tissue profile and 3D images between normal minors with the patients with cleft lip and palate. |
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