A Longitudinal Study of Misarticulations in Postoperative Cleft Palate Children with Adequate Velopharyngeal Function

In order to clarify the frequency of occurrence and changes of various articulation disorders in cleft palate children, longitudinal observations were made of 31 postoperative cleft palate children who obtained adequate velopharyngeal function after early surgical repair of the palate. The results a...

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Published inJournal of Japanese Cleft Palate Association Vol. 14; no. 2; pp. 191 - 204
Main Authors MICHI, Ken-ichi, SUZUKI, Noriko, YAMASHITA, Yukari, IMAI, Satoko
Format Journal Article
LanguageJapanese
Published Japanese Cleft Palate Association 30.09.1989
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Online AccessGet full text
ISSN0386-5185
2186-5701
DOI10.11224/cleftpalate1976.14.2_191

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Abstract In order to clarify the frequency of occurrence and changes of various articulation disorders in cleft palate children, longitudinal observations were made of 31 postoperative cleft palate children who obtained adequate velopharyngeal function after early surgical repair of the palate. The results are as follows; 1. Eighteen of 31 cases (58 %) showed misarticulations after early surgical repair. The frequency of the misarticulation was highest in palatalized misarticulation (PM), followed by glottal stop (GS), nasopharyngeal misarticulation (NM) and lateral misarticulation (LM). 2. In five of 18 cases misarticulation improved spontenously at the conversational level. 3. The percentage of spontenous improvement was higher in GS and NM than PM, but it was not observed in LM. 4. The age of occurrence of spontenous improvement varied depending on the kinds of misarticulations. The age of spontenous improvernen tin GS and NM was between 3: 0 (years: months) and 3: 6, and it was consistent with the age of obtaining adequate velopharyngeal function. That of PM and NM associated with PM was between 4: 6 and 5: 6. 5. Two different processes were observed for the subjects whose PM was improved spontenously. One process showed improvement from the consonant level which was acquired early in phonological development, and from the syllable level to the conversational level by stages. The other process showed the changes of the place of articulation from the tongue dorsum to the tongue tip in all consonants which showed PM at same time. Although the former cases showed the typical dynamic palatogram (DP) patterns of PM whereby the posterior portion of the tongue dorsum contacts the posterior border of the hard palate at the moment of maximum contact, the latter cases showed the DP patterns whereby the whole tongue dorsum contacts the whole hard palate.
AbstractList In order to clarify the frequency of occurrence and changes of various articulation disorders in cleft palate children, longitudinal observations were made of 31 postoperative cleft palate children who obtained adequate velopharyngeal function after early surgical repair of the palate. The results are as follows; 1. Eighteen of 31 cases (58 %) showed misarticulations after early surgical repair. The frequency of the misarticulation was highest in palatalized misarticulation (PM), followed by glottal stop (GS), nasopharyngeal misarticulation (NM) and lateral misarticulation (LM). 2. In five of 18 cases misarticulation improved spontenously at the conversational level. 3. The percentage of spontenous improvement was higher in GS and NM than PM, but it was not observed in LM. 4. The age of occurrence of spontenous improvement varied depending on the kinds of misarticulations. The age of spontenous improvernen tin GS and NM was between 3: 0 (years: months) and 3: 6, and it was consistent with the age of obtaining adequate velopharyngeal function. That of PM and NM associated with PM was between 4: 6 and 5: 6. 5. Two different processes were observed for the subjects whose PM was improved spontenously. One process showed improvement from the consonant level which was acquired early in phonological development, and from the syllable level to the conversational level by stages. The other process showed the changes of the place of articulation from the tongue dorsum to the tongue tip in all consonants which showed PM at same time. Although the former cases showed the typical dynamic palatogram (DP) patterns of PM whereby the posterior portion of the tongue dorsum contacts the posterior border of the hard palate at the moment of maximum contact, the latter cases showed the DP patterns whereby the whole tongue dorsum contacts the whole hard palate.
In order to clarify the frequency of occurrence and changes of various articulation disorders in cleft palate children, longitudinal observations were made of 31 postoperative cleft palate children who obtained adequate velopharyngeal function after early surgical repair of the palate.The results are as follows;1. Eighteen of 31 cases (58 %) showed misarticulations after early surgical repair. The frequency of the misarticulation was highest in palatalized misarticulation (PM), followed by glottal stop (GS), nasopharyngeal misarticulation (NM) and lateral misarticulation (LM).2. In five of 18 cases misarticulation improved spontenously at the conversational level.3. The percentage of spontenous improvement was higher in GS and NM than PM, but it was not observed in LM.4. The age of occurrence of spontenous improvement varied depending on the kinds of misarticulations. The age of spontenous improvernen tin GS and NM was between 3: 0 (years: months) and 3: 6, and it was consistent with the age of obtaining adequate velopharyngeal function. That of PM and NM associated with PM was between 4: 6 and 5: 6.5. Two different processes were observed for the subjects whose PM was improved spontenously. One process showed improvement from the consonant level which was acquired early in phonological development, and from the syllable level to the conversational level by stages. The other process showed the changes of the place of articulation from the tongue dorsum to the tongue tip in all consonants which showed PM at same time. Although the former cases showed the typical dynamic palatogram (DP) patterns of PM whereby the posterior portion of the tongue dorsum contacts the posterior border of the hard palate at the moment of maximum contact, the latter cases showed the DP patterns whereby the whole tongue dorsum contacts the whole hard palate. 早期手術後に良好な鼻咽腔閉鎖機能を獲得した口蓋裂術後症例にみられる種々の構音障害の発現時期および経時的変化を明らかにするために,1977年から1985年までの問に昭和大学第一口腔外科および関連病院において口蓋形成術(粘膜骨膜弁法による口蓋後方移動術)を受け,良好な鼻咽腔閉鎖機能が得られた31例(両側性唇顎口蓋裂5例,片側性唇顎口蓋裂17例,口蓋裂9例)の構音の変化について経年的観察を行ったところ,以下のような結果が得られた。1)異常構音は18例(58%)に認められたが,そのなかでは口蓋化構音が最も多く,ついで声門破裂音,鼻咽腔構音,側音化構音の順であり,咽頭摩擦音,咽頭破裂音は1例も認められなかった。2)異常構音が自然治癒した症例は18例中5例(28%)であり,異常構音延べ27例中でみると自然治癒9例,改善8例,他の異常構音への移行例3例,不変7例であった。自然治癒は声門破裂音が最も多く認められ,ついで鼻咽腔構音,口蓋化構音の順であり,側音化構音には認められなかった。3)自然治癒の時期は異常構音の種類によって異なり,声門破裂音および鼻咽腔構音の単独例では3歳から3歳半の鼻咽腔閉鎖機能の獲得時期と一致し,口蓋化構音症例および口蓋化構音を合併した鼻咽腔構音症例では4歳半から5歳半の間に認められた。4)口蓋化構音の自然治癒および改善の経過には構音発達の過程において早期に獲得される音から,しかも音節レベルから段階的に治癒していくものと,全ての音の構音点が舌運動の習癖の変化に伴い舌背から徐々に舌尖に移行して同時に改善するものとが認められた。前者では口蓋化構音のDPパターンは硬口蓋後縁にのみ接触する型であり,後者では厚い接触であった。
Author MICHI, Ken-ichi
SUZUKI, Noriko
IMAI, Satoko
YAMASHITA, Yukari
Author_FL 山下 夕香里
道 健一
今井 智子
鈴木 規子
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  fullname: MICHI, Ken-ichi
  organization: First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University
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  fullname: SUZUKI, Noriko
  organization: First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University
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  fullname: YAMASHITA, Yukari
  organization: First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University
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  fullname: IMAI, Satoko
  organization: First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University
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References 9) Morley, M. E.: Cleft palate and speech. 7th ed., 171 210, Churchill Livingstone, Edinburgh, London and New York, 1970.
21)岡崎恵子, 加藤正子: 口蓋化構音の音響分析-[s]について. 音声言語医学, 29: 225-231, 1988.
2)岡崎恵子, 加藤正子, 鬼塚卓弥他: 口蓋裂初回手術後の言語成績日口蓋誌, 10: 161-168, 1985.
6)岡崎恵子, 加藤正子, 鬼塚卓弥他: 口蓋化構音症例の口蓋形態. 日形会誌4: 304-315, 1984.
7)佐藤美子, 岡崎恵子, 鬼塚卓弥他: 痩孔のスピーチに及ぼす影響聴覚言語障害, 6: 47-54, 1977.
22)福田登美子, 和田健, 松矢篤三他: 口蓋化構音の音響的分析, (抄). 日口蓋誌, 10: 231-232, 1985.
24)中原寛子: 正常児の調音発達-パラトグラムによる観察. 東北大学歯学雑誌, 2: 93-111, 1983.
8) Cosman, B., Falk, A. S.: Delayed hard palate repair and speech deficiencies: A cautionary report. Cleft Palate J., 17: 27-33, 1980.
12)阿部雅子: 鼻咽腔構音(いわゆる鼻腔構音)の臨床研究. 音声言語医学, 29: 8-14, 1988.
13)相野田紀子: 口蓋裂術後の経過中にみられる-過性異常構音, (抄), 音声言語医学, 29: 85-86, 1988.
23)西村辮作: 構音障害児の構音機能獲得. 笹沼澄子編; 言葉の遅れとその治療. 100-132, 大修館書店, 東京, 1979.
14)相野田紀子, 山下公一, 塚田貞夫: 1歳台で形成術を施行した口蓋裂児の6歳までの構音経過, (抄). 日口蓋誌, 12: 241-242, 1987.
16)岡崎恵子, 佐藤美子, 鬼塚卓弥他: 口蓋裂言語における口蓋化傾向. 聴覚言語障害, 4: 8-15, 1975.
11)福迫陽子, 沢島政行, 阿部雅子: 小児にみられる構音の誤り(いわゆる機能的構音障害)について-その臨床経験-. 音声言語医学, 17: 60-71, 1976.
18)加藤正子, 岡崎恵子, 阿部雅子: 側音化構音の臨床的特徴, (抄). 音声言語医学, 30: 34-35, 1989.
20)大和田健次郎, 中西靖子: 幼児の言葉の発達(6)-構音の恒常性と完成順位-. 耳候, 3: 7-17, 1971.
1)福迫陽子, 沢島政行, 阿部雅子: 口蓋裂術後の言語症状の経過-1-3歳手術例について-. 音声言語医学, 15: 37-46, 1974.
19)松本治雄, 長沢靖子, 斎藤美磨: 構音生成過程の追跡的研究-/su/, /tsu/, /dzu/について-. 国立特殊教育総合研究所紀要, 8: 133-143, 1981.
3)相野田紀子: 1歳台で施行した口蓋裂初回手術例の構音. 日形会誌, 1: 49-63, 1981.
15)岡崎恵子, 佐藤美子, 松本治雄: 口蓋裂幼児の異常構音の経過. 音声言語医学, 20: 113-122, 1979.
5)岡崎恵子: 口蓋裂言語の1型としての口蓋化構音. 日形会誌, 2: 164-176, 1982.
4)吉増秀實, 大平章子, 塩田重利他: 唇・顎口蓋裂患者に対する初回口蓋裂形成術の遠隔成績第一報1歳代および2歳代手術例の言語成績について日口蓋誌, 11: 62-69, 1986.
10)Borden, G. J., Harris, K. S.: Speech science primer. Williams & Wilkins, Baltimore, London, 1980. (広瀬肇訳: ことばの科学入門. 47-162, MRCメディカルリサーチセンター, 東京. 1984.
17)阿部雅子, 福迫陽子, 沢島政行: 口蓋裂60症例の構音訓練成績音声言語医学, 18: 67-73, 1977.
References_xml – reference: 21)岡崎恵子, 加藤正子: 口蓋化構音の音響分析-[s]について. 音声言語医学, 29: 225-231, 1988.
– reference: 1)福迫陽子, 沢島政行, 阿部雅子: 口蓋裂術後の言語症状の経過-1-3歳手術例について-. 音声言語医学, 15: 37-46, 1974.
– reference: 11)福迫陽子, 沢島政行, 阿部雅子: 小児にみられる構音の誤り(いわゆる機能的構音障害)について-その臨床経験-. 音声言語医学, 17: 60-71, 1976.
– reference: 24)中原寛子: 正常児の調音発達-パラトグラムによる観察. 東北大学歯学雑誌, 2: 93-111, 1983.
– reference: 13)相野田紀子: 口蓋裂術後の経過中にみられる-過性異常構音, (抄), 音声言語医学, 29: 85-86, 1988.
– reference: 14)相野田紀子, 山下公一, 塚田貞夫: 1歳台で形成術を施行した口蓋裂児の6歳までの構音経過, (抄). 日口蓋誌, 12: 241-242, 1987.
– reference: 2)岡崎恵子, 加藤正子, 鬼塚卓弥他: 口蓋裂初回手術後の言語成績日口蓋誌, 10: 161-168, 1985.
– reference: 12)阿部雅子: 鼻咽腔構音(いわゆる鼻腔構音)の臨床研究. 音声言語医学, 29: 8-14, 1988.
– reference: 22)福田登美子, 和田健, 松矢篤三他: 口蓋化構音の音響的分析, (抄). 日口蓋誌, 10: 231-232, 1985.
– reference: 6)岡崎恵子, 加藤正子, 鬼塚卓弥他: 口蓋化構音症例の口蓋形態. 日形会誌4: 304-315, 1984.
– reference: 5)岡崎恵子: 口蓋裂言語の1型としての口蓋化構音. 日形会誌, 2: 164-176, 1982.
– reference: 10)Borden, G. J., Harris, K. S.: Speech science primer. Williams & Wilkins, Baltimore, London, 1980. (広瀬肇訳: ことばの科学入門. 47-162, MRCメディカルリサーチセンター, 東京. 1984. )
– reference: 4)吉増秀實, 大平章子, 塩田重利他: 唇・顎口蓋裂患者に対する初回口蓋裂形成術の遠隔成績第一報1歳代および2歳代手術例の言語成績について日口蓋誌, 11: 62-69, 1986.
– reference: 23)西村辮作: 構音障害児の構音機能獲得. 笹沼澄子編; 言葉の遅れとその治療. 100-132, 大修館書店, 東京, 1979.
– reference: 8) Cosman, B., Falk, A. S.: Delayed hard palate repair and speech deficiencies: A cautionary report. Cleft Palate J., 17: 27-33, 1980.
– reference: 16)岡崎恵子, 佐藤美子, 鬼塚卓弥他: 口蓋裂言語における口蓋化傾向. 聴覚言語障害, 4: 8-15, 1975.
– reference: 17)阿部雅子, 福迫陽子, 沢島政行: 口蓋裂60症例の構音訓練成績音声言語医学, 18: 67-73, 1977.
– reference: 3)相野田紀子: 1歳台で施行した口蓋裂初回手術例の構音. 日形会誌, 1: 49-63, 1981.
– reference: 15)岡崎恵子, 佐藤美子, 松本治雄: 口蓋裂幼児の異常構音の経過. 音声言語医学, 20: 113-122, 1979.
– reference: 9) Morley, M. E.: Cleft palate and speech. 7th ed., 171 210, Churchill Livingstone, Edinburgh, London and New York, 1970.
– reference: 19)松本治雄, 長沢靖子, 斎藤美磨: 構音生成過程の追跡的研究-/su/, /tsu/, /dzu/について-. 国立特殊教育総合研究所紀要, 8: 133-143, 1981.
– reference: 7)佐藤美子, 岡崎恵子, 鬼塚卓弥他: 痩孔のスピーチに及ぼす影響聴覚言語障害, 6: 47-54, 1977.
– reference: 18)加藤正子, 岡崎恵子, 阿部雅子: 側音化構音の臨床的特徴, (抄). 音声言語医学, 30: 34-35, 1989.
– reference: 20)大和田健次郎, 中西靖子: 幼児の言葉の発達(6)-構音の恒常性と完成順位-. 耳候, 3: 7-17, 1971.
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Snippet In order to clarify the frequency of occurrence and changes of various articulation disorders in cleft palate children, longitudinal observations were made of...
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SourceType Publisher
StartPage 191
SubjectTerms cleft lip and palate
longitudinal study
manner of misarticulation
misarticulation
spontenous improvement
口蓋裂
構音様式
異常構音
経年的研究
自然治癒
Title A Longitudinal Study of Misarticulations in Postoperative Cleft Palate Children with Adequate Velopharyngeal Function
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