口蓋裂術後の言語症状の経過

―1～3歳手術例について―

抄録

This is a report on speech we observed in 75 cleft palate children during the period of one to five years after operation. The results are summarized as follows:
1) Cases of successful palatal repair
i) About one half of the cases repaired at one year of age showed no deviation in speech throughout the course of observation, while most of the cases repaired at ages of two to three years showed articulation disorders.
ii) Manifestation of articulation disorders appeared to be closely related to speech (articulatory) development of the children. The hyperrhinolalia and the glottal stop were observed less frequently with cases where the palatal repair w as performed at a lower age.
iii) The hyperrhinolalia, which becomes manifest at the age of 1.5 to 2.5 years old, is a direct reflection of the velopharyngeal function, and disappeared spontaneously within a year after the operation.
iv) The glottal stop, the nasal articulation, and the palatalized articulation (use of the body of the tongue instead of the tip or blade, making the articulatory contact with the palate instead of the teeth or the alveolar region) were noted as faulty articulations and were manifest at the age of 1.5 to 2. 5, 2 to 2. 5, and 2.5 to 3 years old respectively. Spontaneous postoperative recovery was observed in the nasal articulation and the glottal stop, but not in the palatalized articulation.
v) From the point of view of speech development, the speech of the mentally retarded children showed a pattern similar to that of the non-retarded children.
vi) There was no case with the pharyngeal fricative articulation which is mentioned in earlier reports. Instead, the palatalized articulation was noted in the present cases, especially those with the complete cleft. This seems to be a new pattern of cleft palate speech where the palatal repair is done early in childhood. This type of faulty articulation appears to be more difficult to correct by training than the glottal stop.
2) Twelve cases underwent repeated surgery after unsuccessful palatal repairs. All of them manifested articulation disorders regardless of the age of the first surgery. The speech was fairly good in cases a satisfactory velopharyngeal function was achieved by the age of 3 years old.