雙側唇顎裂兒童之吞嚥治療：病例報告

Swallowing Therapy in Children with Bilateral Cleft Lip and Palate: A Case Report

張時中(Shih-Chung Chang) ； 楊菁菁(Ching-Ching Yang) ； 黃玉慧(Yu-Hui Huang)

《台灣復健醫學雜誌》 39卷2期 (2011/06) Pp. 123-129

https://doi.org/10.6315/2011.39(2)08

摘要

唇顎裂兒童除了顱顏的異常外，經常併有語言及吞嚥障礙。除了需多次的修補及重建手術外，也需積極的復健治療以改善其語言及吞嚥功能。本篇報告一位十歲男童因嚴重唇顎裂及聲門下狹窄，於出生後即一直依賴鼻胃管灌食及經由氣切造口呼吸。個案於八歲才首次接受吞嚥及語言復健訓練，因個案長期缺乏口腔吞嚥經驗，吞嚥相關之肌肉力量及動作協調能力不佳，再加上個案因聽力障礙及認知發展遲緩，因此訓練不易。其訓練方式包括溫度－觸覺刺激、改變吞嚥姿勢、口腔及喉部運動、神經肌肉電刺激及使用假顎板等。治療後個案除了對糊狀質地的食物會產生喉部堆積及嗆入外，其餘質地的食物（稀水液、低濃稠液及高濃稠液）則沒有明顯之吞嚥障礙，也未再有鼻腔逆流產生，因此個案已可拔除鼻胃管並完全由口進食。本個案的治療過程可提供做爲臨床醫師將來處理類似案例的臨床參考。

關鍵字

唇顎裂 ； 溫度－觸覺刺激 ； 神經肌肉電刺激 ； 假顎板

並列摘要

Other than craniofacial anomaly, children with cleft lip and palate usually have problems of speech and swallowing. Therefore, in addition to multiple sessions of operations for repair and reconstruction, active rehabilitation is also required to improve their function of speech and swallowing. This report disclosed a ten-year-old boy who depended on nasogastric tube feeding and respired via tracheotomy after birth because of bilateral cleft lip and palate as well as subglottic stenosis. He started training of swallowing and speech at the age of 8. However, having lacked adequate practice for a long period of time, coordination and strength of his muscles for swallowing were inappropriate. Furthermore, concurrent hearing impairment and developmental delay perplexed performance of the rehabilitation program. Treatment included thermal-tactile stimulation, changing posture of swallowing, oral and laryngeal exercise, neuromuscular electric stimulation and using cleft palate prosthesis. After treatment, this patient does not experience significant nasal regurgitation and swallowing problems on taking most food (thin liquid, nectar-thick liquid and honey-thick liquid), except paste food that cumulates in his larynx and induces choking. Therefore, the nasogastric tube was removed and this patient can be fed orally. The therapeutic process may be the reference of the clinical practice in the other similar patients.

並列關鍵字

cleft lip and palate ； thermal-tactile stimulation ； neuromuscular electrical stimulation ； cleft palate prosthesis