专业英语 Unit 26教案
UnitTwentySixCleftPalateandCleftLip:aTeamApproachtoClinical ManagementandRehabilitationofthePatientD
UnitTwentySix CleftPalateandCleftLip:aTeamApproachtoClinical ManagementandRehabilitationofthePatient Duringthe1930sand1940smostchildrenwhohadundergonesurgeryforcleftpalaterequiredspeechtherapy. Butatthattimeitwascommonpracticeforsurgeonstowaituntiltheageofthreeorfourtoclosethepalate.Naturallythec hildhaddevelopedhislanguagebyagefourandfrequentlyhadacquiredbecauseofa compensatoryarticulationhabits constrictedmaxillaandanonfunctionalHisconditionmadei(impossibleforhimtoi velopharyngealport.unoperated mpoundairwithintheoralcavity.andcouldnotbeavoided. Nasalairemissionhypernasalresonance Whensurgerywasfinallyperformedthefamilyaswellasthesurgeonwasoftendismayedtofindthatadramatic changeintonalqualityhadnotoccurredwiththeclosingofthecleft.Thechildfrequentlycontinuedtotalkverymuchas hehadtalkedbeforetheoperation,witha"cleftpalatespeech."Inmanycasesthiswasbecausehisspeechh maladaptive abitshadbecomesothathisvoicesounded"familiar"and"right"tohim.Ifhedidnotrecognizeitasabnormal, ingrained thismeantthatheandthespeechclinicianwereinfbralongsiegeoftherapy. Severaltypesofdentalprostheseswereusedin(he1930sand1940sasprimarytreatmentforseparatingtheorala ndnasalcavities;'however,thecleftproblemwasconsideredanexerciseforthesurgeon.Ifandwhentherewasa breakd thesurgeonrepeatedhisproceduresinhisefforttoclosethepalataldefect.Someoftheearlypa owninthesurgicalrepair, tienthistoriesattheinstituterecord10,15,and20surgicalproceduresinattemptingtoclosetheoraldefect. Hypernasal qualityandhabitswereassociatedwiththesemultiplesurgicalfailures.SomeSurgeon voicemaladaptivearticulation feltthatthenextlogicalstepaftersurgicalmanagementfailedwastoreferthepatienttoaprosthodontist.Few speechcli wereavailabletothesurgeonuntiltheteamconceptofcleftpalatemanagementdeveloped. nicians Certainlytheearlysurgeonshadtheirmeasureofsuccess,butthepercentageofgoodresultswasnottoswelluntil thelate1950sandearly1960s,whenplasticsurgeonsexpressedtheirawarenessofhumangrowthanddevelopmentoft hemid-thirdoftheface.Withthisawarenesstheywereabletoimprovetheirtechniquesandtotime(hesurgicalprocedu restominimizeinterferencewithcentersoffacialgrowth.Lengtheningtheoraltissueandutilizingaflapgreatly vomer reduced(hetraumatomaxillarysegments.Moreimportanttospeechdevelopmentwastheimprovedtwostagepalatal closuretechnique,implementedbeforethechildreached18monthsofage.Thesefactshadamarkedinfluenceonthede velopmentofmorenormalspeechandvoicepatternsinchildrenwithacleftpalate. H.KCooperrealizedthatnoone-treatmentprocedurewasaButhisteamconcept,whichhebeganto panacea.im inthe1930s,emphasizethevariedadvantagesofinterdisciplinaryevaluationandtreatmentofcleftpalate.He plement stressedtherehabilitativemanagementofthetotalperson,andasprofessionalmembersoftheinterdisciplinaryteam, werealizedweweredealingwithanintegratedpailof.thewholeperson.Thisistheconceptthathasbeendevelopedand continuallystressedatthelancastercleftpalateclinic. Whyateam? ItiswellrecognizedthatindividualsbomwithcleftsoftheUpandpalateorpalateonlywillfaceanumberofinte rrelatedproblems.Intheearliestdaysofteammanagementofclefts,clinicalobservationsledtotherecognitionthatc hildrenwithcleftlipandpalate(includingacleftofthemaxillaryrequiredlheservicesofareconstructiv alveolararch) esurgeontorepair(heclefts,aspeechtoaddressissueoffunctionandarticulation,andad pathologistvelopharyngeal entalspecialisttoaddressproblemsassociatedwithocclasionandcongenitallymissingteeth. Centerswereoftenbuiltaroundthesetreatmentspecialistsbecauseoftheirlong-terminvolvementwithpatie ntswithclefts.Manyteamsdidnothavepediatricians(eventhoughthemajorityofpatientswerechildren),or otolaryn
