Speech and the Maxillofacial Complex

Abstract

SUMMARY The development of speech in the growing craniofacial complex is highly dependent on the integrity of the structure and its function. Although development begins in utero, much of the growth for potential communicative language occurs postnatally and is highly dependent on neurologic and cognitive integ-rity. Genetic and acquired deformations often result in severe dental and skeletal malocchi-sions, thus introducing the potential for disturbed speech production. The resulting disturbance may range from minor distortions of specific sounds to significant articulation disorders significantly affecting communicative effectiveness. Assessment of speech disorders in a child presenting with a maxillofacial disorder must be based on principles involving structural growth, timing, and presence of compensatory gestures, in addition to the assessment of speech and language modalities. Treatment of maxillofacial disorders generally requires both orthognathic surgery and orthodontic treatment. Although deformations can negatively affect speech, orthognathic surgery has been known to improve articulatory dis-tortions.5, 13, 17, 20, 22 In more severe cases, such as clefting and syndromic anomalies, orthog-nathic surgery has been shown to have minimal negative effects and to provide the patient with an esthetic and functional mechanism on which to develop articulated speech. A truly interdisciplinary approach is the best means of providing the patient with comprehensive, coordinated care. It is essential that the speech pathologist and the maxillofacial surgeon carefully coordinate treatment efforts so that they can develop a rehabilitative plan and schedule that are both effective and efficient.