Clinical evaluation of the speech following maxillectomy.

The influence of maxillectomy on speech sound articulation and intelligibility were studied by ten cases. These cases were anatomically classified into Type I (unilateral), II (unilateral), and III (bilateral) in maxillectomy type. Pressure consonants, such as plosives r p, b, t, d, k, g], fricatives [s, <;] and affricates [ts, dz, ts, d5], were defective in maxillectomized patients. Vowels [i, u] were inclined to be hypernasal. Nasal consonants [m, n] and fricatives [F, h; j, w] were rarely misarticulated. Dental obtulator, denture or maxillo-dental prosthesis for unilateral maxillectomy produced effective recovery of speech in most of cases, but did not so much for bilateral maxillectomy. When patients with unilateral maxillectomy (Type I or II) obtained intraoral pressure ratio of 0. 8 or more with the use of such prosthesis, their speech became intelligible. The patients with bilateral maxillectomy (Type III), however, could not attain to such acceptable speech level. Articulation test composed of eight consonants [p, b, t, d, k, g, s, <;] and five vowels [a, o, e, u, i] is recommended for such patients conclusively in consideration of this experimental result. 359 INTRODUCTION the former needs rehabilitation program, while the latter needs habilitative speech therapy. Many patients with a partial or subtotal resection of maxilla for the treatment of their tumor have been suffered from speech disorders3-7,9, 11 • 14 16>. It is not well known, however, what is the best method to evaluate their speech problems. It will be of great use for the treatment of such patients, if it is predicted before surgery, how deviated the speech will be under the influence of their maxillectomy. Maxillectomized patients are generally older than the cleft palate patients. Most of them are adult, and usually they have not any speech disorders before the operation. They also have not any defects or deformities in their oral structures. So if their resected maxillae can be recovered in form by prosthesis as good as possible, their speech will be different from the articulation of the cleft palate patients with innate nasopharyngeal incompetence. In short, Cleft palate speech is now analyzed by many measures, such as oral inspection, articulation test, intelligibility estimation, intraoral pressure test, X-ray film analysis, fiberscopy, sound spectrography and so on. But for the appraisal of the communicative disorders derived from partial to total maxillectomy, modified convenient tests are required. Up to date there are, however, hardly any reports on the problems. So new estimation method of speech for this purpose must be developed and discussed. In this article, study on the clinical evaluation of the speech following maxillectomy was made to look for the best tool of evaluating comunicative disorders and to apprehend the grade of speech recovery by the use of prosthesis after partial, subtotal or total resection. 360 K. Takeuchi et al. SUBJECTS AND METHODS 1. Subjects Subjects were ten patients who went through maxillectomy at the Department of Oral, & Maxillofacilal Surgery II, Hiroshima University Dental Hospital, between May 1975 and November 1977, and followed by the Division of Speech Disorders. They have no communicative disorders before the surgery. Articulation disorders caused by maxillectomy were derived from the impossibility of impounding breath pressure in oral cavity. It has been reported that the speech problems of such patients do not depend on the width of the maxillectomy, but the position and the shape of the resected maxillae. Therefore, the con di tions of maxillectomy were classified into three types as follows: Type I (unilateral maxillectomy): complete openig between oral cavity and unilateral maxillary sinus, but only natural anatomical opening between nasal cavity and sinus. Type II (unilateral maxillectomy): complete opening among oral cavity, unilateral nasal cavity and unilateral maxillary sinus, as a result of non-resected nasal septum. Type III (bilateral maxillectomy) : entire opening among oral cavity, bilateral nasal cavity and sinus, as a result of resected nasal septum. The grade of maxillary resection are assorted with narrow (N) and wide (W). Figure 1 Table I. Classification of patients (sex, age, side, and width) of maxillectomy