Variations in Function and Vocal Acoustic Characteristics After Orthognathic Surgery: Preliminary Results

Mario Palone; Edoardo Mannelli; Elisabetta Pontarolo; Flavia Nardi; Teresa Menegus; Paolo Santoni; Ugo Baciliero

Authors

Mario Palone
Edoardo Mannelli
Elisabetta Pontarolo
Flavia Nardi
Teresa Menegus
Paolo Santoni
Ugo Baciliero

Keywords:

Orthodontics, Orthopedics, Pathology, Oral, Surgery, Oral, Oral Health

Abstract

Objective: To determine the effects of orthognathic surgery on oral function and vocal quality in order to assess the need for speech therapy after surgery. Material and Methods: Thirty-seven patients scheduled for mono-jaw surgery, specifically maxillary (G1:15 patients), mandibular advancement (G2:10 patients) or mandibular set-back (G3:12 patients), were recruited for this prospective cohort study. Evaluation of oral functions, video recordings of speech articulation and audio recordings of voice were obtained before surgery (T0), and at 1 (T1) and 6 months (T2) after surgery. Spectrographic analysis and self-evaluation questionnaire regarding the vocal performance (VAPP) were performed. Both qualitative and quantitative statistical analysis was performed, mainly using generalized linear models for dichotomous data (p<0.05). Results: The formant frequencies (F1 and F2) of the main vowels vary after orthognathic surgery according to the type of surgery. Before surgery, 84% of patients analyzed showed difficulties in breathing and positioning the tongue both at rest and swallowing. Thanks to surgical correction of the malocclusion, the major part of these issues were resolved within 6 months. In 25% of cases, a change in the voice and/or articulation had occurred. Conclusion: Vocality improves after orthognathic surgery and it changes in relation to the type of surgery. However, vocality did not normalize completely. Speech assessment should be considered after surgery in order to offer adequate speech therapy if necessary.

References

Lucchese A, Manuelli M, Albertini P, Ghislanzoni LH. Transverse and torque dental changes after passive self-ligating fixed therapy: A two-year follow-up study. Am J Orthod Dentofa-cial Orthop 2019; 156(1):94-103. https://doi.org/r10.1016/j.ajodo.2018.08.019.

Albertini P, Giraud L, Cremonini F, Palone M. Phonetic alterations caused by different lingual appliances. Pesqui Bras Odontopediatria Clín Integr 2021; 21:e0026. https://doi.org/10.1590/pboci.2021.092

Maino BG, Paoletto E, Cremonini F, Liou E, Lombardo L. Tandem skeletal expander and MAPA protocol for palatal expansion in adults. J Clin Orthod 2020; 54(11):690-704.

Lombardo L, Albertini P, Cervinara F, Brucculeri L, Siciliani G. Early Class III treatment with hybrid rapid palatal expander combined with facemask. Int Orthod 2020; 18(3):624-35. https://doi.org/10.1016/j.ortho.2020.05.002

Albertini P, Albertini E, Siciliani G, Lombardo L. Fluorescence-aided composite removal during lingual bracket debonding. J Esthet Restor Dent 2020; 32(7):634-637. https://doi.org/10.1111/jerd.12618

Albertini P, Cremonini F, Palone M. Comparative analysis of stiffness of lingual appliances: an in vitro study. Pesqui Bras Odontopediatria Clín Integr 2021; 21:e0024. https://doi.org/10.1590/pboci.2021.085

Ghaemi H, Emrani E, Labafchi A, Famili K, Hashemzadeh H, Samieirad S. The effect of bimaxillary orthognathic surgery on nasalance, articulation errors, and speech intelligibility in skeletal Class III deformity patients. World J Plast Surg 2021; 10(1):8-14. https://doi.org/10.29252/wjps.10.1.8

Vallino LD. Speech, velopharyngeal function, and hearing before and after orthognathic surgery. J Oral Maxillofac Surg 1990; 48(12):1274-82. https://doi.org/10.1016/0278-2391(90)90481-g

Dalston RM, Vig PS. Effects of orthognathic surgery on speech: a prospective study. Am J Orthod 1984; 86(4):291-8. https://doi.org/10.1016/0002-9416(84)90139-8

Glass L, Knapp J, Bloomer HH. Speech and lingual behavior before and after mandibular osteotomy. J Oral Surg 1977; 35(2):104-9.

Turvey TA, Journot V, Epker BN. Correction of anterior open bite deformity: a study of tongue function, speech changes, and stability. J Maxillofac Surg 1976; 4(2):93-101. https://doi.org/10.1016/s0301-0503(76)80014-8

Kummer AW, Strife JL, Grau WH, Creaghead NA, Lee L. The effects of Le Fort I osteotomy with maxillary movement on articulation, resonance, and velopharyngeal function. Cleft Palate J 1989; 26(3):193-200.

Ruscello DM, Tekieli ME, Jakomis T, Cook L, Van Sickels JE. The effects of orthognathic surgery on speech production. Am J Orthod 1986; 89(3):237-41. https://doi.org/10.1016/0002-9416(86)90038-2

Lee AS, Whitehill TL, Ciocca V, Samman N. Acoustic and perceptual analysis of the sibilant sound /s/ before and after orthognathic surgery. J Oral Maxillofac Surg 2002; 60(4):364-73. https://doi.org/10.1053/joms.2002.31221

Weimer K, Astrand P. Effect on speech of mandibular prognathism before and after surgical treatment. Swed Dent J 1977; 1(5):173-6.

Witzel MA, Ross RB, Munro IR. Articulation before and after facial osteotomy. J Maxillofac Surg 1980; 8(3):195-202. https://doi.org/10.1016/s0301-0503(80)80100-7

Van Lierde KM, Schepers S, Timmermans L, Verhoye I, Van Cauwenberge P. The impact of mandibular advancement on articulation, resonance and voice characteristics in Flemish speaking adults: a pilot study. Int J Oral Maxillofac Surg 2006; 35(2):137-44. https://doi.org/10.1016/j.ijom.2005.06.011

Oliverio T, Cremonini F, Lombardo L, Siciliani G. Tooth whitening in association with clear aligner treatment. J Clin Orthod 2019; 53(9):508-17.

Lombardo L, Arreghini A, Ramina F, Huanca Ghislanzoni LT, Siciliani G. Predictability of orthodontic movement with orthodontic aligners: a retrospective study. Prog Orthod 2017; 18(1):35. https://doi.org/10.1186/s40510-017-0190-0

Niemi M, Laaksonen JP, Peltomäki T, Kurimo J, Aaltonen O, Happonen RP. Acoustic comparison of vowel sounds produced before and after orthognathic surgery for mandibular advancement. J Oral Maxillofac Surg 2006; 64(6):910-16. https://doi.org/10.1016/j.joms.2006.02.009

Laine T. Articulatory disorders in speech as related to size of the alveolar arches. Eur J Orthod 1986;8(3):192-7. https://doi.org/10.1093/ejo/8.3.192

Yamamoto T, Imai T, Umeda K. Acoustic Characteristic of the Fricatives in the Surgical Class III Patients. In: Brain and Oral Functions: Oral Motor Function and Dysfunction. Amsterdam: Elsevier; 1995. pp. 611-615.

Subtenly J, Sakuda M. Open bite: diagnosis and treatment. Am J Orthod 1964; 50:337-8. https://doi.org/10.1016/0002-9416(64)90175-7

Rathbone J, Snidecor J. Appraisal of speech defects in dental anomalies with reference to speech improvement. Angle Orthod 1959; 29(1):54-9.

Mozzanica F, Ginocchio D, Borghi E, Bachmann C, Schindler A. Reliability and validity of the Italian version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Folia Phoniatr Logop 2013; 65(5):257-65. https://doi.org/10.1159/000356479

Kleemola L, Helminen M, Rorarius E, Sihvo M, Isotalo E. Twelve-month clinical follow-up study of voice patients' recovery using the Voice Activity and Participation Profile (VAPP). J Voice 2011; 25(5):e245-e254. https://doi.org/10.1016/j.jvoice.2010.05.003

He J, Wang Y, Hu H, Liao Q, Zhang W, Xiang X, et al. Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal Class III malocclusion: a systematic review and meta-analysis. Int J Surg 2017; 38:31-40. https://doi.org/10.1016/j.ijsu.2016.12.033

Trawitzki LV, Dantas RO, Mello-Filho FV, Marques W Jr. Masticatory muscle function three years after surgical correction of class III dentofacial deformity. Int J Oral Maxillofac Surg 2010; 39(9):853-6. https://doi.org/10.1016/j.ijom.2009.03.006

Jorge TM, Brasolotto AG, Gonçales ES, Filho HN, Berretin-Felix G. Influence of orthognathic surgery on voice fundamental frequency. J Craniofac Surg 2009; 20(1):161-4. https://doi.org/10.1097/SCS.0b013e3181945a64

Macari AT, Ziade G, Khandakji M, Tamim H, Hamdan A. Effect of rapid maxillary expansion on voice. J Voice 2016; 30(6):760.e1–6. https://doi.org/10.1016/j.jvoice.2015.09.013

Neamati M, Jamali M, Tabrizi R, Barati B. Does maxillary advancement alter vocal acoustic parameters in Class III skeletal patients? Br J Oral Maxillofac Surg 2021; S0266-4356(21)002424. https://doi.org/10.1016/j.bjoms.2021.06.010

Hong JS, Oh KM, Kim BR, Kim YJ, Park YH. Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible. Am J Orthod Dentofacial Orthop 2011; 140(4):e161-e169. https://doi.org/10.1016/j.ajodo.2011.04.020

Magno Caldognetto E. Introduzione all’interpretazione Articolatoria dei dati Spettrografici. Bologna: Patron; 1980. [In Italian].

Hwang S, Chung CJ, Choi YJ, Huh JK, Kim KH. Changes of hyoid, tongue and pharyngeal airway after mandibular setback surgery by intraoral vertical ramus osteotomy. Angle Orthod 2010; 80(2):302-8. https://doi.org/10.2319/040209-188.1

Enacar A, Aksoy AU, Sençift Y, Haydar B, Aras K. Changes in hypopharyngeal airway space and in tongue and hyoid bone positions following the surgical correction of mandibular prognathism. Int J Adult Orthodon Orthognath Surg 1994; 9(4):285-90.

Wang H, Qi S, Wang J, Cai Z, Li C. Detection to changes in hyoid and tongue positions and pharyngeal airway following mandibular setback surgery by cone beam CT. Hua Xi Kou Qiang Yi Xue Za Zhi 2012; 30(6):650-4.

Kawakami M, Yamamoto K, Fujimoto M, Ohgi K, Inoue M, Kirita T. Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery. J Craniomaxillofac Surg 2005; 33(2):107-10. https://doi.org/10.1016/j.jcms.2004.10.005

Lombardo L, Gracco A, Zampini F, Stefanoni F, Mollica F. Optimal palatal configuration for miniscrew applications. Angle Orthod 2010; 80(1):145-52. https://doi.org/10.2319/122908-662.1

Kagawa H, Kaku M, Yamamoto T, Yashima Y, Sumi H, Kamiya T, et al. Changes in tongue-palatal contact during swallowing in patients with skeletal mandibular prognathism after orthognathic surgery. PLoS One 2021; 16(5):e0251759. https://doi.org/10.1371/journal.pone.0251759

Doshi UH, Bhad-Patil WA. Speech defect and orthodontics: a contemporary review. Orthodontics 2011; 12(4):340-53.