الفهرس Only 14 pages are availabe for public view
 |  | from | 235 |  |  |
| | | from | 235 | | |
Abstract
The speech problems related to malocclusion are either a dyslalia, due to a faulty speech sound production, or an open nasality, caused by an associated velopharyngeal valve incompetence, that may occur as a part of the craniofacial anomaly causing the malocclusion.
The causes of malocclusion are either local or general. Both of those categories could be divided into:
A. Hereditary
B. Acquired
C. Other causes.
There is an overlap between these groups, only the causes of malocclusion related to faulty speech production were included in this study.
These common causes include, genetic syndromes such as cleft lip and palate, systemic diseases as rickets or endocrinal disorder such as acromegaly. The symptoms in some patient will be originally tracked down to a perinatal or postnatal trauma. Dental diseases such as premature loss o dentition, or early loss of permanent teeth may also result in manifestation.
For the assessment and management of those cases, there must be an multidisciplinary team, including phoniatrician, plastic surgeon, orthodontist, logopedists and psychologists. The members of this team should interact together for the benefit of those patients.
Protocol of assessment:
(I)Elementary diagnostic procedures:
5. Patient and parent interview.
6. Auditory perceptual assessment (APA).
7. Visual assessment of the facial proportions and dental occlusion.
8. Simple clinical tests to screen for open nasality.
(II)Clinical diagnostic aids:
4. Documentation of APA by high fidelity voice recording.
5. Documentation of clinical assessment.
a. Endoscopy
b. Lateral skull radiograph.
c. Anthropometry.
6. Formal testing.
(III)Additional instrumental measures:
6. Acoustic analysis of speech.
a. Spectrograph and spectrogram.
b. Nasometry
7. Aerodynamics.
8. Computerized tomography and multiple view videofluroscopy.
9. Cephalometry via the cephalostat.
10. Electropalatograph.
When managing those cases the interdisciplinary team should be targeting the patient’s chief complaint. The team will either start by a management of the malocclusion, and the pathology causing it, following that with a speech therapy directed towards correcting the outcome of malocclusion. Or the team may begin with speech therapy sessions. Surgery and speech therapy are both integrated into a homogenous management protocol where all members of the interdisciplinary team, the patient or his parents, take part in therapy and decision