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Part 5–One From the Team: Speech Therapy and the School-Aged Child

Surgery and Speech Therapy

My child just had a jaw surgery to get ready for braces.  Will surgery and braces make more problems for his speech?

Palatal expanders. Many children report additional speech problems related to palatal expanders which are often worn before the bone graft surgery on the alveolar ridge (gum line).  During this time, children may struggle for as long as two weeks with poorer speech clarity and problems managing their saliva (spit).  After about two weeks most children have adapted to the appliances and things improve. This is not a good time for speech therapy as your child’s dental structures are moving and changing.  As the structures stabilize, speech therapy may or may not be needed. Certainly any new speech errors created by the expander (an example only, I’m not picking on palatal expanders or my orthodontic partners!) should disappear after the expander is removed or your child has adapted to its presence.

Some children require orthognathic surgery that moves upper and/or lower jaws forward (or back). Even though many of these larger surgeries are done during the teen or young adult years, there is a possibility with some of these procedures that a child’s palate becomes “short” in proximity to the back of their throat. If your child had a surgery to improve speech, such as a pharyngeal flap, when younger, the flap may create some pull on the movement the oral surgeon is trying to create. Releasing the flap may assist with the orthognathic surgery; however, this should be done in coordination with the team to minimize a negative impact on speech. There are many factors that feed into the outcome if this situation presents itself and too many factors to detail here, but this is an example of how critical the team consultation is to those outcomes.

speech mechanism

 Human speech is produced by the functioning of many complex structures in the mouth and throat.

Changes to the structure around the soft palate (back roof of mouth)–even without surgery or use of an appliance like an expander–can affect speech. This is another great opportunity to resource all the expertise available through your cleft palate team treatment team. Input from the speech pathologist, surgeons and dental professionals are needed to monitor, anticipate or minimize the effect the physical changes may have on speech and healthy speech development.  If your child’s speech changed/worsened as a result of another medical procedure, the team assessment will include a plan for improving speech. Although sometimes this can mean another surgery, the goal  is normal speech and resonance and so it should not be assumed, without further assessment or input from the whole team, that things cannot be improved upon.

Finally, by the time your child is involved in some of these orthodontic or oral surgery procedures, he or she is old enough to be actively involved in the discussion about treatment planning and follow up care. Engaging the child/patient in this way minimizes surprises for them and contributes to better outcomes–and that’s the ultimate common goal for parents, patients, and healthcare providers!

Miss earlier posts in this series?

Part 1Speech with the Team, Speech at School here.

Part 2–Building the Relationship Between Parents, Team and School here.

Part 3–Timing and Need for Speech Therapy here.

Part 4–Why Aren’t we Done Yet? here

About this series: We recently asked Theresa M Snelling, M.A.,CCC-SLP, to help us learn more about speech development and support for the school-aged child. We are so pleased to share her response with you in this special eight-part, One From the Team series, Speech Therapy and the School-Aged Child.

Teresa is clinical coordinator for the Cleft Palate and Craniofacial Center at Rose Medical Center, Denver, CO and has been working with patients and families affected by clefts for more than 30 years. If you need assistance locating a team or a cleft-specializing speech therapist, please, drop us a line or give us a call! 1.800.242.5338 or info@cleftline.org.