Comparison of speech and resonance outcomes across three methods of treatment for maxillary defects

Purpose: Treatment of maxillary defects, whether by prosthetic rehabilitation or surgical reconstruction, should aim to restore speech function and resonance balance. With the advent of technology and changing clinical practices related to maxillary defect management, speech outcomes need to be evaluated and compared in order to determine efficacy of differing approaches. Materials and Methods: One hundred and four patients across three treatment groups for maxillary defects were included: 38 patients who were treated with maxillary obturators (OBT group), 39 patients who were treated with a standard fibular free flap reconstruction that did not involve digital planning of the reconstruction (Standard group) and 27 patients who were reconstructed using a digitally planned surgical design and simulation fibular free flap reconstruction (SDS group). Speech assessments were completed to assess word and sentence intelligibility, resonance balance and aeromechanical orifice estimation among these three groups. Assessments included the Computerized Assessment of Intelligibility of Dysarthric Speech (C-AIDS), nasalance scores via the Nasometer and palatopharyngeal orifice area via the PERCI-SARS. Results: Significant differences were found in word intelligibility between the SDS and the Standard groups (p =.035) and on nasalance scores between the SDS and the OBT groups (p=.027). Conclusions: Patients treated with digital reconstruction (SDS) had better speech outcomes than the other two treatment groups, whose mean scores on certain speech variables were not within normal limits. Speech outcomes in the SDS group were consistently within the normal range across all measured speech variables.