The Complementary Use of Speech Prostheses and Pharyngeal Flaps in Palatal Insufficiency

Abstract

Traditionally, speech prostheses and pharyngeal flaps have been used in cases of palate-pharyngeal insufficiency to assist speech by improving ability to impound air. In 1960 (1) , the use of speech prostheses as temporary devices for speech training was discussed and a patient was described Who, after obtaining a speech appliance, apparently developed so much pharyngeal constriction associated with speech, that the obturator was reduced in size and subsequently removed completely without appreciable detrimental effect on speech. This kind of clinical observation along with that of others (3, 5) has led to the belief that a broader approach might be taken to speech prostheses than has traditionally been used. ' Rather than considering a patient with palato—pharyngeal insufficiency as a possible candidate for either a speech prosthesis or a pharyngeal flap, it might be advantageous in selected cases to consider utilizing the assets of both the obturator and the pharyngeal flap and possibly reducing the liabilities of each. Proponents of treatment by prosthesis (4) have pointed out the modifia-bility of the obturator in terms of size, shape, level of placement, and the fact that it can usually be placed earlier than the pharyngeal flap. It is also suggested (6') that an obturator may stimulate greater pharyngeal con— striction for speech purposes. Those favoring the pharyngeal flap operation may show that a speech prosthesis can traumatize the teeth and interfere with orthodontic treatment. It can be defended that utilization of a patient's own tissue is a physiologically more healthy and more permanent form of treatment than is the placing of a foreign body in the oral cavity. A speech prosthesis needs cleaning, technical adjustments, change with growth, and ultimately requires that the speech be partly dependent upon sound teeth. Further, a patient may reject the speech appliance and thus refuse to wear it. Clinical observations of patients receiving obturators compared with those receiving pharyngeal flaps suggest that obturators are generally more