Orthognathic speech pathology: Understanding how jaw disharmonies and their surgical correction influence speech

摘要 科学方法：患有严重牙面部不和谐(DFD；颌骨不和谐)的患者寻求正颌 手术和正畸护理，以解决咀嚼，美学和语言问题。初步数据来自 我们在北卡罗来纳大学-CH分校的同事产生的数千名DFD患者表明，对语言的担忧超过了损害 咀嚼是手术的动力。由于研究有限，作为提供者，我们无法提供证据- 基于我们的正畸和手术干预是否能解决语言障碍的建议 与DFD相关联。尽管数据有限，患者还是接受了侵入性的下颌手术，希望能说话 进步。为了解决这一知识差距，我们收集了手术记录和术前音频 DFD患者的录音以定量描述他们的言语特征。在这份提案中，我们提出 确定重大发音错误的解剖学阈值的初步数据。根据这些数据，我们 假设语音失真与前后颌骨和垂直颌骨的严重程度相关 不和谐，矫正手术会带来长期的语言改善。我们建议 以下旨在解决这一假说，并探索颌骨不和谐矫正之间的关系 和演讲。目的1：研究下牙合(III类)与开牙合不和谐的关系， 和语音失真。目的2：评价矫治正颌外科手术的近期和远期疗效。 下牙合和张开咬合患者的语音失真。 培训方法：雅各克斯博士是一名双重培训的临床医生兼科学家，他在完成牙科学校的同时完成了 哈佛大学牙科医学院研究生院(HSDM-DMD)和文理研究生院 (GSA-PHD)。此外，她还是美国正畸委员会的认证文凭。她的研究 这个应用程序的程序和焦点的灵感来自于一位寻求治疗以帮助她说话的患者 正常情况下，循证治疗的选择并不明确。本次K08的辅导计划 该奖项旨在确保雅各克斯博士将成为一名全面和成功的独立临床医生-科学家 在完成本提案中的活动之后。雅各克斯博士组建了一支强大的指导团队来指导 她的专业发展和她的独立研究计划的建立。两位共同导师和 来自不同但适当的科学和专业背景的四名顾问将协助完成这项工作 训练和科学活动的一部分。科学互动以及语音科学的教学培训和 语音科学技术将增加雅各克斯博士在临床正畸和生物学方面的坚实基础 牙齿面部的不和谐。这些增长机会将使拟议的 实验，而专业发展活动将补充培训活动，并提供博士。 雅各克斯拥有在学术上茁壮成长所需的技能，并启动了她的独立研究计划。

ABSTRACT Scientific Approach: Patients with severe dentofacial disharmonies (DFD; jaw disharmonies) seek orthognathic surgery and orthodontic care to address issues with mastication, esthetics and speech. Preliminary data from thousands of DFD patients generated by our colleagues at UNC-CH indicate speech concerns surpass impaired chewing function as a motivator for surgery. Due to limited studies, we, as providers, are unable to give evidence- based recommendations as to whether our orthodontic and surgical interventions will address speech disorders associated with DFD. Despite limited data, patients undergo invasive jaw surgery in hopes of speech improvement. To address this gap in knowledge, we have gathered surgical records and pre-operative audio recordings of patients with DFD to quantitatively characterize their speech. In this proposal, we present preliminary data identifying anatomical thresholds for significant articulation errors. Based on these data, we hypothesize that speech distortions correlate with severity of anterior-posterior and vertical jaw disharmonies, and that corrective surgery yields long-term improvement in speech. We propose the following aims to address this hypothesis and explore the relationship between correction of jaw disharmonies and speech. Aim 1: To examine the relationship between underbite (Class III) and open bite jaw disharmonies, and speech distortion. Aim 2: To assess short- and long-term effects of corrective orthognathic surgery on speech distortion in patients with underbite and open bite. Training approach: Dr. Jacox is a dual-trained clinician-scientist, who completed dental school in parallel with graduate school at Harvard School of Dental Medicine (HSDM- DMD) and Graduate School of Arts and Sciences (GSAS- PhD). In addition, she is a certified diplomate of the American Board of Orthodontics. Her research program and focus of this application was inspired by a patient seeking treatment `to help her talk normally', whereby an evidence-based treatment option was not clear. The mentoring plan for this K08 award is designed to ensure Dr. Jacox will be a well-rounded and successful independent clinician-scientist following completion of the activities in this proposal. Dr. Jacox has assembled a strong mentoring team to guide her professional development and the establishment of her independent research program. Two co-mentors and four consultants from diverse yet appropriate scientific and professional backgrounds will assist in the completion of the training and scientific activities. Scientific interactions as well as didactic training in speech science and technologies of speech science will add to Dr. Jacox's strong foundation in clinical orthodontics and the biology of dentofacial disharmonies. These growth opportunities will allow for successful completion of the proposed experiments, while the professional development activities will complement the training activities and provide Dr. Jacox with skills necessary to thrive in academics and launch her independent research program.