# The Logopedic Evaluation of Adult Patients after Orthognathic Surgery
## 4 Discussion  
The associations between abnormalities in the teeth, mandible, and maxilla and articulatory speech disorders are mostly equivocal. The results presented in this study may highlight some areas which have been omitted or underestimated so far. In 2007, [PERSON] et al. [23] published a review article on the effects of orthognathic surgery on speech, in which 18 longitudinal research studies conducted over the previous 50 years were evaluated. However, those reports were mainly limited and contradictory. The reason for the above resulted from the limited size of the examined groups, most of which lacked a reference group, and even if the reference was present, it was too small to compare appropriately. Many of them also did not have well-prepared statistical analyses. It was added that generally, every study differed by methodological assumptions. Some of them focused on the type of surgery, and some did not. The choice of testing tools and methods also differed. However, the most important and fundamental value of this article is that it proved how difficult it was to create a proper reference group. Considering reference groups, it must be noted that in Poland, children by the age of 3 are generally incorporated in speech therapy, which, in a standard way, lasts until they are 10-12 years old. This means that adolescents and adults with speech deficiency and malocclusion had finished their therapy by then and rarely attended speech therapy later on. The presented study focuses on the specific and multimodal approach to treat adult patients, taking into account their previous therapies. To discuss the results, it is vital to point out that the Total Lip Efficiency has improved significantly. However, the Total Tongue Efficiency did not improve as immediately as it was expected to. As the articulation movements depend mainly on muscles, not bone, the recovery and repatterning of muscle functions take time. The patients were examined 3 months after the surgery. Considering that the lip functions are closely connected with the alignment of the maxilla and the mandible, the time of examination seemed to be perfect. The test of \"teeth lips catch\" proves easy to perform when the occlusion becomes normal. Moreover, there is no or weak muscle tension in the orofacial region, and some flexibility in the anterior-posterior movements of the mandible is visible. As far as the tongue functions are concerned, the evaluation time should be longer, as the recovery and remodelling process is prolonged and needs the assistance of a speech therapist. Perhaps the change in the skeletal determinants of tongue position and function is much more altered by surgery than the lips muscle position itself. The framing of the tongue by the mandibular body, the tension of the ligaments and muscles spanning between the mandibular arm and the base of the skull, and the tension of the suprahyoid muscles are greatly influenced by mandibular displacement during orthognathic surgery [15,24]. This may be seen in the \"Arched Tongue\" test in the preoperational group in comparison to the preoperational and reference groups. This test is very difficult to patients prior to the surgery, especially due to the high palate. After the surgery, the shape and height of the palate changes, and it results in a better performance afterwards. There is no good literature that could be discussed in comparison with these findings. Thus, in previous research on tongue fronotomy effectiveness [19], it was highlighted that the tongue with a short frenulum impairs normal functions such as swallowing and resting position and may even affect articulation. One of the possible answers for why the tongue performance does not improve may be that some participants were asked to consider fronotomy before the orthognathic surgery, and they did not accept the treatment.