# Speech Disorders in Dysgnathic Adult Patients in the Field of Severity of Primary Dysfunction
## 2 Materials and Methods  
This study was approved by the Bioethical Committee of the University of Lodz no. RNN/73/19/KE. The research, in general, was about the relationship between malocclusion, speech and articulation disorders. Previous papers on the subject have published data on the impact of short frenulum on speech and logopaedic evaluation of adult patients after orthognathic surgery [10; 11]. In the presented study, the materials and the method were extended and adjusted. In addition, inclusion and exclusion criteria (Table 1) were established. The authors collected the data from 181 consecutive adult (26.4 \(\pm\) 7.6 y.o.) patients (61 males and 120 females) diagnosed with class II and III skeletal deformities, who were treated at the Department of the Maxillofacial Surgery of Medical University of Lodz, Poland. The patients were enrolled to research randomly, based on reporting time to the Maxillofacial Outputatien Clinic and the possibilities of coordinating all medical and speech examinations before the surgery. The data present disorders prior to the surgery. The group consisted of 4 patients with laterogenia, 117 with progenia, 44 with retrogenia and 16 with open bite. All the selected participants had undergone a combined orthodontic and orthognathic treatment accompanied by a qualified speech-language pathologist's diagnosis, and orofacial myofunctional therapy, if necessary, along with evaluation. The study was performed in stages: a patient's qualification for combined treatment along with orthodontic diagnosis (Table 2), a detailed interview with particular emphasis on information about previous speech-language therapy with external and intraoral examinations by a speech-language pathologist. The study took into account overall language proficiency and thorough phonetic analysis of the collected speech samples. Speech-language pathology diagnosis was based on the Speech Organ Fitness Questionnaire [13] and the Articulation Test for Children and Adolescents [14]. Every patient was diagnosed by the same speech-language pathologist and the same maxillofacial surgeon conducted the surgery. Both tools were adapted for this study. Table 3 presents all phonemes tested. The previous research. The Logopaedic Evaluation of Adult Patients after Orthognathic Surgery-statistically confirmed and presented a new classification: Skeletal Consonants (SC) consisting predominantly of alveolar, palatal and dental consonants. The second group of consonants detected by mathematic analysis are Soft Tissue (STC) consonants. They consisted mainly of bilabial and labiodental consonants. Skeletal consonants and soft tissue consonants are terms used for the second time according to modern logopaedics worldwide. That is a proposed form of a new kind of classification. \begin{table}
\begin{tabular}{c c} \hline
**Inclusion Criteria** & **Exclusion Criteria** \\ \hline (1) skeletal class II or skeletal class III & (1) cleft lip/palate \\ (2) age between 18 to 50 years old & (2) alveolar process cleft \\ (3) misarticulation and primary function disorders & (3) treatment protocol: surgical correction of dysgnathia \\ (4) patient consent for treatment & (surgery first), then orthodontic treatment \\ (5) patient consent for full speech pathology examination & (4) lack of dysgnathia \\ (6) treatment protocol: orthodontic decompensation, then & (5) lack of any of patient’s consents, documents \\ surgical correction of dysgnathia & (6) age under 18 and above 50 years old \\ (7) speech diagnosis before and after the surgery & (7) hearing, sight, fonation disorders (i.e., pace and fluency, stuttering) \\ \hline \end{tabular}
\end{table} 
Table 1: Inclusion and exclusion criteria. Some additional examinations on breathing, swallowing, chewing and biting patterns were added. The study was conducted and recorded using a digital voice recorder.