Some children have speech difficulties because the structural apparatus required to produce fluent clear speech is damaged or has not developed in such a way as to promote good speech production. Every child’s face is different, but for most, the physiological proportions of the bones and muscles around the head and neck enable clear speech development and production. Speech is articulated by using a range of muscles and these are connected to bones and cartilage. When any of these muscles or bones are mis-shapen or inflexible it can effect speech production.

The articulation of speech involves the tongue, teeth, facial and neck muscles, pharynx, naso-pharynx, palate, mandible (jaw) and maxilla. These are supplied by nerves and blood vessels.

Types of structural abnormalities

These can be any type of growth, abnormal tissue, fistular, abnormal opening, over growth of bone or muscle, or lack of bone or muscle responsible in the production of speech. Examples of these abnormalities:

• Cleft lip and / or palate
• Velopharyngeal insufficiency
• An occlusion of the mandible or maxilla (underbite or overbite)
• Dental abnormalities or missing teeth
• Tongue size, including “tongue tie”
• Fusion of bones such as the mandible

Accidents can cause any manner of these abnormalities, but they can also be caused by genetic syndromes or behaviours such continually sucking foreign objects as a child.

Surgeons and orthodontists are now able to repair many facial abnormalities. When structural surgery is accompanied by speech and language therapy many children can acquire normal speech.

Cleft lip and palate

A cleft lip and/or palate usually forms before birth. It is a separation of either, or all of the lip, hard and soft palate. Sometimes it will be minor such as a small hole in the hard palate or a small gap in the lip, but at the other extreme it can be opening at the lip all the way along the hard and soft palate, exposing the nasal cavity.

There are believed to be a number of causes. There is often a genetic link, but exposure to certain drugs, alcohol, solvents, cigarettes etc during pregnancy have all been linked with the development of cleft lip and palate.

Despite the severity of some cleft palates, modern surgery can be very successful at rejoining the lip and palate, often with minimal scarring. Surgery is often carried out on the child within a few months of birth. A team approach is essential for a positive outcome and will involve a number of professionals including a surgeon, orthodontist and speech and language therapist/pathologist. Support services around psychosocial issues should also be involved if needed because of the very visual nature of this disorder.

Velopharyngeal insufficiency

This occurs when the soft palate is not long or big enough to close off the nasal cavity. When this occurs, air escapes into the nasal cavity during speech causing speech articulation difficulties and speech to be very nasal (hypernasality). Velopharyngeal insufficiency is often associated with a cleft palate, but may be an abnormality of its own. Operations to lengthen the soft palate can be successful, but in less severe cases speech therapy may be sufficient.

Occlusion of the mandible or maxilla

This can be a hereditary feature, although repeated pressure put onto the jaw or maxilla early on in a child’s life can cause this to occur. I have witnessed a boy who wore an oxygen mask to bed each night and this pressure over a period time had caused his maxilla to not grow in line with the rest of his face. This had caused his lower teeth and jaw to be further forward than his upper teeth, causing a speech difficulty. However, orthodontists and surgeons can now do amazing work to bring the teeth in line.

Ankyloglossia (Tongue Tie)

Tongue Tie is an oral anomaly where the tongue has a lack of mobility because the lingual frenulum (the membrane connecting the tongue to the floor of the mouth) is too thick or short. This condition can range in severity and can cause articulatory problems, but not in all cases. If the condition is severe and affecting speech and feeding then a minor operation (frenotomy or frenuloplasty) can take place to allow the tongue more movement. In less severe cases the speech problem may correct itself or may require some sessions of speech therapy.

Other abnormalities

There are a range of other structural abnormalities that may occur around the head and neck due to accident or disorders. In these cases surgical intervention and/or speech therapy can help to improve communication.