Speaking and swallowing are functions that many take for granted on a daily basis. In order to understand better how we speak and swallow this section will very briefly describe the anatomy that allows us to speak and swallow, describe the jobs of these muscles, and talk about some of the prosthetic devices that could aid in overcoming alterations made to these muscles by birth, trauma, or treatment of disease.

Swallowing and speaking are controlled at the level of the back of the mouth and top of the throat (orophayrnx) by complex movements of several muscles. The soft palate forms the muscular back part of the roof of the mouth and vibrates when you say “AHH.” The throat is made of several muscle groups and will be divided into the right and left side walls and the back wall. This group of muscles forms the palatopharyngeal sphincter (pă-lĭt'a-fa-rĭn' -jē'al sfĩngk'tar, syn. velopharyngeal sphincter) and during swallowing and speaking the soft palate moves up and back, the side walls move in, and the back wall moves forward forming a valve. This valve prevents food/liquid from going into the nose (nasopharynx) during swallowing and it prevents excessive air from escaping when speaking (hypernasality).

Patients are diagnosed with Palatopharyngeal inadequacy¹ (pă-lĭt'a-fa-rĭn' -jē'al, -făr'ĭn-jē'al ĭn-ăd'ĭ-kwa-sē) if there is any problem allowing complete closure of the sphincter and this is further defined as one or both of the following:

1. If any part of the muscles are missing or altered from birth (cleft palate), surgery, or trauma the valve can have a hole in it. This is known as palatopharyngeal insufficiency (pă-lĭt'a-fa-rĭn' -jē'al ĭn' sa- fĭsh'an-sē)
2. If the muscles are not altered in volume but fail to move due to disease or trauma to the nerves (whiplash, stroke, blunt force to back head, etc) or stiffening from radiation therapy the valve will not close completely and this is defined as palatopharyngeal incompetence (pă-lĭt'a-fa-rĭn' -jē'al ĭn-kŏm'pĭ-tans)

A prosthodontist with maxillofacial prosthetics training often is able to aid in correcting palatopharyngeal inadequacies. This is accomplished by building one of several types of prostheses to plug the hole or pick up the soft palate. A soft palate obturator (also known as a speech and feeding aid/device) replaces the missing piece(s) of muscle(s) and fills the hole. A palatal lift prosthesis aids in repositioning the soft palate in the raised closed position.

The process for making these prostheses requires a mold of the moth to be made and either a metal framework or an all plastic prosthesis will be used. In each case the patient will require some adjustments to the prosthesis as this an area that moves every time the patient speaks or swallows. Adjusting either of these prostheses is a fine balance between swallowing and speaking. If the valve is closed too tightly then swallowing is very good but speaking will sound as if the patient has a cold or stuffy nose (hyponasality). If the valve is left more open then speech will sound better but food/liquid leakage when swallowing may be increased. In addition, healing from surgery or radiation treatment will alter this area and require frequent adjustments until all healing is completed.

Caring for the prosthesis is relatively easy. Simply brushing the prosthesis or rinsing with soap and water when cleaning the teeth is adequate. Effervescent partial denture cleaning tablets can be used as well when the prosthesis is soaking while the patient is sleeping.

In conclusion, these two prostheses aid in improving a complex muscular valve disfunction. With patience and time these prosthetic devices can be fine tuned to be very functional and comfortable.

1. Glossary of Prosthodontic Terms, 8th ed. J Pros Dent 2005;94(1):1-104.

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These documents and links are intended to inform you of issues, sequelae, and treatment options related to various diagnoses and maxillofacial prosthodontic treatments that may interest you. The information is not intended to suggest or dictate treatment or outcomes, but may serve to begin a discussion with your physician and prosthodontist.