Vijay Pratap Singh, MDS' Cirisb Bharadwai, 8DS" K. Chandrasekharan Nair, BDS, MDS— Direct Observation of Department of Frosthodontics and Maxillofacial Prosthetics Tongue Positions in Speech— Oental College Trivandrum A Patient Study Kerala, India Tongue position for four selected consonants, /s/, /k/, /I/, and /t/, was observed and photographed through an opening in the cheek of a patient. The cheek had been resected to remove a tumor. On comparison of the tongue positions with those described in the literature, it was found that the variations in tongue position were negligible. Although the patient had a large facial defect, speech clarity was also not affected. As reconstructive surgery was not immediately feasible, a cheek prosthesis was fabricated for the facial aspect, Int J Prosthodont 1997;10:23!-234. ll speech sounds are made by a controlled flow Patient Report Aof air,' A series of musculoskelefal valves posi- tioned from tbe palatopharyngeal to the bilabial A 65-year-old woman reported fo fhe Department valve control the airstream to produce the full range of Prosthodontics and Maxillofacial Prosthetics af of speech sounds. The tongue, teeth, and lips serve the Dental College in Trivandrum following the re- as articulators and are responsible for the actual section of her left cheek as a sequel to cancer ther- emission of sound and the difference in speech apy. The patient was sent for provisional rehabilita- sounds,^^ Speech can be studied by: peroral view- tion. On examination it was found that there were ing, the use of oral panendoscope,^ observation of no teeth in the posterior segment of the left maxil- the behavior of the patient during speech and cer- lary and mandibular arches, making direct vision tain nonspeech activities, oral manometer,^ spiro- of the oral cavity possible (Fig 1), The patient was meter,^ a nasal anemometer/ speech spectrograph,^ able to speak normally. It was decided to study the total oral nasal acoustic ration (Tonar),^ lateral role of the tongue in the production of consonants. roentgenograms of the head and neck,''' laminagra- After obtaining consent, the patient was asked to phy," pulsed ultrasound,''•'^•'^ cinefluoroscopic and pronounce four consonants, /$/, /k/, /I/, and /t/, and vldeofluoroscopic fechniques,'"* palatography,'' and the tongue positions in the pronunciation of these continuous palatography,'^'" Direct observation, if phonemes were photographed through the cheek possible, is undoubtedly fhe best method to study opening. The consonants selected were those in- the process involved In speech. Such a rare opportu- volving tongue movements,'^ nity is presented in this report. The phoneme /s/ was produced by the contact of the lateral margin of the tongue with the alveolar ridges; the blade of the tongue nearly contacted the "Former Post Graduate Student. rugae region of the palate with the tip of the tongue "Post Graduate Student. placed behind the maxillary teeth (Fig 2], In fhis way '"Associate Professor and Head. a narrow midline tongue groove was formed Reprint requests: Dr K. Chandrasekharan Nair, J4/726, through which air passed, thus producing the conso- lakshmi, Nsndavanam, Trivandrum - 595 033, Kerala, India. nant. For a person with a normal speech mecha- Í10, Njmher3, 1997 231 The Inlernational journal of Prosthodonlics Direct Observiition of Torgiit Pfi5ilir>nç in Speech nism, the lingua-alveolar fricative /s/ rcsLiits from the formation of a narrow midline tongue groove through which air is directed against the incisai edge of the teeth. The lateral margins of ihe tongue con- tact the teeth and gingivae, and the blade of the tongue nearly touches the alveolar ridge^^ (Fig 3). The size and shape of this small space determines the quality of sound.' The palatopharyngeal valve is closed. Some speakers may place the tip of the tongue behind the maxillary teeth and others behind the mandibular teeth. In this patient, the tongue was placed behind the maxillary teeth. The most impor- tant consideration is the constriction of the air stream by the narrow groove and its impedance by the residual ridge and teeth. The breath stream is voiced for /s/. There was no difference noticed be- Fig 1 me extent cf the patient's cheek defect. tween the tongue position of the patient studied and that which is documented in the literature. Fig 2 (Above) Tcngue position wnile producing the conso- nant /s/. Fig 3 (Right) Normal tongue position during the prcducticn of the ccnsonant Is/. Fig 4 (Above) Tongue positicn for production of the conso- nant /kf. Fig 5 (Right) Normai tongue positicn during the production ofthe consonant/k/. The Inlerralionai Journal of ProBthodonlits 232 Volume 10. Number 3. 1997 Singh el al ationol Tongue Positk The consonant/k/was produced when the mid- tongue contacts the alveolar ridge and the lateral dle and posterior dorsal region of the tongue con- margins of the tongue are lowered so that the air tacted the posterior region of the hard palate and stream flows laterally on either side of the contact the soft palate (Fig 4). Normally the lingua-velar (Eig 7). The palatopharyngeai valve is closed.'^ The consonant /k/, a guttural, is produced when the tongue position for the production of/I/ in the pa- middle of the tongue contacts the soft palate, the tient was similar to that in normal individuals. palatopharyngeal valve is closed, and pressure is The phoneme Ixj was produced when the tip of built up behind the lingua-velar contact and then the tongue tightly contacted the palatal surface of released'"" (Fig 5). The production of this plosive in maxillary anterior teeth and the lateral margins of the patient was similar to that in normal individu- the tongue lightly contacted the buccal alveolar als, except that the contact area of the tongue was ridge and teeth (Fig 8). In a normal individual the widened to include the posterior region of the bard lingua-alveolar consonant /t/, a plosive, is pro- palate. duced when the tip of the tongue contacts the To produce the consonant /I/, the tip of the pa- alveolar ridge and the sides of the tongue are in tient's tongue contacted the alveolar ridge in the tight contact with the teeth and gingivae, and the region of the incisive papilla (Eig 6). The lingua- palatopharyngeal valve is closed" (Fig 9), This is alveolar consonant /I/, a voiced semivowel, is pro- similar to what was observed in the patient. duced in normal persons when the tip of the Fig 6 (Above) Tongue position wtiile producing the conso- nant IV. Fig 7 (Right) Normal tongue position during trie production of the consonant /I/. Fig 8 (Above) Tongue position while producing the consc- nant/t/. Fig 9 (Right) Normal tongue position during the production of the consonant/t/. : 10, Number 3, 1997 233 The International lournal of Pjostliodontic Direct Ûbservaiioii of Tongue Positioris in Speech References 1, Hickey JC, Zarb GA, Boiender CL, Boucher's Prosthodortjc Treatment for Edentulous Patients, ed 9. Ontario; Mosby, 1985:390-393, 2, Gyton AC, Textbook of Medical Fhysioiogy, ed 8, Philadel- phia: Saunders, 1991:412^13. Í Denes PB, Pinson EN, The Speech Chain, Baltimore: Wavedy Press Inc., 1964: Cited in Northern JL, Voder DE, Speecli Language and Hearing, vol 1, Philadelphia: Saunders 1982:217. 4, Cliierici C, Lawson L, Ciinicai speech considerations in proith odor tics: Perspectives of the prosthodontist and speech pathologist, I Prostliet Dent 1973:29:29-39, 5, Taub S. The Taub oral parendoscope—A new technique, Fig 10 The patient rehabiiitated with the split cheek prosthesis. Cieft Paiale J 1966;3:328-346, 6. Hardy |C, Arkebauer HI. Development of a test for velopha- ryngeai toriipeterce during speech, Cieft Palate | 1966;3: 6-21, 7. Quigley LF |r, Shiere FR, Webster RC, Cobb CM. Measuring palatopharyngeai competence witli the nasal anemometer. Direct observation is an ideal method of study- Cleft Palate I 1964;1;3O4-31 3, ing speech, especially the role of the tongue in the 8 Dickson DR, An acoustic study uf nasality. J Speech Hear Res speech articulation mechanism, but the dark 1962;5:1O3-111. closed space of the oral cavity does not readily 9. Fletcher SG, Bishop ME, Measurement of nasality with Tonar. permit observation beyond the tip of the tongue. Cleft Paiate | 1970;7:610-621, Direct observation of the tongue would be possible 10. Hoibrook RT, Carmondy |F, X-ray studies oí speech articula- tion. In: Modern Physiology, voi, 20, University of Caiifornia only if it could be observed through the cheek Publications, 1937, Cited in Laney WR, Cibilisco |A, space following removal of the cheek, which might Diagnosis and Treatment in Proslhodontics. Philadelphia: Lea be a consequence of carcinoma or traumatic in- and Febiger, 1983:373, juries. The authors had such a rare opportunity to 11. Moli KL. Photographic and radiographie procedures in observe the tongue position in a patient. speech research. In: Conference on Communicative Problems m Cieft Paiale lASHA Reports No,l). Washington, As old age and the medically compromised status DC: American Speech and Hearing Association, Í96S: of the patient precluded plastic reconstructive 129-139. surgery, the patient was rehabilitated with the aid of 12. Ryan W], Hawkins CF, Uitrasonic measurement of lateral a cheek prosthesis. Impressions of her maxillary and pharyngeal wall movement at the velopharyngeal port. Cleft mandibuiar arches were made, and clasp-retained Palatel 1976;13:156-164, 13, Skolnick ML, Zagîebski |A, Watkin KL. Two-dimensionai ui- removable partial dentures were fabricated for both trasonic demonstration of lateral pharyngeal wall movement the arches. Impressions were made of the cheek of in real time—A preliminary report. Cleft Palate 1 197S;12t another female having a resemblance to the patient, 299-303, and a split-cheek prosthesis was constructed with 14, Skolnick ML, Videofluoroscopic examination oí the velophs- fiber-reinforced autopolymerizing acrylic resin ryngeal portal during phonation in ialeral and base projec- tions—A new technique for studying the mechanics of cio- tinted with Cosmedica (Cosmedica, UWIST, Cardiff, surcClpft Palate J I970;7:803-ai6, UK) stains to match the patient's skin.