Speech and acoustic outcomes after maxillary reconstruction with an anterolateral thigh flap: a prospective...

Maxillary reconstruction with an anterolateral thigh flap (ALTF) is widely used for the rehabilitation of maxillary defects; however, its impact on postoperative speech function remains incompletely understood. This prospective exploratory cohort study aimed to evaluate early speech and acoustic outcomes after maxillary reconstruction with ALTF and to identify factors associated with postoperative speech impairment.

Thirty-three patients who underwent maxillary reconstruction with ALTF were prospectively enrolled. Speech assessments were performed preoperatively and during the early postoperative period. Evaluations included speech intelligibility (SI), nasalance, velopharyngeal closure (VPC) assessed by nasopharyngoscopy, acoustic analysis of vowel formants and vowel space area (VSA), radiographic measurements of the velopharyngeal anatomy, and patient-reported speech outcomes. Associations between clinical variables and postoperative speech outcomes were analyzed.

Postoperatively, most patients maintained favorable speech intelligibility, while objective acoustic analyses demonstrated significant alterations in vowel production. VSA decreased significantly after surgery, indicating reduced articulatory range. Patients with defects involving ≥ 1/2 of the soft palate exhibited significantly poorer speech outcomes, including lower SI, higher rates of velopharyngeal insufficiency, and reduced VSA values. Incomplete VPC was associated with less favorable acoustic parameters and poorer speech performance. Patients with a history of tracheotomy demonstrated poorer velopharyngeal competence and less favorable acoustic outcomes. Patient-reported assessments revealed that speech remained one of the most frequently perceived postoperative functional concerns.

Early speech outcomes following maxillary reconstruction with ALTF were generally acceptable; however, objective acoustic abnormalities and velopharyngeal dysfunction remained common. The extent of soft palate involvement and postoperative velopharyngeal competence were important determinants of speech outcomes. Acoustic analysis may provide valuable complementary information beyond perceptual speech evaluation for the assessment of postoperative speech function after maxillary reconstruction. Larger multicenter studies with standardized speech assessment and longer follow-up are needed to confirm these findings and guide individualized speech rehabilitation.