Initial speech problems in patients treated with multiple zygomatic implants.

PURPOSE: The aim of this study was to investigate the speech ability of patients treated with multiple zygomatic implants. This technique can be used in patients with severe atrophy of the maxilla when there is insufficient residual bone in the anterior region for placement of conventional implants. MATERIALS AND METHODS: Between 2004 and 2008, audio recordings were performed in patients treated with fixed dental prostheses (FDP) supported by multiple zygomatic implants. Patients with extensive resorption of the basal bone of the maxilla (Cawood and Howell Class VI) were included in the study. No bone grafts were used. Audio recordings were conducted before treatment (pretreatment), within 1 week after the FDP was inserted (1 week posttreatment), and then again after 4 months (4 months posttreatment). Perceptual evaluations of the recordings were performed by a panel of speech and language pathologists (n = 3), and the patients' subjective views of speech quality were investigated on the three different occasions. RESULTS: Seven consecutive patients were treated with a total of 28 zygomatic implants and five conventional implants. All patients received a FDP. According to the evaluations by professionals, five of the seven patients, all of whom wore a removable conventional denture prior to treatment, had normal speech before treatment. One patient could not be evaluated by the professionals because of medical impairment. In five of the six remaining patients, a mild deterioration in articulation was registered at 1 week posttreatment, and these problems remained after 4 months. Patients' subjective views reflected a dramatic improvement in speech at 1 week posttreatment for the two patients presenting with the highest degree of maxillary bone resorption. The three patients who reported completely normal speech before treatment all experienced a drop in their ability at 1 week posttreatment. Four patients displayed a similar pattern after treatment according to the professionals' opinions and the patients' subjective reports. CONCLUSION: A mild deterioration in speech can be anticipated in patients subjected to treatment with a FDP supported by multiple zygomatic implants.

New complexities in the genetics of stuttering: significant sex-specific linkage signals.

Stuttering is a speech disorder long recognized to have a genetic component. Recent linkage studies mapped a susceptibility locus for stuttering to chromosome 12 in 46 highly inbred families ascertained in Pakistan. We report here on linkage studies in 100 families of European descent ascertained in the United States, Sweden, and Israel. These families included 252 individuals exhibiting persistent stuttering, 45 individuals classified as recovered from stuttering, and 19 individuals too young to classify. Primary analyses identified moderate evidence for linkage of the broader diagnosis of "ever stuttered" (including both persistent and recovered stuttering) on chromosome 9 (LOD = 2.3 at 60 cM) and of the narrower diagnosis of persistent stuttering on chromosome 15 (LOD = 1.95 at 23 cM). In contrast, sex-specific evidence for linkage on chromosome 7 at 153 cM in the male-only data subset (LOD = 2.99) and on chromosome 21 at 34 cM in the female-only data subset (LOD = 4.5) met genomewide criteria for significance. Secondary analyses revealed a significant increase in the evidence for linkage on chromosome 12, conditional on the evidence for linkage at chromosome 7, with the location of the increased signal congruent with the previously reported signal in families ascertained in Pakistan. In addition, a region on chromosome 2 (193 cM) showed a significant increase in the evidence for linkage conditional on either chromosome 9 (positive) or chromosome 7 (negative); this chromosome 2 region has been implicated elsewhere in studies on autism, with increased evidence for linkage observed when the sample is restricted to those with delayed onset of phrase speech. Our results support the hypothesis that the genetic component to stuttering has significant sex effects.