title: Longitudinal progress of overall intelligibility, voice, resonance, articulation and oromyofunctional behavior during the first 21 months after Belgian facial transplantation.
abstract: OBJECTIVE
  The purpose of this study is to document the longitudinal progress of speech intelligibility, speech acceptability, voice, resonance, articulation and oromyofunctional behavior in a male facial transplant patient 8 days, 15 days, 5 months, 12 months and, finally, 21 months after surgery.
  
  
  METHODS
  Identical objective (Dysphonia Severity Index, nasometry, acoustic analysis) and subjective (consensus perceptual evaluation, Dutch speech intelligibility test; flexible videolaryngostroboscopy/naso-endoscopy) assessment techniques and questionnaires (speech and voice handicap index, oral health impact profile, facial disability index) were used during each of the five postsurgical assessments.
  
  
  RESULTS
  The pattern of results shows a longitudinal progress of speech intelligibility and acceptability and of the interactive processes underpinning overall speech intelligibility. Vocal quality is normal and resonance is characterized by hypernasality. The phonetic inventory is complete but four phonetic disorders remain. Outcomes pertaining to articulation (formant analysis) show evident progress over time. Lip functions are improving but still decreased.
  
  
  CONCLUSIONS
  Transplantation of the face in this patient has largely restored speech. To what extent resonance, articulation, and lip functions can be enhanced by the permanent use of a palatal obturator, by specialized facial and lip movement exercises in combination with motor-oriented speech therapy, is subject for further research. Learning outcomes Facial transplantation: Readers will be able to (1) describe the relationship between facial transplantation and the impact on speech and oromyofunctional behavior, (2) identify variables that influence the outcome after facial transplantation, (3) define an assessment protocol after facial transplantation, (4) define facial transplantation.
authors.affiliation: Department of Speech, Language and Hearing sciences, University Gent, De Pintelaan 185, 9000 Gent, Belgium. Electronic address: kristiane.vanlierde@ugent.be.
authors.forename: Kristiane M
authors.initials: KM
authors.lastname: Van Lierde
authors.affiliation: Department of Speech, Language and Hearing sciences, University Gent, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Miet
authors.initials: M
authors.lastname: De Letter
authors.affiliation: Department of Head and Neck Surgery, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Hubert
authors.initials: H
authors.lastname: Vermeersch
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roche
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Stillaert
authors.affiliation: Department of Psychiatry and Medical Psychology, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Lemmens
authors.affiliation: Department of Nephrology, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Peeters
authors.affiliation: Department of Transplant Surgery, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Phillip
authors.initials: P
authors.lastname: Blondeel
authors.affiliation: Department of Speech, Language and Hearing sciences, University Gent, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Corthals
mesh_terms: D005151:Facial Injuries / Q000601:surgery; D005152:Facial Muscles / Q000502:physiology; D054445:Facial Transplantation / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013060:Speech; D013065:Speech Intelligibility; D013997:Time Factors; D014831:Voice
keywords: Facial transplantation; Intelligibility; Resonance; Speech