Improvement of speech by facial prosthesis in a midfacial defect with a gunshot injury: A case report

Gunshot wounds in the maxillofacial region may cause serious defects that result in functional and esthetic disabilities. A 14-year-old male patient was referred to the prosthodontics clinic for provisional prosthetic restoration 5 months after an injury involving the midline midfacial region. An interim extraoral silicone maxillofacial prosthesis (MFP), also known as an epithesis, replacing the nose and upper lip, was fabricated to enhance appearance and speech intelligibility. The effect of the prosthesis insertion on speech outcome was assessed over 6 months. Blood pulse oxygen saturation levels and heart rate were monitored to assess ventilation following the prosthesis insertion. Results of the Assessment of Articulation Subtest revealed the patient produced the target speech sounds of 31 more words correctly at 6 months follow-up. Bilabial, labiodental, and postalveolar speech sounds in the phonetic inventory improved. Fabrication of an extraoral silicone MFP, modifying substructure design, and prosthesis usage over time contributed to the significant enhancement of speech intelligibility and did not significantly change the blood pulse oxygen saturation levels and heart rate. It led to an improvement in overall aesthetic outcomes and was a useful tool for the patient's social integration.