Ages Eight to Twelve Years
Ages eight to twelve are called the period of mixed dentition because children lose their primary (baby) teeth, and their secondary (permanent) is used to move the teeth into a more normal position. This enables the orthodontist to create a normal arch form and a good positioning of the upper and lower teeth.
If there is underdevelopment of the upper jaw, overdevelopment of the lower jaw or a combination of two, further recommendations for treatment will be made. In about ten percent of all cases, surgical treatment may be necessary to correct skeletal deformities of the upper and/or lower jaws. Treatment is delayed until orthodontic alignment of the teeth is completed, and this surgery is performed no earlier than fourteen to sixteen years of age.
Upper jaw surgery involves incisions in the soft tissues inside the mouth which cover maxilla, allowing the surgeon to advance or move it forward. The new position of the bone is then secured with miniplate fixation. While this type of surgery is not frequently required, it can enhance the function and appearance of the teeth and jaws while speech and nasal breathing.
Surgery on the lower jaw may be necessary to correct the skeletal deformity. It is performed when the jaw appears to be overgrown and must be set back to balance both the upper and lower lower jaws. This setback procedure is called a mandibular osteotomy.
Nasopharyngoscopy is a technique used by the physician to visualize or look at the back of the throat and the velopharynx. It can be performed in children as young as four to five years of age and is done while the child is awake and talking. Nasopharyngoscopy involves placing a small tube through the nose and into the throat. The physician and / or speech pathologist can look through this tube to analyze the movements of the soft palate and throat as the child talks. Recordings of these movements are made on a videotape synchronized with the speech sounds
Nasometry is a method of measuring the acoustic correlates of resonance and velopharyngeal function through a computer based instrument which gives a nasalance score, which is the percentage of nasal acoustic energy of the total energy(nasal + oral). The Nasometer is used for assessment purpose, by analyzing on standardized reading passages overtime for up to 100 seconds. Measures such as mean nasalance, maximum and minimum nasalance, and more, can be instantly calculated. Statistics, which can be stored, reflects the production of standardized reading passages and can be compared to normative data on subjects within patient’s age group.
Based on the results, Speech pathologist suggest for Secondary Palate repair (if required) usually at the age of four years. The child must be old enough to co-operate for the speech assessment. Usually, the age is four to five years, although occasionally it is possible to assess children as young as three years old. Post operatively, after two to three months, speech therapy will be recommended and also early speech and language evaluation also important (From 1yr to 3yrs) to counsel the parents regarding Speech and language development. Parents play a very important role in working with the child to encourage the development of normal speech and language. The Speech Pathologist will provide guidance for parents throughout the intervention.
