Employing deliberate practice to overcome the effects of hemifacial condylar hyperplasia and hypoplasia on a classical singing technique

Abstract

Hypoplasia and hyperplasia both result in asymmetry of the face, with the chin deviating to the unaffected side and the occurrence of cross-bite malocclusion. Wright and Flaggert (1993) explain that abnormal growth stimulation in the jaw can be classified as congenital, in other words a genetic trait, or acquired, caused by mechanical injuries such as a sudden impact on the temporomandibular joint. These conditions may cause functional problems and joint dysfunction, which may result in pain (Almeida, et al., 2015) and are often corrected by orthognathic surgery (Kaneyama, et al., 2009). In a study done on the changes in temporomandibular joint dysfunction (TMD) after orthognathic surgery, it was found that patients who suffered from TMD symptoms, especially pain, prior to mandibular advancements were more likely to experience a significant increase in symptoms postsurgery (Wolford, et al., 2003). When the masticatory muscles are in spasm over a long period of time due to TMD, the muscles will begin to shorten causing permanent damage preventing a person from sufficiently opening the oral cavity (Burt & Burt, 2014). This describes my own journey from a very young age, through surgery after commencement of my master’s studies and up to the ongoing process of rehabilitation. Early dental treatment, including the need for braces and dental elastics, resulted in undesirable habits which affected my singing technique. Technical improvement became a constant battle, as I did not possess sufficiently free mandibular movement to create the desired degree of mouth aperture for optimal resonation. Instead, I would continue to spread my lips when singing high notes. Not only was I unable to sing for a lengthy period following the operation, but the pain post-surgery resulted in the avoidance of regular practice, which in turn led to self-doubt and performance anxiety. I therefore decided to embark on a journey of discovery to find solutions for these challenges. Using a p-l methodology and implementing a deliberate practice regime, various interventions were explored to either overcome or manage the residual effects of having lived and sung with this condition over a prolonged period of time.