The Interplay of Orofacial Morphology, Gonial Angle, and Emotional Regulation in Speech and Functional TMJ Impairment and Personalized Approaches

<i>Background and Objectives</i>: Speech sound disorders, particularly dislalia (DIS), often stem from multifactorial anatomical, functional, and emotional causes during child development. Early identification of risk factors can improve therapy outcomes and prevent long-term communicative and social impairments. This study aimed to assess the relationship between structural (orofacial anomalies, dental arch morphology, and gonial angle (GA)), emotional, and therapeutic variables as predictors of DIS and its subtypes in children aged 5-12 years. <i>Materials and Methods</i>: A cross-sectional observational study was conducted on 121 pediatric subjects (58 boys; 63 girls; median age 7.5 years) using clinical examination, standardized speech assessments, emotional-behavioral questionnaires, and radiological imaging(GA measurement). Associations between DIS types, TMJ function, anatomical variation, and therapy outcomes were analyzed using chi-square tests (χ²), odds ratios (ORs), and 95% confidence intervals (CIs). <i>Results</i>: Cleft-type (OR = 21.43; <i>p</i> = 0.003), asymmetrical (OR = 14.66; <i>p</i> = 0.004), and crossbite arches (OR = 6.43; <i>p</i> = 0.013) significantly predicted DIS. A GA > 130° and <120° trended toward increased speech and motor dysfunction (OR = 4.67; <i>p</i> = 0.086). Emotional dysregulation (ED) moderately increased the functional temporomandibular joint dysfunction (FTMJD) risk (OR = 2.26; <i>p</i> = 0.060). Early therapy initiation (<7 years) and FTMDJ normalization were consistently associated with superior speech improvement outcomes (OR = 3.10 and 2.40; <i>p</i> < 0.01). <i>Conclusions</i>: DIS is strongly impacted by structural craniofacial anomalies, particularly cleft-type arches and severe jaw angle deviations. Our findings provide evidence that preliminary personalized approaches and emotional regulation may be beneficial for improving treatment outcomes. These exploratory associations support the rationale for interdisciplinary screening in pediatric populations, but confirmation in multicentric and longitudinal studies is needed.