A&P Flashcards
3 Parts of the Palate
- Primary = Premaxilla (alveolar ridge)
- Secondary = hard palate
- Velum = thing of its own
Craniofacial Anomalies
- Abnormal structures of head & face
- Congenital
Highest to Lowest Incidence Rates in order by Race
Native Americans, Japanese, Chinese, White, African-American
Levator Palatini Muscle
- Most important part of velum for VP closure
- Contracts up & out to elevate & retract velum
Cleft Lip
Opening in the lip (usually upper lip. Lower lip is rare)
- Cleft lips are rare & usually accompanied by cleft palate (but not the other way around)
- Congenital & present at birth
- More commonly unilateral & on left side, but can be bilateral
Submucous Cleft Indicators
- Zona Polusada = tissue looks blue
- Bifid Uvula
- Tenting
- History of food out of nose
- Hypernasal
Cleft Palate Basics
- Various Congenital Malformation resulting in opening in hard or soft palate, or both
- About 1 in 600-750 births are dx with clefts
- More males have greater severity
Craniofacial Development in Utero
6-8 wks - primary palate forms
8-10 wks - secondary palate forms
9-12 wks - cleft fully formed
14 wks - face fully formed
Cleft Classifications
Cleft Lip - compete, incomplete, unilateral, bilateral
Cleft of Alveolar Processes - Unilateral, Bilateral, Median, Submucous
Cleft Palate (soft, hard, submucous)
Cleft prepalate, palate
Other Facial Clefts (horizontal, lower mandibular, lateral oro-ocular, naso-ocular)
Obligatory Errors
Affect manner more than anything.
Hard to understand but it’s out of their control.
Compensatory Errors
Affect place.
Intelligible but takes a long time to correct.
Hearing Issues with CP
- OME
- Eustachian tube dysfunction -> conductive HL -> prob with tensor palatini
Articulation Issues with CP
- Diff. with voiceless sounds
- Sound distortions
- Pressure Consonant issues
- NAE -> consonants
- Substitutions of stops, fricatives, affricates with post. movements/glottal stops/unusual movements
Language Issues in CP
- Not usually affected unless they have other dx
- Initially delayed exp. lang. but usually “normal” by age 4
CP Assessment of Velopharyngeal Adequacy
- Nasopharyngoscopy
- Oral Manomter - suck or blow from mouthpiece
- Nasometer
- Orofacial exam
CP Assessment of Speech
- Not standardized
- Iowa Pressure Artic Test
CP Assessment of Voice & Resonance
- Visipitch or Phonatory Function Analyzer
- PJs for Voice & Resonance
Surgical Management of Cleft Lips
- Straight Line:
tight, restrict growth of maxilla, no longer done - Tennison-Randall
Triangular flap, lip cut away, very tight, for uni or bilateral - Millard
Most common. Rotation Advancement Technique. Don’t lose tissue - extra length added. Uni or bilateral
One-Stage Repair
- 10-24 months (10-15 months earliest)
- Velum & HP fixed together, not lips
- Free-Flap: tissue comes from arm/knee
- Furlow Z-Plasty: soft palate made longer
- V-Y Retroposition aka Wardill Pushback: soft tissue closure to center
- Von Langenbeck: release hard palate tiss.
Two-Stage Repair
- 12-24 months
- Now shunned!
- Fixed velum then HP thinking cleft would resolve on its own.
Maxillary Osteotomy
- Major disruption of blood, nerve supply & growth can bring face forward.
- Le Fort Procedures! done by oral maxillary surgeon or craniofacial surgeon
Result in VPI -> hypernasality. Small adenoid pad, short VP
Not done until facial growth complete
Three types of Le Fort:
I: alveolar brought forward
II: Maxilla moved forward
III: includes eye orbit - craniofacial surgeon
Non-Surgical Options
- Obturator - plug hole with retainer
- Lifts - appliance under velum to lift it -long term teeth extractor
Language eval for CP
- Lang eval
- FNAE & Hypernasality
- Dev. Errors, Phono Processes
- Endoscopic eval
- Inform family about S&L development
- Inform about abnormal speech
