Anatomy and Physiology

Question 1

Soft Palate/Velum

Answer 1

• Held in place by internal muscles
• Anterior portion has very few muscle fibers
• Aponeursis serves as anchoring point for muscles – where levator enters
• Posterior-uvula (not contribute to vp function)

Question 2

Levator veli palatini

Answer 2

• Main muscle mass of soft palate
• Takes up middle 40% of entire
velum
• Responsible for velar elevation
• Creates a ‘sling

Question 3

Superior Pharyngeal Constrictor Muscle

Answer 3

• Upper fibers responsible for medial movement of pharyngeal walls

Question 4

Palatoglossus

Answer 4

• Lowers the velum
• Responsible for the rapid downward movement of velum during connected speech
• Located in the anterior faucial pillar

Question 5

Palatopharyngeous

Answer 5

• Function not well understood
• Muscles thought to move the pharyngeal walls medially to narrow the pharynx
• Also may assist w/ lowering the velum

Question 6

Uvulae

Answer 6

• Bulge on the posterior part of nasal surface of velum
• Provides stiffness to velum
• Not in uvula but in posterior part of the velum
• Area where contracts called velar eminence (nasal side)

Question 7

Nasal sounds

Answer 7

velum is maintained in lowered position (palatoglossus/palatopharyngeus muscles)

Question 8

Oral sounds

Answer 8

velum must elevate and close off nasal cavity from oral cavity below:

1. Posterior and superior movement of velum
2. Anterio-medial movement of pharyngeal walls
3. Complete contact of velum against posterior pharyngeal wall

Question 9

Velopharyngeal Closure Patterns

Answer 9

Coronal, Sagittal, Circular

Question 10

Coronal

Answer 10

post movement of sp-minimal movement of lateral pharyngeal wall (lpw)

Question 11

Sagittal

Answer 11

lpw move medially-little movement of soft-palate (sp)

Question 12

Circular

Answer 12

post pharyngeal wall (ppw*),lpw and sp move-looks like a sphincter

Question 13

Posterior

Answer 13

Contact on:
– Posterior Pharyngeal Wall
– Passavant’s ridge
– Adenoid pads to create closure

Question 14

Passavants Ridge

Answer 14

• Shelf like ridge that projects from posterior pharyngeal wall during speech.
• Dynamic structure
• Should not be confused with general anterior movement of post pharyngeal wall during speech.
• Formed by constricting of superior pharyngeal constrictor muscles and fibers of palatopharyneous

Question 15

Timing

Answer 15

• Voice onset and velopharyngeal closure for oral sounds must begin prior to onset of phonation.
• ..so that sounds are not nasal.
• (Ha, Sim.Zhi, and Kuehn 2004

Question 16

Tonsils

Answer 16

surround the opening of orophaynx

Question 17

Faucial tonsils

Answer 17

– Between anterior and posterior faucial pillars

Question 18

Lingual tonsils

Answer 18

– Located at base of of the tongue

Question 19

Adenoids

Answer 19

are located in nasopharynx

Question 20

Functions of Tonsils and Adenoids

Answer 20

• Lymphoid tissue
• Important during first years of life to fight off infection.
• There are other protective mechanisms
• The GI tract is lined with similar structures.

Question 21

Atrophy of Tonsils and Adenoids

Answer 21

• Start to atrophy at 6 years ols
• Disappear completely by age 15
– Only some residual tissue is left

Question 22

Adenotonsillar Hypertrophy

Answer 22

• Obstracutive Sleep Apnea (OSA)
• Large tonsils affect swallowing and breathing
• Chronic infection

Question 23

Obstracutive Sleep Apnea (OSA)

Answer 23

– Breathing difficulty seen mainly during inhalaion when sleeping
– Snoring
– May need sleep study

Question 24

Chronic infection

Answer 24

– Open mouth posture
– Anterior tongue position
– Jaw forward &downward
– Facial elongation – Puffy eyes

Question 25

Obstruction of airway in children

Answer 25

Not necessary due to enlarged adenoids/tonsils
May be due to small nasopharynx
E.g. In midface hypoplasia (Syndromes - Crouzon, Apert, Down)
• May be due to small mandible or maxilla (can cause sleep apnea as well)
• E.g. micrognathic (Treacher- Collins syndrome, Pierre- Robin sequence)

Question 26

Effects of Tonsillar Hypertrophy

Answer 26

• Tonsil size is graded on a scale of 1 – 4
• If too large—
• Hyponasality because of blockage or…
• Hypernasality because large tonsils keep palate from moving.
• Or both
• If too large, can obstruct the opening of Eustacian tub, and disrupt middle ear function (equalize pressure)
• Speech can be hyponasal due to blockage done by adenoid
• Can assist with closure of velopharygeal mech. (short palate, history of cleft palate, submucous cleft)

Question 27

Tonsil size is graded on a scale of 1 – 4

Answer 27

– 1+: tonsils are contained with the tonsillar pillars
– 2+: tonsils extend minimally beyond the pillars
– 3+: tonsils obstruct oropharyngeal passageway moderately
– 4+: tonsils are touching each other at midline