Ch. 8 Flashcards
Cleft palate and craniofacial anomalies can have an impact on the various functions.
Abnormalities of the ____, ____, and ____ particularly affect the ____ and ____ of ____
Cleft palate and craniofacial anomalies can have an impact on the various functions.
Abnormalities of the ear, nose, and throat particularly affect the quality and intelligibility of speech.
Chapter 8Facial, Oral, and Pharyngeal Anomalies
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External Ear
____—_____ of a normal _____
____ (____) _____—closure of the _____ _____
_____—small _____
Treatment can include _____ and/or _____ _____ hearing aids.
Atresia—closure of a normal opening
Aural (auditory) atresia—closure of the auditory canal
Microtia—small auricle
Treatment can include surgery and/or bone conduction hearing aids.
Middle Ear
_____ may be ____, _____, or _____.
_____ _____ may be absent or hypoplastic.
_____ _____ malformations cause ______ hearing loss.
Treatment can include surgery and/or bone conduction hearing aids.
Ossicles may be absent, hypoplastic, or ankylosed.
Tympanic membrane may be absent or hypoplastic.
Middle ear malformations cause conductive hearing loss.
Treatment can include surgery and/or bone conduction hearing aids.
Eustachian Tube Function
At \_\_\_\_, Eustachian tube is \_\_\_\_. During \_\_\_\_\_ (and \_\_\_\_), \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ muscle contracts to \_\_\_\_\_ Eustachian tube. Opening of Eustachian tube: Provides \_\_\_\_\_ for \_\_\_\_ ear \_\_\_\_\_ middle ear \_\_\_\_\_ with environment Allows \_\_\_\_ to drain
At rest, Eustachian tube is closed.
During swallowing (and yawning), tensor veli palatini muscle contracts to open Eustachian tube.
Opening of Eustachian tube:
Provides ventilation for middle ear
Equalizes middle ear pressure with environment
Allows fluids to drain
Eustachian Tube Malfunction
Children under age ____ are predisposed to Eustachian tube malfunction, causing ____ ear ____ and ____ ____ ____.
Eustachian tubes lie in a ____ plane, which ____ drainage.
____ ____ ____ muscles are directed at an unfavorable angle for function.
Children with cleft palate or submucous cleft are at greater ____ due to abnormality of tensor muscles.
Children under age 6 are predisposed to Eustachian tube malfunction, causing middle ear effusion and acute otitis media.
Eustachian tubes lie in a horizontal plane, which impairs drainage.
Tensor veli palatini muscles are directed at an unfavorable angle for function.
Children with cleft palate or submucous cleft are at greater risk due to abnormality of tensor muscles.
Eustachian Tube Malfunction CONT.
____ collect within the ____ ear (middle ear ____) due to the ____ pressure and cannot ____.
_____ can ascend tube and grow in fluid, leading to an ____ _____ (____ _____ ____).
Fluids collect within the middle ear (middle ear effusion) due to the negative pressure and cannot drain.
Bacteria can ascend tube and grow in fluid, leading to an ear infection (acute otitis media).
Eustachian Tube Malfunction CONT.
Middle ear \_\_\_\_ can cause: \_\_\_\_\_ hearing loss \_\_\_\_ and \_\_\_\_\_ delay Otitis media can cause serious potential complications, including: \_\_\_\_ \_\_\_\_\_ hearing loss due to \_\_\_\_
Middle ear effusion can cause: Conductive hearing loss Speech and language delay Otitis media can cause serious potential complications, including: Mastoiditis Sensorineural hearing loss due to toxins
Treatment for Chronic Otitis Media
_____
_____ (small _____) and placement of ____ (____ ____) tubes in tympanic membranes
Often done prophylactically for children with history of ____, usually with lip repair at _____ months
____
Antibiotics
Myringotomy (small incision) and placement of PE (pressure equalizing) tubes in tympanic membranes
Often done prophylactically for children with history of CLP, usually with lip repair at 3 months
Adenoidectomy
Inner Ear
____ can occur in the ____, _____ system, and _____ nerve, causing a _____ hearing loss.
Treatment includes:
_____ _____(s)
_____ _____(s)
Malformations can occur in the cochlea, vestibular system, and auditory nerve, causing a sensorineural hearing loss.
Treatment includes:
Hearing aid(s)
Cochlear implant(s)
Audiologic Care
The American Cleft Palate-Craniofacial Association (ACPA) has specific recommendations for audiologic management for children born with cleft lip/palate or other craniofacial anomalies.
Patients should see an _____ and _____ periodically through adolescence.
The American Cleft Palate-Craniofacial Association (ACPA) has specific recommendations for audiologic management for children born with cleft lip/palate or other craniofacial anomalies.
Patients should see an audiologist and otolaryngologist periodically through adolescence.
Facial Structures
_____
_____
_____ Nerve
Nose
Maxilla
Facial Nerve
Nose
____ cavity compromised by _____ cleft deformities
_____ septum
Common with _____ cleft lip/palate
Deflects to the _____ side of the _____
_____ _____ _____
_____ _____ secondary to _____ repair
____ _____ or enlarged _____ blocking the _____
Nasal cavity compromised by midline cleft deformities
Deviated septum
Common with unilateral cleft lip/palate
Deflects to the cleft side of the nose
Pyriform aperture stenosis
Stenotic nares secondary to lip repair
Choanal atresia or enlarged adenoids blocking the choana
Nose CONT.
_____ obstruction of the _____ cavity
Can be due to _____ _____, _____ _____ _____, or _____ _____
Causes nasal ____-____-_____ resonance
_____ obstruction of the ____ cavity
Can be due to _____ _____/_____ or enlarged _____
Causes _____
Anterior obstruction of the nasal cavity
Can be due to deviated septum, pyriform aperture stenosis, or stenotic nares
Causes nasal cul-de-sac resonance
Posterior obstruction of the nasal cavity
Can be due to choanal stenosis/atresia or enlarged adenoids
Causes hyponasality
Maxilla
Can cause: \_\_\_\_-\_\_\_\_\_ deficiency Anterior \_\_\_\_ with Class \_\_\_\_\_ malocclusion \_\_\_\_\_ and \_\_\_\_\_ airway restriction \_\_\_\_\_
Can cause: Mid-face deficiency Anterior crossbite with Class III malocclusion Pharyngeal and nasal airway restriction Hyponasality
Facial Nerve (VII)
_____ syndrome with _____ paralysis
Causes a “_____-_____” facies
Moebius syndrome with facial paralysis
Causes a “mask-like” facies
Facial Nerve (VII) Paralysis
Facial nerve paralysis causes a lack of facial _____ and _____ movement.
It affects _____ and sometimes _____ sounds.
_____ movement is usually _____.
Individuals may learn to compensate by producing _____ sounds with the ____.
Facial nerve paralysis causes a lack of facial expression and lip movement.
It affects bilabial and sometimes labiodental sounds.
Tongue movement is usually unaffected.
Individuals may learn to compensate by producing labial sounds with the tongue.
The Oral Cavity
____
____
____
____
Lips
Mouth
Tongue
Palate
Upper Lip
____ lip may be ____ after cleft repair due to:
Basic ____ from the cleft lip
_____ effects of the ____ from the lip repair
Relative lip _____ due to protruding ____
Upper lip may be short after cleft repair due to:
Basic dysmorphology from the cleft lip
Contractile effects of the scar from the lip repair
Relative lip shortening due to protruding premaxilla
Upper Lip
Short upper lip can…
Cause difficulty with ____ competence at rest
Affect production of _____ sounds (____,____,____)
Result in _____ placement as a substitute
Short upper lip can…
Cause difficulty with bilabial competence at rest
Affect production of bilabial sounds (p, b, m)
Result in labiodental placement as a substitute
Mouth
____ (large)
____ (small)
____ (mouth)
Macro (large)
Micro (small)
Stomia (mouth)
Macrostomia
Associated with facial clefts and syndromes, especially _____ _____, due to extension of _____ into _____
Usually does ____ affect speech
Associated with facial clefts and syndromes, especially hemifacial microsomia, due to extension of mouth into cheek
Usually does not affect speech
Microstomia
Can have a slight affect on _____
May cause oral ____-_____-____ resonance, with _____, ____ volume sound
Can have a slight affect on articulation
May cause oral cul-de-sac resonance, with muffled, low volume sound
Tongue
____
_____
_____ tongue (thick chunks of tissue)
_____
Macroglossia
Microglossia
Lobulated tongue
Ankyloglossia
Macroglossia
Tongue is very _____ relative to the oral cavity size.
Macroglossia is associated with _____ _____ and _____-_____ syndrome.
Tongue is very large relative to the oral cavity size.
Macroglossia is associated with Down’s syndrome and Beckwith-Wiedeman syndrome.
Macroglossia CONT.
Large tongue causes: \_\_\_\_\_ protrusion \_\_\_\_\_\_ obstruction \_\_\_\_\_-\_\_\_\_\_\_ posture \_\_\_\_\_\_ open bite \_\_\_\_\_\_
Large tongue causes: Lingual protrusion Airway obstruction Open-mouth posture Anterior open bite Drooling
Macroglossia CONT.
Effects on speech
It interferes with _____ _____ sounds (_____-_____ and _____).
_____-______ production is common.
It causes _____ (and occasionally lateral) distortion.
Oral ____-_____-____ resonance is often noted.
Effects on speech
It interferes with tongue tip sounds (lingual-alveolars and sibilants).
Palatal-dorsal production is common.
It causes frontal (and occasionally lateral) distortion.
Oral cul-de-sac resonance is often noted.
Microglossia
Tongue is ____ in size, especially relative to oral cavity size.
Microglossia _____ causes speech problems.
Tongue is small in size, especially relative to oral cavity size.
Microglossia rarely causes speech problems.
Lobulated Tongue
Seen in some syndromes, such as _____ ______ (OFD)
Usually has _____ significant effect on speech
Seen in some syndromes, such as orofaciodigital syndrome (OFD)
Usually has no significant effect on speech
Ankyloglossia (“Tongue-Tie”)
Ankyloglossia is a ____ anomaly.
_____ _____ under tongue is too _____ and/or attaches close to the _____ of the tongue (rather than a third of the way back).
Ankyloglossia is a congenital anomaly.
Lingual frenulum under tongue is too short and/or attaches close to the tip of the tongue (rather than a third of the way back).
Causes of Tongue-Tie
_____
Very _____
Often not symptomatic
Unknown
Very common
Often not symptomatic
Functional Characteristics
With mouth open, patient cannot touch ____ of mouth with tongue tip.
Patient cannot protrude tongue past ____ edge of lower gingiva.
With protrusion attempts, tongue is indented in _____ and looks heart-_____, thus limiting normal lingual movements.
With mouth open, patient cannot touch roof of mouth with tongue tip.
Patient cannot protrude tongue past incisal edge of lower gingiva.
With protrusion attempts, tongue is indented in midline and looks heart-shaped, thus limiting normal lingual movements.
Ankyoglossia and Speech
Common belief:
Because tongue tip cannot move well, it therefore affects` speech.
However, there is no evidence in literature that ankyloglossia causes speech defects.
Common belief:
Because tongue tip cannot move well, it therefore affects` speech.
However, there is no evidence in literature that ankyloglossia causes speech defects.
Ankyloglossia and Speech CONT.
Common sense approach
Maximum need for _____: /____/
Maximum need for _____: /____/ and /____/
These sounds can usually be produced, even with significant tongue tip restriction, so speech is usually not affected.
Spanish /____/ may be affected, however.
Common sense approach
Maximum need for elevation: /l/
Maximum need for protrusion: /θ/ and /ð/
These sounds can usually be produced, even with significant tongue tip restriction, so speech is usually not affected.
Spanish /r/ may be affected, however.
Indications for Frenulectomy
Difficulty _____
Can affect _____ to a nipple
Restricts movement of a _____ and clearing of food from _____ and _____
Causing separation of gingiva between lower mandibular incisors
______ concerns
Difficulty “____ _____”
Rarely for speech, except if there is _____-_____ dysfunction
Difficulty feeding
Can affect latching to a nipple
Restricts movement of a bolus and clearing of food from sulci and molars
Causing separation of gingiva between lower mandibular incisors
Cosmetic concerns
Difficulty “French kissing”
Rarely for speech, except if there is oral-motor dysfunction
Palate
Abnormal palatal _____ can cause:
Lingual _____, resulting in _____ or _____-_____ articulation
Abnormal _____ due to small cavity size
Abnormal palatal arch can cause:
Lingual crowding, resulting in anterior or palatal-dorsal articulation
Abnormal resonance due to small cavity size
Palatal (Oronasal) Fistula
_____—an abnormal _____ in the _____
Fistula occurs in the line of the cleft, often in the following areas:
Junction of the _____ and _____ palate
Junction of _____ and ______ segments
Fistula can be due to breakdown of _____ repair.
Small, asymptomatic fistula can open with maxillary expansion or growth.
Fistula—an abnormal opening in the palate
Fistula occurs in the line of the cleft, often in the following areas:
Junction of the hard and soft palate
Junction of premaxilla and lateral segments
Fistula can be due to breakdown of surgical repair.
Small, asymptomatic fistula can open with maxillary expansion or growth.
Palatal Fistulas: Effect on Speech
Effect on speech depends on _____ and _____.
Small fistula can cause:
No effect on speech because airflow is _____ to opening
_____ air emission on sounds with tongue _____ elevation
Medium-sized fistula can cause:
Consistent nasal emission
Compensatory ______ productions
To close the fistula with the _____ during speech
To produce the sound behind the fistula and _____ leak
Large fistula can cause:
______ and consistent _____ _____
Effect on speech depends on size and location.
Small fistula can cause:
No effect on speech because airflow is horizontal to opening
Nasal air emission on sounds with tongue tip elevation
Medium-sized fistula can cause:
Consistent nasal emission
Compensatory articulation productions
To close the fistula with the tongue during speech
To produce the sound behind the fistula and air leak
Large fistula can cause:
Hypernasality and consistent nasal emission
Palatal Fistulas
Usually repaired with _____ graft around age _____–_____
Could consider an _____ or earlier repair if affects speech sound development
Usually repaired with bone graft around age 6–7
Could consider an obturator or earlier repair if affects speech sound development
Tonsils and Adenoids
_____ _____—consists of a complex of _____ tissue that encircles the _____
_____ (_____ tonsils)
_____ (_____ tonsils)
_____ tonsil
Plays a role in the mucosal immune system
Waldeyer’s Ring—consists of a complex of lymphoid tissue that encircles the pharynx
Tonsils (palatine tonsils)
Adenoids (pharyngeal tonsils)
Lingual tonsil
Plays a role in the mucosal immune system
Hypertophic Tonsils and Adenoids
Prominent in _____ children
Usually _____ around puberty
Tonsil and adenoid _____ (abnormal enlargement) common in young children
Prominent in prepubescent children
Usually atrophy around puberty
Tonsil and adenoid hypertrophy (abnormal enlargement) common in young children
Hypertrophic Tonsils
Can cause…
Pharyngeal ____-_____-_____ resonance
_____ _____, if a tonsil intrudes into the _____, thus limiting _____ wall motion or interfering with _____ closure
_____ of velars, if it displaces the tongue down and forward
Difficulty _____ a bolus
Can cause…
Pharyngeal cul-de-sac resonance
Nasal emission, if a tonsil intrudes into the pharynx, thus limiting lateral wall motion or interfering with VP closure
Fronting of velars, if it displaces the tongue down and forward
Difficulty swallowing a bolus
Hypertrophic Adenoids
Can cause
_____
Nasal _____/_____ if irregular, thus affecting the firmness of ____ closure
_____ _____ _____, _____ _____, and _____ hearing loss if it obstructs the Eustachian tube opening
Chronic _____
Airway obstruction causing an obligatory _____ breathing, _____ tongue position, _____, and sleep _____
Skeletal _____, if the ____ is always _____ for ____ breathing
Can cause
Hyponasality
Nasal emission/rustle if irregular, thus affecting the firmness of VP closure
Middle ear effusion, otitis media, and conductive hearing loss if it obstructs the Eustachian tube opening
Chronic pharyngitis
Airway obstruction causing an obligatory mouth breathing, anterior tongue position, snoring, and sleep apnea
Skeletal malocclusion, if the jaw is always open for oral breathing
Lingual Tonsil Hypertrophy
Rarely occurs, except in _____ _____
Can cause _____ ____-____-_____ resonance
Rarely occurs, except in Down syndrome
Can cause pharyngeal cul-de-sac resonance
Upper Airway Obstruction
Upper airway obstruction can cause:
_____ _____ (also seen with tonsillar hypertrophy):
An ____-mouth posture and anterior _____ position
A ____ and _____ position of the ____
Facial ____
_____ ____ (“____ eyes”) and _____ eyes
Appearance of _____ nostrils
Upper airway obstruction can cause:
Adenoid facies (also seen with tonsillar hypertrophy):
An open-mouth posture and anterior tongue position
A forward and downward position of the mandible
Facial elongation
Suborbital coloring (“black eyes”) and puffy eyes
Appearance of pinched nostrils
Upper Airway Obstruction CONT.
Upper airway obstruction can cause: \_\_\_\_ breathing issues \_\_\_\_\_ (a heavy \_\_\_\_\_ \_\_\_\_) breathing Chronic \_\_\_\_\_ breathing \_\_\_\_\_ snoring, and \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_ (\_\_\_\_\_)
Upper airway obstruction can cause:
Nasal breathing issues
Stertorous (a heavy snoring sound) breathing
Chronic mouth breathing
Loud snoring, and obstructive sleep apnea (OSA)
Pharynx
May be deep due to _____ base anomalies, causing _____
May be shallow due to _____ _____, causing _____ and obstructive sleep apnea (OSA)
May have medial displacement of internal carotid arteries
VCFS
May be deep due to cranial base anomalies, causing VPI
May be shallow due to maxillary retrusion, causing hyponasality and obstructive sleep apnea (OSA)
May have medial displacement of internal carotid arteries
VCFS
Treatment of Upper Airway Obstruction
_____ and/or _____
_____
_____ (UPPP)
_____ _____ _____ _____ (_____)
Tonsillectomy and/or adenoidectomy
Tracheostomy
Uvulopalatopharyngoplasty (UPPP)
Continuous Positive Airway Pressure (CPAP)
Tonsillectomy
Except in very rare circumstances, has no _____ effect on speech or resonance
May improve _____ production
May improve _____
Except in very rare circumstances, has no negative effect on speech or resonance
May improve speech production
May improve resonance
Adenoidectomy
May improve _____ _____
May improve _____
May cause _____ due to the _____ in _____ space
Risk for VPI low in the general population
Greatest risk with history of cleft palate or submucous cleft
May improve speech production
May improve resonance
May cause VPI due to the increase in nasopharyngeal space
Risk for VPI low in the general population
Greatest risk with history of cleft palate or submucous cleft
Tracheostomy
Done to relieve _____ that is life threatening
Often indicated for _____ anomalies, such as _____ stenosis, _____ stenosis, laryngeal _____ or _____ associated with _____ _____ sequence
Done to relieve obstruction that is life threatening
Often indicated for congenital anomalies, such as subglottic stenosis, tracheal stenosis, laryngeal web or glossoptosis associated with Pierre Robin sequence
UPPP
Procedure _____ snoring.
Sleep apnea usually _____.
Aggressive UPPP has been known to cause _____ and _____ difficulties.
Procedure improves snoring.
Sleep apnea usually persists.
Aggressive UPPP has been known to cause swallowing and speech difficulties.
CPAP
_____-term resolution for _____ apnea
Consists of a _____ mask and ____ _____ generator
Prevents _____ collapse while sleeping
Long-term resolution for obstructive apnea
Consists of a face mask and air pressure generator
Prevents laryngeal collapse while sleeping
Summary
Speech-language pathologists and otolaryngologists should form a partnership to _____ and _____ the disorders related to _____ anomalies.
Speech-language pathologists and otolaryngologists should form a partnership to diagnose and treat the disorders related to oropharyngeal anomalies.
