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Cleft Palate > Chapter Eight > Flashcards

Chapter Eight Flashcards

1
Q

Oral, Facial, and Pharyngeal Anomalies

Cleft palate and craniofacial anomalies can have an impact on the various ______.

Abnormalities of the _______particularly affect the _____ and _____of speech.

A

functions

ear, nose, and throat

quality; intelligibility

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2
Q

External Ear

Atresia—

Aural (auditory) atresia—

Microtia—

A

closure of a normal opening

closure of the auditory canal

small auricle
Treatment can include surgery and/or bone conduction hearing aids.

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3
Q

Middle Ear

Ossicles may be …

________may be absent or hypoplastic.

Middle ear malformations cause …

Treatment can include ….

A

absent, hypoplastic, or ankylosed.

Tympanic membrane

conductive hearing loss

surgery and/or bone conduction hearing aids.

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4
Q

Eustachian Tube Function

At rest, Eustachian tube is ____.

During swallowing (and yawning), _______muscle contracts to open Eustachian tube.

Opening of Eustachian tube:

  1. Provides …
  2. Equalizes ….
  3. Allows …
A

closed

tensor veli palatini

  1. ventilation for middle ear
  2. middle ear pressure with environment
  3. fluids to drain
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5
Q

Eustachian Tube Malfunction

Children under age ___are predisposed to Eustachian tube malfunction, causing ___________

Eustachian tubes lie in a ____ plane, which impairs _____.

________muscles are directed at an unfavorable angle for function.

Children with __________ are at greater risk due to abnormality of ______.

A

6; middle ear effusion and acute otitis media.

horizontal; drainage

Tensor veli palatini

cleft palate or submucous cleft; tensor muscles

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6
Q

Eustachian Tube Malfunction

Fluids collect within the middle ear (________) due to the ….

Bacteria can ascend tube and ______ in fluid, leading to an ear infection (acute otitis media).

A

middle ear effusion; negative pressure and cannot drain.

grow

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7
Q

Eustachian Tube Malfunction

Middle ear effusion can cause:
1.
2.

Otitis media can cause serious potential complications, including:
1.
2.

A
  1. Conductive hearing loss
  2. Speech and language delay
  3. Mastoiditis
  4. Sensorineural hearing loss due to toxins
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8
Q

Treatment for Chronic Otitis Media

1.
2.
3.

A

1.Antibiotics

  1. 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

3.Adenoidectomy

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9
Q

Inner Ear

Malformations can occur in the cochlea, vestibular system, and auditory nerve, causing a _______hearing loss.

Treatment includes:
1.
2.

A

sensorineural

  1. Hearing aid(s)
  2. Cochlear implant(s)
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10
Q

Audiologic Care

The American Cleft Palate-Craniofacial Association (ACPA) has specific recommendations for audiologic management for children born with _______

Patients should see an _____and _____periodically through _____.

A

cleft lip/palate or other craniofacial anomalies.

audiologist ; otolaryngologist; adolescence

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11
Q

Facial Structures

A

Nose

Maxilla

Facial Nerve

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12
Q

Nose

Nasal cavity compromised by _________

Deviated septum:
Common with ______

Deflects to the _____of the nose

_________stenosis

_______secondary to lip repair

_______or enlarged _____blocking the choana

A

midline cleft deformities

unilateral cleft lip/palate

cleft side

Pyriform aperture

Stenotic nares

Choanal atresia; adenoids

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13
Q

Nose

_____obstruction of the nasal cavity

Can be due to
1.
2.
3.

Causes ______resonance

_____ obstruction of the nasal cavity

Can be due to ______or enlarged adenoids

Causes _______

A

Anterior

  1. deviated septum,
  2. pyriform aperture stenosis, or 3.stenotic nares

nasal cul-de-sac

Posterior

choanal stenosis/atresia

hyponasality

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14
Q

Maxilla

Can cause:

A

Mid-face deficiency

Anterior crossbite with Class III malocclusion

Pharyngeal and nasal airway restriction

Hyponasality

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15
Q

Facial Nerve (CN VII)

_______with facial paralysis

Causes a…

A

Moebius syndrome

“mask-like” facies

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16
Q

Facial Nerve (CN VII) Paralysis

Facial nerve paralysis causes a ….

It affects _____and sometimes ______sounds.

Tongue movement is usually _____

Individuals may learn to compensate by …..

A

lack of facial expression and lip movement.

bilabial; labiodental

unaffected.

producing labial sounds with the tongue

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17
Q

The Oral Cavity

A

Lips

Mouth

Tongue

Palate

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18
Q

Upper Lip

Upper lip may be ____after cleft repair due to:

1.
2.
3.

A

short

  1. Basic dysmorphology from the cleft lip
  2. Contractile effects of the scar from the lip repair
  3. Relative lip shortening due to protruding premaxilla
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19
Q

Upper Lip
Short upper lip can…

1.
2.
3.

A

Cause difficulty with bilabial competence at rest

Affect production of bilabial sounds (p, b, m)

Result in labiodental placement as a substitute

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20
Q

Mouth

A

Macro (large)

Micro (small)

Stomia (mouth)

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21
Q

Macrostomia

Associated with facial clefts and syndromes, especially _______, due to …

Usually does not affect ____

A

hemifacial microsomia; extension of mouth into cheek

speech

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22
Q

Microstomia

Can have a ____affect on _____

May cause

A

slight ;articulation

oral cul-de-sac resonance, with muffled, low volume sound

23
Q

Tongue

A

Macroglossia

Microglossia

Lobulated tongue

Ankyloglossia

24
Q

Macroglossia

Tongue is…

Macroglossia is associated with _______and _____.

A

very large relative to the oral cavity size.

Down’s syndrome; Beckwith-Wiedeman syndrome

25
Q

Macroglossia

Large tongue causes:
1.
2.
3.
4.
5.
A

Lingual protrusion

Airway obstruction

Open-mouth posture

Anterior open bite

Drooling

26
Q

Macroglossia

Effects on speech:

It interferes with…

________is common.

It causes _______ distortion.

________is often noted.

A

tongue tip sounds (lingual-alveolars and sibilants).

Palatal-dorsal production

frontal (and occasionally lateral)

Oral cul-de-sac resonance

27
Q

Microglossia

Tongue is…

Microglossia…

A

small in size, especially relative to oral cavity size.

rarely causes speech problems.

28
Q

Lobulated Tongue

Seen in some syndromes, such as _____

Usually has …

A

“thick chunks of tissue on tongue”

orofaciodigital syndrome (OFD)

no significant effect on speech

29
Q

Ankyloglossia (_______)

Ankyloglossia is a ______

_______under tongue is ______ and/or attaches close to the tip of the tongue (rather than a third of the way back).

A

(“Tongue-Tie”)

congenital anomaly.

Lingual frenulum; too short

30
Q

Causes of Tongue-Tie

A

Unknown

Very common

Often not symptomatic

31
Q

Functional Characteristics

With mouth open, patient cannot ______.

Patient cannot ______

With protrusion attempts, tongue is ______and looks _______, thus limiting normal lingual movements.

A

touch roof of mouth with tongue tip

protrude tongue past incisal edge of lower gingiva.

indented in midline; heart-shaped

32
Q

Ankyloglossia and Speech

Common belief:

A

Because tongue tip cannot move well, it therefore affects` speech.

However, there is no evidence in literature that ankyloglossia causes speech defects.

33
Q

Ankyloglossia and Speech

Common sense approach:
1.
2.

These sounds can usually be produced, even with significant ______, so speech is usually not affected.

_____may be affected, however.

A

Maximum need for elevation: /l/

Maximum need for protrusion: /θ/ and /ð/

tongue tip restriction

Spanish /r/

34
Q

Indications for Frenulectomy

Difficulty ______

Can affect _____

Restricts movement of a ______ and…

Causing ______between lower mandibular incisors

______concerns

Difficulty _____

Rarely for speech, except if there is _______

A

feeding

latching to a nipple

bolus and clearing of food from sulci and molars

separation of gingiva

Cosmetic

“French kissing”

oral-motor dysfunction

35
Q

Palate

Abnormal palatal arch can cause:

A

Lingual crowding, resulting in anterior or palatal-dorsal articulation

Abnormal resonance due to small cavity size

36
Q

Palatal (Oronasal) Fistula

Fistula—

Fistula occurs in the _____, often in the following areas:

Junction of the _____

Junction of _____

Fistula can be due to breakdown of ______.

Small, asymptomatic fistula can open with ______.

A

an abnormal opening in the palate

line of the cleft

hard and soft palate

premaxilla and lateral segments

surgical repair

maxillary expansion or growth

37
Q

Palatal Fistulas: Effect on Speech

Effect on speech depends on ____and _____.

Small fistula can cause:
1.
2.

Medium-sized fistula can cause:

Large fistula can cause:
1.

A

size and location

  1. No effect on speech because airflow is horizontal to opening
  2. Nasal air emission on sounds with tongue tip elevation
  3. Consistent nasal emission
  4. Compensatory articulation productions
    a) To close the fistula with the tongue during speech
    b) To produce the sound behind the fistula and air leak

1.Hypernasality and consistent nasal emission

38
Q

Palatal Fistulas

Usually repaired with _____ around age

Could consider an ______ or earlier repair if affects speech sound development

A

bone graft; 6–7

obturator;

39
Q

Tonsils and Adenoids

_________—consists of a complex of lymphoid tissue that encircles the pharynx

Tonsils (______)

Adenoids (________)

______tonsil

Plays a role in the ______

A

Waldeyer’s Ring

palatine tonsils

pharyngeal tonsils

Lingual

mucosal immune system

40
Q

Hypertrophic Tonsils and Adenoids

Prominent in ______

Usually _____around puberty

Tonsil and adenoid ______ (abnormal enlargement) common in _______

A

prepubescent children

atrophy

hypertrophy; young children

41
Q

Hypertrophic Tonsils

A

Image

42
Q

Hypertrophic Tonsils

Can cause…

A
  1. Pharyngeal cul-de-sac resonance
  2. Nasal emission, if a tonsil intrudes into the pharynx, thus limiting lateral wall motion or interfering with VP closure
  3. Fronting of velars, if it displaces the tongue down and forward
  4. Difficulty swallowing a bolus
43
Q

Hypertrophic Adenoids

Can cause:

_______

_______if irregular, thus affecting the ______of VP closure

______, ______, and _______if it obstructs the Eustachian tube opening

Chronic _____

Airway obstruction causing:

______, if the jaw is always open for oral breathing

A

Hyponasality

Nasal emission/rustle; firmness

Middle ear effusion; otitis media; conductive hearing loss

pharyngitis

obligatory mouth breathing, anterior tongue position, snoring, and sleep apnea

Skeletal malocclusion

44
Q

Lingual Tonsil Hypertrophy

Rarely occurs, except in _____

Can cause _______

A

Down syndrome

pharyngeal cul-de-sac resonance

45
Q

Upper Airway Obstruction

Upper airway obstruction can cause:

A

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

46
Q

Upper Airway Obstruction

Upper airway obstruction can cause:

____breathing issues:
1.
2.
3.

A

Nasal

  1. Stertorous (a heavy snoring sound) breathing
  2. Chronic mouth breathing
  3. Loud snoring, and obstructive sleep apnea (OSA)
47
Q

Pharynx

May be ____due to ______, causing VPI

May be _____due to _____, causing _______and _______

May have medial displacement of _____VCFS

A

deep; cranial
base anomalies

shallow; maxillary retrusion
hyponasality and obstructive sleep apnea (OSA)

internal carotid arteries

48
Q

Treatment of Upper Airway Obstruction:

1.
2.
3.
4.

A

Tonsillectomy and/or adenoidectomy

Tracheostomy

Uvulopalatopharyngoplasty (UPPP)

Continuous Positive Airway Pressure (CPAP)

49
Q

Tonsillectomy

Except in very rare circumstances, has no negative effect on ______

May improve ______

May improve ______

A

speech or resonance

speech production

resonance

50
Q

Adenoidectomy

May improve _____

May improve ______

May cause ____due to the increase in n_____ space

Risk for VPI ____in the general population

Greatest risk with ____________

A

speech production

resonance

VPI; asopharyngeal

low

history of cleft palate or submucous cleft

51
Q

Tracheostomy

Done to…

Often indicated for ….

A

relieve obstruction that is life threatening

congenital anomalies, such as subglottic stenosis, tracheal stenosis, laryngeal web or glossoptosis associated with Pierre Robin sequence

52
Q

UPPP

Procedure improves _____.

Sleep apnea usually _____.

Aggressive UPPP has been known to cause _______.

A

snoring

persists

swallowing and speech difficulties

53
Q

CPAP

Long-term resolution for _____

Consists of a _____ and ______

Prevents _______

A

obstructive apnea

face mask and air pressure generator

laryngeal collapse while sleeping

54
Q

Summary

_______and _______should form a partnership to diagnose and treat the disorders related to oropharyngeal anomalies.

A

Speech-language pathologists ;

otolaryngologists

Cleft Palate (19 decks)

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