Chapter Eight Flashcards
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.
functions
ear, nose, and throat
quality; intelligibility
External Ear
Atresia—
Aural (auditory) atresia—
Microtia—
closure of a normal opening
closure of the auditory canal
small auricle
Treatment can include surgery and/or bone conduction hearing aids.
Middle Ear
Ossicles may be …
________may be absent or hypoplastic.
Middle ear malformations cause …
Treatment can include ….
absent, hypoplastic, or ankylosed.
Tympanic membrane
conductive hearing loss
surgery and/or bone conduction hearing aids.
Eustachian Tube Function
At rest, Eustachian tube is ____.
During swallowing (and yawning), _______muscle contracts to open Eustachian tube.
Opening of Eustachian tube:
- Provides …
- Equalizes ….
- Allows …
closed
tensor veli palatini
- ventilation for middle ear
- middle ear pressure with environment
- fluids to drain
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 ______.
6; middle ear effusion and acute otitis media.
horizontal; drainage
Tensor veli palatini
cleft palate or submucous cleft; tensor muscles
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).
middle ear effusion; negative pressure and cannot drain.
grow
Eustachian Tube Malfunction
Middle ear effusion can cause:
1.
2.
Otitis media can cause serious potential complications, including:
1.
2.
- Conductive hearing loss
- Speech and language delay
- Mastoiditis
- Sensorineural hearing loss due to toxins
Treatment for Chronic Otitis Media
1.
2.
3.
1.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
3.Adenoidectomy
Inner Ear
Malformations can occur in the cochlea, vestibular system, and auditory nerve, causing a _______hearing loss.
Treatment includes:
1.
2.
sensorineural
- 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 _______
Patients should see an _____and _____periodically through _____.
cleft lip/palate or other craniofacial anomalies.
audiologist ; otolaryngologist; adolescence
Facial Structures
Nose
Maxilla
Facial Nerve
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
midline cleft deformities
unilateral cleft lip/palate
cleft side
Pyriform aperture
Stenotic nares
Choanal atresia; adenoids
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 _______
Anterior
- deviated septum,
- pyriform aperture stenosis, or 3.stenotic nares
nasal cul-de-sac
Posterior
choanal stenosis/atresia
hyponasality
Maxilla
Can cause:
Mid-face deficiency
Anterior crossbite with Class III malocclusion
Pharyngeal and nasal airway restriction
Hyponasality
Facial Nerve (CN VII)
_______with facial paralysis
Causes a…
Moebius syndrome
“mask-like” facies
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 …..
lack of facial expression and lip movement.
bilabial; labiodental
unaffected.
producing labial sounds with the tongue
The Oral Cavity
Lips
Mouth
Tongue
Palate
Upper Lip
Upper lip may be ____after cleft repair due to:
1.
2.
3.
short
- 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…
1.
2.
3.
Cause difficulty with bilabial competence at rest
Affect production of bilabial sounds (p, b, m)
Result in labiodental placement as a substitute
Mouth
Macro (large)
Micro (small)
Stomia (mouth)
Macrostomia
Associated with facial clefts and syndromes, especially _______, due to …
Usually does not affect ____
hemifacial microsomia; extension of mouth into cheek
speech
Microstomia
Can have a ____affect on _____
May cause
slight ;articulation
oral cul-de-sac resonance, with muffled, low volume sound
Tongue
Macroglossia
Microglossia
Lobulated tongue
Ankyloglossia
Macroglossia
Tongue is…
Macroglossia is associated with _______and _____.
very large relative to the oral cavity size.
Down’s syndrome; Beckwith-Wiedeman syndrome
Macroglossia
Large tongue causes: 1. 2. 3. 4. 5.
Lingual protrusion
Airway obstruction
Open-mouth posture
Anterior open bite
Drooling
Macroglossia
Effects on speech:
It interferes with…
________is common.
It causes _______ distortion.
________is often noted.
tongue tip sounds (lingual-alveolars and sibilants).
Palatal-dorsal production
frontal (and occasionally lateral)
Oral cul-de-sac resonance
Microglossia
Tongue is…
Microglossia…
small in size, especially relative to oral cavity size.
rarely causes speech problems.
Lobulated Tongue
Seen in some syndromes, such as _____
Usually has …
“thick chunks of tissue on tongue”
orofaciodigital syndrome (OFD)
no significant effect on speech
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).
(“Tongue-Tie”)
congenital anomaly.
Lingual frenulum; too short
Causes of Tongue-Tie
Unknown
Very common
Often not symptomatic
Functional Characteristics
With mouth open, patient cannot ______.
Patient cannot ______
With protrusion attempts, tongue is ______and looks _______, thus limiting normal lingual movements.
touch roof of mouth with tongue tip
protrude tongue past incisal edge of lower gingiva.
indented in midline; heart-shaped
Ankyloglossia 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.
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.
Maximum need for elevation: /l/
Maximum need for protrusion: /θ/ and /ð/
tongue tip restriction
Spanish /r/
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 _______
feeding
latching to a nipple
bolus and clearing of food from sulci and molars
separation of gingiva
Cosmetic
“French kissing”
oral-motor dysfunction
Palate
Abnormal palatal arch can cause:
Lingual crowding, resulting in anterior or palatal-dorsal articulation
Abnormal resonance due to small cavity size
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 ______.
an abnormal opening in the palate
line of the cleft
hard and soft palate
premaxilla and lateral segments
surgical repair
maxillary expansion or growth
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.
size and location
- No effect on speech because airflow is horizontal to opening
- Nasal air emission on sounds with tongue tip elevation
- Consistent nasal emission
- 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
Palatal Fistulas
Usually repaired with _____ around age
Could consider an ______ or earlier repair if affects speech sound development
bone graft; 6–7
obturator;
Tonsils and Adenoids
_________—consists of a complex of lymphoid tissue that encircles the pharynx
Tonsils (______)
Adenoids (________)
______tonsil
Plays a role in the ______
Waldeyer’s Ring
palatine tonsils
pharyngeal tonsils
Lingual
mucosal immune system
Hypertrophic Tonsils and Adenoids
Prominent in ______
Usually _____around puberty
Tonsil and adenoid ______ (abnormal enlargement) common in _______
prepubescent children
atrophy
hypertrophy; young children
Hypertrophic Tonsils
Image
Hypertrophic Tonsils
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:
_______
_______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
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
Lingual Tonsil Hypertrophy
Rarely occurs, except in _____
Can cause _______
Down syndrome
pharyngeal cul-de-sac resonance
Upper Airway Obstruction
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
Upper airway obstruction can cause:
____breathing issues:
1.
2.
3.
Nasal
- Stertorous (a heavy snoring sound) breathing
- Chronic mouth breathing
- Loud snoring, and obstructive sleep apnea (OSA)
Pharynx
May be ____due to ______, causing VPI
May be _____due to _____, causing _______and _______
May have medial displacement of _____VCFS
deep; cranial
base anomalies
shallow; maxillary retrusion
hyponasality and obstructive sleep apnea (OSA)
internal carotid arteries
Treatment of Upper Airway Obstruction:
1.
2.
3.
4.
Tonsillectomy and/or adenoidectomy
Tracheostomy
Uvulopalatopharyngoplasty (UPPP)
Continuous Positive Airway Pressure (CPAP)
Tonsillectomy
Except in very rare circumstances, has no negative effect on ______
May improve ______
May improve ______
speech or resonance
speech production
resonance
Adenoidectomy
May improve _____
May improve ______
May cause ____due to the increase in n_____ space
Risk for VPI ____in the general population
Greatest risk with ____________
speech production
resonance
VPI; asopharyngeal
low
history of cleft palate or submucous cleft
Tracheostomy
Done to…
Often indicated for ….
relieve obstruction that is life threatening
congenital anomalies, such as subglottic stenosis, tracheal stenosis, laryngeal web or glossoptosis associated with Pierre Robin sequence
UPPP
Procedure improves _____.
Sleep apnea usually _____.
Aggressive UPPP has been known to cause _______.
snoring
persists
swallowing and speech difficulties
CPAP
Long-term resolution for _____
Consists of a _____ and ______
Prevents _______
obstructive apnea
face mask and air pressure generator
laryngeal collapse while sleeping
Summary
_______and _______should form a partnership to diagnose and treat the disorders related to oropharyngeal anomalies.
Speech-language pathologists ;
otolaryngologists
