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Cleft Palate > Chapter Seventeen > Flashcards

Chapter Seventeen Flashcards

1
Q

Chapter 17Nasopharyngoscopy

A

booooo

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2
Q

Endoscopy—

Nasopharyngoscopy (also called nasendoscopy or videonasendoscopy)—

A

a procedure that allows the visualization of the interior of a canal or hollow organ by means of a special instrument called an endoscope

a minimally invasive endoscopic procedure that allows visual observation and analysis of the velopharyngeal mechanism during speech

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3
Q

Equipment: Basics

Flexible fiberoptic endoscope

A

Range in size from 2.2 mm to almost 5 mm diameter

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4
Q

Equipment: Complete System

A

Eyepiece with a lever for moving the tip of the scope

Specially designed camera that attaches to the eyepiece

External microphone

High-intensity light source for illumination, typically halogen or xenon

High-resolution monitor

High-quality digital video recorder

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5
Q

Clinical Uses for Nasopharyngoscopy

Nasopharyngoscopy is widely used for….

It can determine

A

evaluation of velopharyngeal function

the size, location, and probable cause of VPI, which is important for surgical planning

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6
Q

Clinical Uses for Nasopharyngoscopy

Nasal surface of velum may reveal evidence of ______

Absent or dysplastic _______

Concavity or notch in velum, especially the _______

__________corresponding to defect in velum

Nasal surface of the hard palate may show ….

A

submucous cleft:

musculus uvulae

posterior border

VP gap in midline

actual size and extent of an oronasal fistula.

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7
Q

Clinical Uses for Nasopharyngoscopy

Posterior pharyngeal wall may show:

A

1.Evidence of Passavant’s ridge

  1. Adenoid pad
    a) Can evaluate size and potential for airway obstruction
    b) Can evaluate for protrusions or fissures the can affect firmness of velo-adenoidal closure

3.Displaced internal carotids, based on pulsations on the posterior pharyngeal wall

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8
Q

Clinical Uses for Nasopharyngoscopy

Larynx and vocal folds may show:

A

Vocal fold nodules

Laryngeal anomalies associated with craniofacial anomalies

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9
Q

Clinical Uses for Nasopharyngoscopy

Treatment planning for VPI:
1.
2.

A

Can determine the best surgical procedure for the patient

Can help the prosthodontist design and modify an effective appliance, if surgery is not an option

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10
Q

Can evaluate the results of surgery for VPI:

A

If there is residual hypernasality or nasal emission or if there is postop airway obstruction, can help surgeon to determine the appropriate surgical revision procedure.

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11
Q

Clinical Uses of Nasopharyngoscopy

Can be used to…

Can be used to provide…

A

evaluate swallowing

biofeedback when the problem is due to abnormal function

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12
Q

Nasopharyngoscopy Preparation

Child must be able to…

Child must be able to _______

A

produce connected speech and repeat words and short sentences.

cooperate sufficiently.

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13
Q

Nasopharyngoscopy Preparation

Provide info on…

Do a..

Explain

_____and ______(if passing the scope).

A

what to expect before the day of the appointment.

perceptual evaluation and practice speech sample.

the procedure.

Wash hands and wear gloves

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14
Q

Nasopharyngoscopy Preparation

Use a _______(i.e., Afrin) and a _______(i.e., tetracaine), and administer through a nose spray; this must be ordered by a physician and mixed by a pharmacist.

Coat the sides of the scope with _________(2%) gel.

A

decongestant and topical anesthetic

viscous lidocaine

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15
Q

Positioning the Patient

Patient _______

For very young kids:
1.
2.
3.
4.
A

seated upright

Put child on parent’s lap.

Have parent “hug” around the arms and hold the child’s hands.

Parent puts a leg over child’s legs if necessary.

Have nurse or someone else hold the head still.

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16
Q

Learning to Perform the Procedure

Nasopharyngoscopy can be done by a ______ (e.g., an ENT or plastic surgeon) or by a ________

To learn to perform the procedure:
Review _____documents.

Attend focused _____.

Mentor with an _______

Review videotapes of _____.

Obtain supervised ______.

A

physician or speech-language pathologist

ASHA

courses

experienced professional.

exams

experience

17
Q

Passing the Scope

Endoscope inserted..

For unilateral clefts,

A

through largest nostril.

try the unaffected side first.

18
Q

Passing the Scope

Scope is guided…

Inferior meatus is not good because scope will _____ and move with velum during speech.

Superior meatus is _____.

A

up and over the inferior turbinate, through the middle meatus, through the choanal orifice, to the VP port.

rest on velum

too narrow

19
Q

Once the scope is in nasopharynx, it needs to be…

The scope can be rotated slightly from one side to the other to

A

turned down with the lever so that it is perpendicular to the opening.

see both sides of the port.

20
Q

Passing the Scope

VP function is observed on _____

The left side of the screen will show ….

A

a monitor.

the patient’s right side and vice versa

21
Q

Speech Samples

Depends on the results of the \_\_\_\_\_\_\_
1.
2.
3.
4.
A

speech evaluation

Repetition of syllables with pressure-sensitive phonemes

Repetition of sentences loaded with pressure-sensitive phonemes

Counting from 60 to 70

Repetition of nasal syllables and sentences and prolonged /m/ to evaluate nasal obstruction

22
Q

Interpretation

Submucous cleft

A

IMAGE

23
Q

Interpretation

Oronasal fistula

A

IMAGE

24
Q

Interpretation

Irregular adenoids

A

IMAGE

25
Q

Interpretation

Passavant’s Ridge

A

IMAGE

26
Q

Interpretation

Tonsillar hypertrophy with tonsil in the pharynx

A

IMAGE

27
Q

Interpretation

Small gap

A

IMAGE

28
Q

Interpretation

Large gap

A

IMAGE

29
Q

Interpretation

Vocal nodules

A

IMAGE

30
Q

Interpretation

Pharyngeal flap

A

IMAGE

31
Q

Interpretation

Sphincter pharyngoplasty

A

IMAGE

32
Q

Advantages of Nasopharyngoscopy

1.
2.
3.
4.
5.
6.
7.
A

It provides excellent resolution and visualization of all the structures.

The location, size, and shape of the opening can be determined.

Even very small openings can be seen.

The results of surgeries for VPI can be seen.

It can be done without radiation.

It is well tolerated, even by young patients.

It can provide biofeedback.

33
Q

Limitations of Nasopharyngoscopy

1.
2.
3.

A

It requires a degree of cooperation.

It causes slight discomfort and can be scary for kids.

The equipment is expensive to purchase and maintain.

34
Q

Summary

Nasopharyngoscopy is an important procedure for evaluation of ____.

It is effective in determining the ____________ of a velopharyngeal gap, and is used for surgical planning.

It can also be used to evaluate the ________of surgery for VPI.

It can determine the source of _______when it occurs.

It can be used to evaluate ______and vocal fold function.

A

VPI

size, shape, location, and cause

effectiveness

upper airway obstruction

swallowing

Cleft Palate (19 decks)

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