Cleft Lip and Palate Flashcards
timeline for formation of the face in utero
between 4 and 8 weeks
5 prominences of facial formation
- frontonasal prominence
- 2 maxillary prominences
- 2 mandibular prominences
frontonasal prominence will form ?
- forehead
- nose
- central part of the lip
maxillary prominences will form ?
- upper jaw
- upper half of the cheeks (skin, muscles, nerves)
mandibular prominences will form ?
- lower jaw
- lower half of the cheeks (skin, muscles, nerves)
what are fusion lines
- from prominences fusing together
- usually not visible
which fusion lines are visible
the philtral columns (upper lip)
at which week in utero has the palate formed
11
which part of the palate forms first
primary palate
what is the primary palate
anterior palate lying in front of the incisive foramen
what is the secondary palate
palatal shelves that fuse in the midline to form the complete palate
cleft cause
- idiopathic
- genetic component
- failure of prominences to fully fuse
cleft types
- cleft lip in isolation
- unilateral cleft lip and palate
- bilateral cleft lip and palate
- cleft of the hard and soft palate
- cleft of the soft palate
- submucous cleft palate
which cleft types impact speech
- unilateral cleft lip and palate
- bilateral cleft lip and palate
- cleft of the hard and soft palate
- cleft of the soft palate
- submucous cleft palate
which cleft types do not impact speech
cleft lip in isolation
unilateral cleft lip and palate
bilateral cleft lip and palate
cleft of the hard and soft palate
cleft of the soft palate
submucous cleft palate
syndromes associated with cleft lip/palate
- Treacher Collins
- Aperts
- Van der Woude
- Prader-Willi
- Beckwith-Wiedeman
- 22q11 Deletion Syndrome
22q11.2 deletion syndrome
C - cardiac defect
A - abnormal facial feature
T - thymus gland problems and reduced immunity
C - cleft palate/palatal abnormalities
H - hypocalcemia (calcium deficiency)
22 - deletion of chromosome 22
- VPD, laryngotracheal abnormalities
- apraxia, dysarthria, voice disorder, language delay
- intellectual disability, ADHD, ASD, psychiatric diagnoses
most common cleft palate associated with 22q11.2 deletion syndrome
submucous cleft palate
implications of cleft
- feeding
- speech, language, voice
- hearing
- orthodontics
- dentition
- psychosocial
cleft MDT is central to ?
child/family
primary surgery to repair cleft lip age
3-6 months (depends on severity)
primary surgery to repair cleft palate age
6-12 months
secondary speech surgery purpose
- palate re-repair
- pharyngeal flap pharyngoplasty
- buccinator flap palatal lengthening
- pharyngoplasty
lip revision surgery age
- 4-5 years
- push for this to happen when child is older (later surgery = better outcome)
alveolar bone graft age
10-11 years
orthognathic surgery age
17 years
plastic surgery revision of nose and lip age
17 years
oronasal fistula definition
hole or opening in the palate after cleft lip repair
oronasal fistula cause
- breakdown of tissue during healing process post surgery
- can open after maxillary expansion or growth
residual cleft definition
unrepaired cleft of hard palate or alveolus left open to be closed later
are oronasal fistulas or residual clefts more rare
residual clefts
cons of residual clefts
interferes with speech therapy
effects of oronasal fistula and residual cleft depend on ?
- size (larger = more symptomatic)
- location (under tongue tip is problematic)
- may cause nasal regurgitation
normal feeding
- combination of compression and suction to extract milk from teat
- compression helps push milk out of teat and suction results in milk being extracted from the teat
compression definition
- positive pressure on teat
- teat placed between palate and tongue
suction definition
- negative pressure created within the oral cavity
- lower jaw drops, tongue and nasal cavity seal off resulting in an enlarged sealed chamber
common feeding difficulties with cleft lip and palate
- poor suction
- weak suck
- difficulty holding binky in mouth
- poor intake with long breastfeeding sessions
- nasal regurgitation
- intake of extra air
- feeding
- poor weight gain
- stressful feedings
what are the two most common feeding difficulties with cleft lip and palate
- inefficient suck
- inability to develop adequate intraoral negative pressure
what muscle controls opening of the eustachian tube
tensor veli palatini
what nerve supplies the muscle that controls the opening of the eustachian tube
CNV (trigeminal)
eustachian tube function
middle air aeration and drainage
do children with cleft palate have a greater, less than, or equal risk of conductive hearing loss and why?
- greater
- high incidences of OME which causes conductive hearing loss
OME treatments
- grommets
- hearing aids
1 con of grommets
can’t have loads of sets because they can cause scarring to the paper-thin ear drum
which tooth is most affected
lateral incisor
dental variation associated with clefts
- number of teeth
- enamel formation
- eruption of teeth
- teeth formation delay
- missing, fused, peg-shaped teeth
how do dental anomalies affect speech
minimal effect on articulation
alveolar bone graft
- usually graft bone from hip to the gums
- repairs the hole in the gum ridge and stabilizes the bone arch, providing support for the roots of the developing teeth to grow
types of occlusion
- class I
- class II
- class III
which occlusion impacts speech the most and why
- class III
- lack of maxillary space, the tongue may have insufficient space to function
- anterior tongue tip sounds may be incorrectly articulated (lateralization and palatalization of consonants)
- difficult to achieve labiodental placement (bilabial or dentolabial fricatives)
maxillary osteotomy definition
jaw realignment surgery
nasal speech sounds and velopharyngeal position
- n, m, ŋ
- open
oral speech sounds/vowels and velopharyngeal position
- p, b, t, d, k, g, f, v, s, z, ʃ, ʒ, ʧ, ʤ
- vowels
- closed
front oral speech sounds
p, b, t, d, f, v, s, z
back oral speech sounds
k, g
velopharyngeal dysfunction (VPD) definition
insufficient soft palate closure
cleft VPD causes
structural
structural cleft VDP causes
- unrepaired cleft palate
- postsurgical insufficiences (palatal length too short, postadenoidectomy)
why should adenoids not be removed in children with cleft palate
can supplement for VPI
can tonsils cause VPI
yes
non-cleft VPD causes
- structural
- neurogenic
- mislearning
non-cleft velopharyngeal structural insufficiency
- mechanical interference (excessive tonsils)
- palatopharyngeal disproportion (long pharynx, short palate)
- ablative palatal lesions (cancer, traumatic injury)
non-cleft velopharyngeal neurogenic incompetency
- dysarthria
- apraxia
non-cleft velopharyngeal mislearning
- phoneme-specific nasal emission
- persisting postoperative nasal emission
- compensatory misarticulations
- deafness/hearing impairment
routine procedure if VPI appears postadenoidectomy
wait 1 year to see if it resolves on its own
effects of VPI on speech
- hypernasality
- nasal emission/turbulence
- passive cleft speech characteristics
on which phonemes are hypernasality usually perceived on
vowels and consonants
in severe hypernasality which sounds can be perceived as nasal sounds
p, b, g
hypernasality/hyponasality assessment
Temple Street Scale of Nasality and Nasal Airflow (mild, mild-moderate, moderate, moderate-severe, severe)
hyponasality cause
- nasal airway is (partially) blocked
- posterior entrance to the nasal cavity
hypernasality cause
too much air escapes through velum
nasal airflow errors
inappropriate escape of air through the nose during speech
types of nasal airflow errors
- nasal emission
- nasal turbulence
nasal emission
- audible escape of air through the nose
- perceived as frictional sound
- accompanies a phoneme
nasal turbulence
- audible escape of air through the nose
- perceived as turbulent or snorting sound
- accompanies a phoneme
difference between nasal turbulence and emission
- nasal emission, palate is more open causing less noise but more severe
- nasal turbulence, palate is more closed causing more noise but less severe
types of cleft speech characteristics
- active
- passive
active cleft speech characteristics
- adaptive/mislearning
- compensatory
compensatory cleft speech characteristics definition
articulation is altered in response to previous or present abnormal structure
passive cleft speech characteristics
- structurally or physiologically related
- obligatory
obligatory cleft speech characteristics definition
- articulation is normal
- abnormal structure results in distortion of the speech sound
