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Nature of Disorders of Speech, Voice, Fluency, and Swallowing > Cleft Lip and Palate > Flashcards

Cleft Lip and Palate Flashcards

1
Q

timeline for formation of the face in utero

A

between 4 and 8 weeks

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2
Q

5 prominences of facial formation

A
  • frontonasal prominence
  • 2 maxillary prominences
  • 2 mandibular prominences
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3
Q

frontonasal prominence will form ?

A
  • forehead
  • nose
  • central part of the lip
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4
Q

maxillary prominences will form ?

A
  • upper jaw
  • upper half of the cheeks (skin, muscles, nerves)
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5
Q

mandibular prominences will form ?

A
  • lower jaw
  • lower half of the cheeks (skin, muscles, nerves)
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6
Q

what are fusion lines

A
  • from prominences fusing together
  • usually not visible
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7
Q

which fusion lines are visible

A

the philtral columns (upper lip)

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8
Q

at which week in utero has the palate formed

A

11

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9
Q

which part of the palate forms first

A

primary palate

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10
Q

what is the primary palate

A

anterior palate lying in front of the incisive foramen

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11
Q

what is the secondary palate

A

palatal shelves that fuse in the midline to form the complete palate

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12
Q

cleft cause

A
  • idiopathic
  • genetic component
  • failure of prominences to fully fuse
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13
Q

cleft types

A
  • 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
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14
Q

which cleft types impact speech

A
  • 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
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14
Q

which cleft types do not impact speech

A

cleft lip in isolation

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15
Q

unilateral cleft lip and palate

A
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16
Q

bilateral cleft lip and palate

A
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17
Q

cleft of the hard and soft palate

A
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18
Q

cleft of the soft palate

A
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19
Q

submucous cleft palate

A
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20
Q

syndromes associated with cleft lip/palate

A
  • Treacher Collins
  • Aperts
  • Van der Woude
  • Prader-Willi
  • Beckwith-Wiedeman
  • 22q11 Deletion Syndrome
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21
Q

22q11.2 deletion syndrome

A

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
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22
Q

most common cleft palate associated with 22q11.2 deletion syndrome

A

submucous cleft palate

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23
Q

implications of cleft

A
  • feeding
  • speech, language, voice
  • hearing
  • orthodontics
  • dentition
  • psychosocial
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24
Q

cleft MDT is central to ?

A

child/family

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25
Q

primary surgery to repair cleft lip age

A

3-6 months (depends on severity)

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26
Q

primary surgery to repair cleft palate age

A

6-12 months

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27
Q

secondary speech surgery purpose

A
  • palate re-repair
  • pharyngeal flap pharyngoplasty
  • buccinator flap palatal lengthening
  • pharyngoplasty
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28
Q

lip revision surgery age

A
  • 4-5 years
  • push for this to happen when child is older (later surgery = better outcome)
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29
Q

alveolar bone graft age

A

10-11 years

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30
Q

orthognathic surgery age

A

17 years

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31
Q

plastic surgery revision of nose and lip age

A

17 years

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32
Q

oronasal fistula definition

A

hole or opening in the palate after cleft lip repair

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33
Q

oronasal fistula cause

A
  • breakdown of tissue during healing process post surgery
  • can open after maxillary expansion or growth
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34
Q

residual cleft definition

A

unrepaired cleft of hard palate or alveolus left open to be closed later

35
Q

are oronasal fistulas or residual clefts more rare

A

residual clefts

36
Q

cons of residual clefts

A

interferes with speech therapy

37
Q

effects of oronasal fistula and residual cleft depend on ?

A
  • size (larger = more symptomatic)
  • location (under tongue tip is problematic)
  • may cause nasal regurgitation
38
Q

normal feeding

A
  • 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
39
Q

compression definition

A
  • positive pressure on teat
  • teat placed between palate and tongue
40
Q

suction definition

A
  • negative pressure created within the oral cavity
  • lower jaw drops, tongue and nasal cavity seal off resulting in an enlarged sealed chamber
41
Q

common feeding difficulties with cleft lip and palate

A
  • 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
42
Q

what are the two most common feeding difficulties with cleft lip and palate

A
  • inefficient suck
  • inability to develop adequate intraoral negative pressure
43
Q

what muscle controls opening of the eustachian tube

A

tensor veli palatini

44
Q

what nerve supplies the muscle that controls the opening of the eustachian tube

A

CNV (trigeminal)

45
Q

eustachian tube function

A

middle air aeration and drainage

46
Q

do children with cleft palate have a greater, less than, or equal risk of conductive hearing loss and why?

A
  • greater
  • high incidences of OME which causes conductive hearing loss
47
Q

OME treatments

A
  • grommets
  • hearing aids
48
Q

1 con of grommets

A

can’t have loads of sets because they can cause scarring to the paper-thin ear drum

49
Q

which tooth is most affected

A

lateral incisor

50
Q

dental variation associated with clefts

A
  • number of teeth
  • enamel formation
  • eruption of teeth
  • teeth formation delay
  • missing, fused, peg-shaped teeth
51
Q

how do dental anomalies affect speech

A

minimal effect on articulation

52
Q

alveolar bone graft

A
  • 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
53
Q

types of occlusion

A
  • class I
  • class II
  • class III
54
Q

which occlusion impacts speech the most and why

A
  • 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)
55
Q

maxillary osteotomy definition

A

jaw realignment surgery

56
Q

nasal speech sounds and velopharyngeal position

A
  • n, m, ŋ
  • open
57
Q

oral speech sounds/vowels and velopharyngeal position

A
  • p, b, t, d, k, g, f, v, s, z, ʃ, ʒ, ʧ, ʤ
  • vowels
  • closed
58
Q

front oral speech sounds

A

p, b, t, d, f, v, s, z

59
Q

back oral speech sounds

A

k, g

60
Q

velopharyngeal dysfunction (VPD) definition

A

insufficient soft palate closure

61
Q

cleft VPD causes

A

structural

62
Q

structural cleft VDP causes

A
  • unrepaired cleft palate
  • postsurgical insufficiences (palatal length too short, postadenoidectomy)
63
Q

why should adenoids not be removed in children with cleft palate

A

can supplement for VPI

64
Q

can tonsils cause VPI

A

yes

65
Q

non-cleft VPD causes

A
  • structural
  • neurogenic
  • mislearning
66
Q

non-cleft velopharyngeal structural insufficiency

A
  • mechanical interference (excessive tonsils)
  • palatopharyngeal disproportion (long pharynx, short palate)
  • ablative palatal lesions (cancer, traumatic injury)
67
Q

non-cleft velopharyngeal neurogenic incompetency

A
  • dysarthria
  • apraxia
68
Q

non-cleft velopharyngeal mislearning

A
  • phoneme-specific nasal emission
  • persisting postoperative nasal emission
  • compensatory misarticulations
  • deafness/hearing impairment
69
Q

routine procedure if VPI appears postadenoidectomy

A

wait 1 year to see if it resolves on its own

70
Q

effects of VPI on speech

A
  • hypernasality
  • nasal emission/turbulence
  • passive cleft speech characteristics
71
Q

on which phonemes are hypernasality usually perceived on

A

vowels and consonants

72
Q

in severe hypernasality which sounds can be perceived as nasal sounds

A

p, b, g

73
Q

hypernasality/hyponasality assessment

A

Temple Street Scale of Nasality and Nasal Airflow (mild, mild-moderate, moderate, moderate-severe, severe)

74
Q

hyponasality cause

A
  • nasal airway is (partially) blocked
  • posterior entrance to the nasal cavity
75
Q

hypernasality cause

A

too much air escapes through velum

76
Q

nasal airflow errors

A

inappropriate escape of air through the nose during speech

77
Q

types of nasal airflow errors

A
  • nasal emission
  • nasal turbulence
78
Q

nasal emission

A
  • audible escape of air through the nose
  • perceived as frictional sound
  • accompanies a phoneme
79
Q

nasal turbulence

A
  • audible escape of air through the nose
  • perceived as turbulent or snorting sound
  • accompanies a phoneme
80
Q

difference between nasal turbulence and emission

A
  • nasal emission, palate is more open causing less noise but more severe
  • nasal turbulence, palate is more closed causing more noise but less severe
81
Q

types of cleft speech characteristics

A
  • active
  • passive
82
Q

active cleft speech characteristics

A
  • adaptive/mislearning
  • compensatory
83
Q

compensatory cleft speech characteristics definition

A

articulation is altered in response to previous or present abnormal structure

84
Q

passive cleft speech characteristics

A
  • structurally or physiologically related
  • obligatory
85
Q

obligatory cleft speech characteristics definition

A
  • articulation is normal
  • abnormal structure results in distortion of the speech sound

Nature of Disorders of Speech, Voice, Fluency, and Swallowing (6 decks)

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