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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
cleft MDT is central to ?
child/family
25
primary surgery to repair cleft lip age
3-6 months (depends on severity)
26
primary surgery to repair cleft palate age
6-12 months
27
secondary speech surgery purpose
- palate re-repair - pharyngeal flap pharyngoplasty - buccinator flap palatal lengthening - pharyngoplasty
28
lip revision surgery age
- 4-5 years - push for this to happen when child is older (later surgery = better outcome)
29
alveolar bone graft age
10-11 years
30
orthognathic surgery age
17 years
31
plastic surgery revision of nose and lip age
17 years
32
oronasal fistula definition
hole or opening in the palate after cleft lip repair
33
oronasal fistula cause
- breakdown of tissue during healing process post surgery - can open after maxillary expansion or growth
34
residual cleft definition
unrepaired cleft of hard palate or alveolus left open to be closed later
35
are oronasal fistulas or residual clefts more rare
residual clefts
36
cons of residual clefts
interferes with speech therapy
37
effects of oronasal fistula and residual cleft depend on ?
- size (larger = more symptomatic) - location (under tongue tip is problematic) - may cause nasal regurgitation
38
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
39
compression definition
- positive pressure on teat - teat placed between palate and tongue
40
suction definition
- negative pressure created within the oral cavity - lower jaw drops, tongue and nasal cavity seal off resulting in an enlarged sealed chamber
41
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
42
what are the two most common feeding difficulties with cleft lip and palate
- inefficient suck - inability to develop adequate intraoral negative pressure
43
what muscle controls opening of the eustachian tube
tensor veli palatini
44
what nerve supplies the muscle that controls the opening of the eustachian tube
CNV (trigeminal)
45
eustachian tube function
middle air aeration and drainage
46
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
47
OME treatments
- grommets - hearing aids
48
1 con of grommets
can't have loads of sets because they can cause scarring to the paper-thin ear drum
49
which tooth is most affected
lateral incisor
50
dental variation associated with clefts
- number of teeth - enamel formation - eruption of teeth - teeth formation delay - missing, fused, peg-shaped teeth
51
how do dental anomalies affect speech
minimal effect on articulation
52
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
53
types of occlusion
- class I - class II - class III
54
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)
55
maxillary osteotomy definition
jaw realignment surgery
56
nasal speech sounds and velopharyngeal position
- n, m, ŋ - open
57
oral speech sounds/vowels and velopharyngeal position
- p, b, t, d, k, g, f, v, s, z, ʃ, ʒ, ʧ, ʤ - vowels - closed
58
front oral speech sounds
p, b, t, d, f, v, s, z
59
back oral speech sounds
k, g
60
velopharyngeal dysfunction (VPD) definition
insufficient soft palate closure
61
cleft VPD causes
structural
62
structural cleft VDP causes
- unrepaired cleft palate - postsurgical insufficiences (palatal length too short, postadenoidectomy)
63
why should adenoids not be removed in children with cleft palate
can supplement for VPI
64
can tonsils cause VPI
yes
65
non-cleft VPD causes
- structural - neurogenic - mislearning
66
non-cleft velopharyngeal structural insufficiency
- mechanical interference (excessive tonsils) - palatopharyngeal disproportion (long pharynx, short palate) - ablative palatal lesions (cancer, traumatic injury)
67
non-cleft velopharyngeal neurogenic incompetency
- dysarthria - apraxia
68
non-cleft velopharyngeal mislearning
- phoneme-specific nasal emission - persisting postoperative nasal emission - compensatory misarticulations - deafness/hearing impairment
69
routine procedure if VPI appears postadenoidectomy
wait 1 year to see if it resolves on its own
70
effects of VPI on speech
- hypernasality - nasal emission/turbulence - passive cleft speech characteristics
71
on which phonemes are hypernasality usually perceived on
vowels and consonants
72
in severe hypernasality which sounds can be perceived as nasal sounds
p, b, g
73
hypernasality/hyponasality assessment
Temple Street Scale of Nasality and Nasal Airflow (mild, mild-moderate, moderate, moderate-severe, severe)
74
hyponasality cause
- nasal airway is (partially) blocked - posterior entrance to the nasal cavity
75
hypernasality cause
too much air escapes through velum
76
nasal airflow errors
inappropriate escape of air through the nose during speech
77
types of nasal airflow errors
- nasal emission - nasal turbulence
78
nasal emission
- audible escape of air through the nose - perceived as frictional sound - accompanies a phoneme
79
nasal turbulence
- audible escape of air through the nose - perceived as turbulent or snorting sound - accompanies a phoneme
80
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
81
types of cleft speech characteristics
- active - passive
82
active cleft speech characteristics
- adaptive/mislearning - compensatory
83
compensatory cleft speech characteristics definition
articulation is altered in response to previous or present abnormal structure
84
passive cleft speech characteristics
- structurally or physiologically related - obligatory
85
obligatory cleft speech characteristics definition
- 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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