Cleft Palate

Question 1

What 5 specific structures are involved in cleft palate?

Answer 1

Nose, upper lip, hard palate, soft palate, and pharynx

Question 2

What is the most important structure for closing off the airway so speech comes out the mouth instead of the nose?

Answer 2

Soft palate/velum

Question 3

What is the #1 muscle responsible for raising the velum?

Answer 3

Levator veli palatini

Question 4

What muscle opens and closes the eustachian tube?

Answer 4

Tensor veli palatini

Question 5

In cleft palate surgery, what differentiates a good surgery that makes a difference in the velum raising and lowering vs. just a cosmetic surgery?

Answer 5

If they reconnected muscles or not (better to do a z-plasty suture instead of just a midline suture)

Question 6

Cleft palates are the ___ most common birth defect and the ___ common congenital defect of the face.

Answer 6

4th most common

most common defect of face

Question 7

When do cleft palates occur?

Answer 7

During the first trimester

Question 8

What are the 4 basic causes of cleft palate?

Answer 8

1 - chromosomal disorders
2 - genetic disorders
3 - environmental teratogens
4 - mechanical factors in utero

Question 9

What are the 2 categories of classification of cleft palate?

Answer 9

Cleft of the primary palate and cleft of the secondary palate

Question 10

What is the primary palate?

Answer 10

Anterior to incisive foramen, includes the lips!

Question 11

What is the secondary palate?

Answer 11

Posterior to the incisive foramen

Question 12

What is the incisive foramen?

Answer 12

Where everything starts fusing together

Question 13

What does it mean if a cleft LIP is incomplete?

Answer 13

Can be just a notch in the lip with alveolar ridge intact (can go into nasal sill)

Question 14

What is a complete cleft lip?

Answer 14

Cleft of primary palatea ll the way to incisive foramen through entire lip and alveolus

Question 15

What is an incomplete cleft palate?

Answer 15

Can be bifid uvula only or farther into the velum

Question 16

What is a complete cleft palate?

Answer 16

Extends through uvula and velum and through hard palate (usually associated with some type of syndrome)

Question 17

What is a submucous cleft?

Answer 17

Congenital defect that is in the underlying structures of the palate, not on the oral surface; can involve muscles of the soft palate and or boney structures of the hard palate

Question 18

What are some classic characteristics of a submucous cleft?

Answer 18

Bifid uvula, bluish line, or a notable inverted V

Question 19

What are the three primary effects of cleft palate?

Answer 19

1 - nasalized speech
2 - articulation errors
3 - increased risk of otitis media, possible hearing loss

Question 20

What are the 2 different ways to classify cleft palate speech errors?

Answer 20

Obligatory and compensatory

Question 21

What are obligatory errors a consequence of?

Answer 21

Direct consequence of anatomic or physiological defects

Question 22

When will obligatory errors be corrected?

Answer 22

They will spontaneously correct when the cause of the error is corrected (surgery!!)

Question 23

What are some examples of obligatory errors?

Answer 23

Nasal emission (during consonants), hypernasality (during vowels), weak consonants, nasal turbulence, etc.

Question 24

What are compensatory errors?

Answer 24

Things that a speaker does to replace sounds when they are unable to physically produce an actual sound

Question 25

Examples of compensatory errors?

Answer 25

Glottal stops, pharyngeal fricatives, pharyngeal stops, etc.

Question 26

What are 3 different ways to assess CP speech?

Answer 26

1 - perceptual assessment
2 - intra-oral assessment (oral periph)
3 - instrumental assessment

Question 27

What is the protocol for a perceptual assessment?

Answer 27

1 - obtain an adequate speech sample
2 - analyze speech sample
3 - correlate perceptual data with orofacial exam findings
4 - interpret the clinical data

Question 28

Connected speech samples are the best representations to do what 3 things?

Answer 28

1 - judge speech intelligibility
2 - check for consistency of errors
3 - judge voice quality and resonance

Question 29

What are some ways to test for hypernasality?

Answer 29

Sample should contained voiced, oral sounds (vowels)

• prolong “ah”
• repeating oral syllables “papapapa, titititi, kakakaka,” etc.
• See Scape, fogging on mirror, etc.

Question 30

What are some ways to test for nasal emission?

Answer 30

Voiceless, pressure sensitive consonants (lots of “s”s)
Look for facial grimacing
Counting 60-70

Question 31

Say “no” to speech intervention ONLY if..

Answer 31

If the cause of the speech disorder is abnormal structure only; if nasality is consistent across all phonemes; if there is a consistent velopharyngeal opening due to insufficiency

Question 32

What speech therapy options are there for an abnormal structure?

Answer 32

ONLY surgical correction!

Question 33

What is our goal of therapy prior to surgery?

Answer 33

Early intervention - goal is to minimize those compensatory errors! Seriously educate the parents.