Cleft Palate Flashcards
What 5 specific structures are involved in cleft palate?
Nose, upper lip, hard palate, soft palate, and pharynx
What is the most important structure for closing off the airway so speech comes out the mouth instead of the nose?
Soft palate/velum
What is the #1 muscle responsible for raising the velum?
Levator veli palatini
What muscle opens and closes the eustachian tube?
Tensor veli palatini
In cleft palate surgery, what differentiates a good surgery that makes a difference in the velum raising and lowering vs. just a cosmetic surgery?
If they reconnected muscles or not (better to do a z-plasty suture instead of just a midline suture)
Cleft palates are the ___ most common birth defect and the ___ common congenital defect of the face.
4th most common
most common defect of face
When do cleft palates occur?
During the first trimester
What are the 4 basic causes of cleft palate?
1 - chromosomal disorders
2 - genetic disorders
3 - environmental teratogens
4 - mechanical factors in utero
What are the 2 categories of classification of cleft palate?
Cleft of the primary palate and cleft of the secondary palate
What is the primary palate?
Anterior to incisive foramen, includes the lips!
What is the secondary palate?
Posterior to the incisive foramen
What is the incisive foramen?
Where everything starts fusing together
What does it mean if a cleft LIP is incomplete?
Can be just a notch in the lip with alveolar ridge intact (can go into nasal sill)
What is a complete cleft lip?
Cleft of primary palatea ll the way to incisive foramen through entire lip and alveolus
What is an incomplete cleft palate?
Can be bifid uvula only or farther into the velum
What is a complete cleft palate?
Extends through uvula and velum and through hard palate (usually associated with some type of syndrome)
What is a submucous cleft?
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
What are some classic characteristics of a submucous cleft?
Bifid uvula, bluish line, or a notable inverted V
What are the three primary effects of cleft palate?
1 - nasalized speech
2 - articulation errors
3 - increased risk of otitis media, possible hearing loss
What are the 2 different ways to classify cleft palate speech errors?
Obligatory and compensatory
What are obligatory errors a consequence of?
Direct consequence of anatomic or physiological defects
When will obligatory errors be corrected?
They will spontaneously correct when the cause of the error is corrected (surgery!!)
What are some examples of obligatory errors?
Nasal emission (during consonants), hypernasality (during vowels), weak consonants, nasal turbulence, etc.
What are compensatory errors?
Things that a speaker does to replace sounds when they are unable to physically produce an actual sound
Examples of compensatory errors?
Glottal stops, pharyngeal fricatives, pharyngeal stops, etc.
What are 3 different ways to assess CP speech?
1 - perceptual assessment
2 - intra-oral assessment (oral periph)
3 - instrumental assessment
What is the protocol for a perceptual assessment?
1 - obtain an adequate speech sample
2 - analyze speech sample
3 - correlate perceptual data with orofacial exam findings
4 - interpret the clinical data
Connected speech samples are the best representations to do what 3 things?
1 - judge speech intelligibility
2 - check for consistency of errors
3 - judge voice quality and resonance
What are some ways to test for hypernasality?
Sample should contained voiced, oral sounds (vowels)
- prolong “ah”
- repeating oral syllables “papapapa, titititi, kakakaka,” etc.
- See Scape, fogging on mirror, etc.
What are some ways to test for nasal emission?
Voiceless, pressure sensitive consonants (lots of “s”s)
Look for facial grimacing
Counting 60-70
Say “no” to speech intervention ONLY if..
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
What speech therapy options are there for an abnormal structure?
ONLY surgical correction!
What is our goal of therapy prior to surgery?
Early intervention - goal is to minimize those compensatory errors! Seriously educate the parents.
