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cleft palate Flashcards

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1
Q

True/false: during nasal breathing, the velum rests against the base of the tongue creating a patent airway

A

true (pg.333)

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2
Q

True/false: during speech the velum raises in a superior and posterior direction to contact the posterior pharyngeal wall

A

true (pg.333)

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3
Q

a shelf-like projection from the posterior pharyngeal wall that occurs inconsistently in some normal and abnormal individuals during velopharyngeal activities, such as speech, whistling, and blowing

A

passavant’s ridge (pg.334)

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4
Q

true/false: passavant’s ridge indicates an abnormality

A

false (pg.334)

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5
Q

a. levator veli palatini
b. superior constrictors
c. palatopharyngeus
d. tensor veli palatini

-provide the man muscle mass of the velum

A

a. levator veli palatini (pg.334)

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6
Q

a. levator veli palatini
b. superior constrictors
c. palatopharyngeus
d. tensor veli palatini

-responsible for the medial displacement of the lateral pharyngeal walls to narrow the velophraryngeal port to close around the velum

A

b. superior constrictors (pg.334)

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7
Q

a. levator veli palatini
b. superior constrictors
c. palatopharyngeus
d. tensor veli palatini

-assocaited with the medial movement of the lateral pharyngeal walls

A

c. palatopharyngeus (pg.334)

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8
Q

a. levator veli palatini
b. superior constrictors
c. palatopharyngeus
d. tensor veli palatini

  • open the eustachian tubes when the velum moves during swallowing or yawning:
  • enhances middle ear aeration and draining
A

d. tensor veli palatini (pg.334)

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9
Q

a. palatoglossus
b. salpingopharyngeus
c. musculus uvulae

-depresses the velum for production of nasal consonants in connected speech

A

a. palatoglossus (pg.334)

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10
Q

a. palatoglossus
b. salpingopharyngeus
c. musculus uvulae

-have no significant role in achieving velopharyngeal closure

A

b. salpingopharyngeus (pg.334)

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11
Q

a. palatoglossus
b. salpingopharyngeus
c. musculus uvulae

  • only intrinsic muscles of the velum
  • contracts during phonation to create a bulge on the superior and posterior part of the nasal surface of the velum
  • provides additional stiffness to the nasal side of the velum during velopharyngeal closure
A

c. musculus uvulae (pg.334)

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12
Q

variations in velopharygeal closure among speakers

a. coronal
b. circular
c. sagital

  • most common closure pattern
  • posterior movement of the soft palate closes against a broad area of the posterior pharyngeal wall
  • little contribution from lateral pharyngeal wall
  • when closure is complete, there is a coronal slit
A

a. coronal (pg.334)

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13
Q

variations in velopharygeal closure among speakers

a. coronal
b. circular
c. sagital

  • second-most common pattern
  • soft palate moves posteriorly, the posterior pharyngeal wall moves anteriorly and the lateral pharyngal wall moves medially
  • closes like a true sphincter
  • when closure is complete there is a circular slit
  • passavan’ts ride is commonly seen with this type of closure
A

b. circular (pg.334)

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14
Q

variations in velopharygeal closure among speakers

a. coronal
b. circular
c. sagital

  • least common pattern
  • lateral pharyngeal walls move medially to meet in milling behind the velum
  • there is minimal posterior displacement of the soft palate for closure
  • when closure is complete, there is a sagittal slit
A

c. sagital (pg.334)

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15
Q

______ activities do not involve air pressure

nonpneumatic or pneumatic activities

A

non pneumatic (pg.335) including

-swallwong, gagging and vomiting

pneumatic activities= blowing, whistling, singing, and speech

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16
Q

true/false: blowing and sucking exercises do not improve velopharyngeal function for speech

A

true (pg.335)

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17
Q

a. primary cleft palate
b. secondary cleft palate

  • complete cleft of the primary palate extended through the lip and alveolus to incisive foramen
  • incomplete cleft do not extend all the way to the incisive formen and include
    • a slight notch of the lip
    • a cleft of the lip only
    • a cleft of the lip and just part of the alveolus
  • can be unilateral or bilateral
A

a. primary cleft palate (pg.335)

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18
Q

a. primary cleft palate
b. secondary cleft palate

  • complete clefts of the secondary palate extend from the uvula to incisive foramen
  • incomplete clefts do not extend all the way to the incisive foramen and can include
    • a bifid uvula
    • a cleft of velum only
    • a cleft of the velum and just part of the hard palate
  • cleft location midline only
A

b. secondary cleft palate (pg.335)

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19
Q
  • a wide, bell-sharped cleft palate
  • seen with micrognathia (small mandible), glossoptosis (posterior tongue position)
  • airway and feeding problems
  • speech issues secondary to velopharyngeal insufficiency
A

pierre robins sequence (pg.335)

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20
Q

a. velocardiofacial syndrome
b. stickler syndrome
c. fetal alcohol syndrome
d. trisomy 13

  • usually occult submucosus cleft or velopharyngeal hypotonia
  • hypernasality
  • minor cardiac and vascular abnormalities
  • microcephaly
  • micorgnathia
  • nasal anomalies
  • narrow palpebral fissures
  • thin upper lip
  • minor auricular anomalies
  • abundant scalp hair
  • long slender features
  • hyperansality and speech sound errors, language delay and learning problems and risk psychiatric problems in adolescence
A

a. velocardiofacial syndrome (pg.336)

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21
Q

a. velocardiofacial syndrome
b. stickler syndrome
c. fetal alcohol syndrome
d. trisomy 13

  • cleft palate only
  • pierre robin sequence
  • wide flat face with mid face hypoplasia
  • epicnathal folds
  • sensorineural hearing loss
  • high myopia and risk for retinal detachments
  • risk for velopharyngeal insufficiency
A

b. stickler syndrome (pg.336)

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22
Q

a. velocardiofacial syndrome
b. stickler syndrome
c. fetal alcohol syndrome
d. trisomy 13

  • pierre robin sequence, cleft palate and cleft lip
  • short palpebral fissures
  • short nose, flat philtrum and thin upper lip
  • microcephaly
  • developmental disabilities, behavior problems and speech and language disorders
A

c. fetal alcohol syndrome (pg.336)

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23
Q

a. velocardiofacial syndrome
b. stickler syndrome
c. fetal alcohol syndrome
d. trisomy 13

  • cleft lip and palate, may have a midline cleft
  • holoprosencephaly, severe eye deficits, midline facial deformities
  • usually fatal before the first birthday
A

d. trisomy 13 (pg.336)

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24
Q

a. optiz G
b. van der woude
c. orofacialdigital syndrome
d. wolf-hichhorn

  • laryngeal cleft, cleft lip, cleft palate,
  • hypertelorism, flat nasal bridge, thin upper lip and low-set ears
  • voice and swallowing problems if there is a laryngeal cleft
A

a. optiz G (pg.336)

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25
Q

a. optiz G
b. van der woude
c. orofacialdigital syndrome
d. wolf-hichhorn

  • cleft lip and palate
  • bilateral lip pits on the lower lip, missing teeth
  • speech disorders related to cleft lip and palate
A

b. van der woude (pg.336)

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26
Q

a. optiz G
b. van der woude
c. orofacialdigital syndrome
d. wolf-hichhorn

  • cleft lip, cleft palate, midline cleft lip
  • hyperterlorism
  • lobulated tongue
  • multiple hyperplastic oral frenula
  • notching in alveolar ridge
  • broad nose
  • hydrocephalus
  • absence of corpus callosum
  • developmental disabilities and speech and language disorders
A

c. orofacialdigital syndrome (pg. 336)

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27
Q

a. saethre-chotzen
b. crouzon
c. apert
d. pfeiffer

  • cleft palate or submoucous cleft palate
  • oronasal synostosis, ptosis of the eyelids, mid face hypoplasia, external ear anomalies
  • risk for developmental disabilities
A

a. Saethre-chotzen (pg.337)

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28
Q

a. saethre-chotzen
b. crouzon
c. apert
d. pfeiffer

  • cleft palate, sub mucous cleft palate is occasionally seen
  • similar to apert syndrome including a broad forehead
  • flat occiput, exposthalmos, hypertelorism, antimongoloid slant, strabismus and mid face hypoplasia/retrusion, class III malocclusion, low-set ears
  • risk of developmental disabilities and upper airway obstruction
A

b crouzon (pg.337)

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29
Q

a. saethre-chotzen
b. crouzon
c. apert
d. pfeiffer

  • cleft palate occurs infrequently
  • similar to crouzon, including prominent forehead with a flat occiput, exophthalmos, hyperterlorism, antimongoloid slant, strabismus and mid face hypoplasia retrusion, class III malocclusion, low-set ears,
  • developmental disabilities, speech and language disorders, upper airway obstruction
A

c. apert (pg.337)

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30
Q

a. saethre-chotzen
b. crouzon
c. apert
d. pfeiffer

  • cleft palate is rare
  • coronal craniosynostosis
  • midface hypoplasia
  • shallow orbits with exophthalmos
  • hyperterolrism
  • tracheal anomalies
  • upper airway stenosis
  • hearing loss, developmental disabilities in type 1 and type 2 and upper airway obstruction
A

d. pfeiffer (pg.337)

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31
Q

true/false: treatment for velopharyngeal insufficiency always requires physical management

A

true (pg.338)

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32
Q

true/false: speech therapy is often required to change compensatory productions that developed as a result of the VPI

A

true (pg.338)

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33
Q

true/false: treatment for velopharyngeal incompetence usually requires physical management (palatal lift, or even surgery)

A

True (pg.339)

34
Q

true/false: treatment for velopharyngeal mislearning always requires speech therapy and never requires surgery

A

true (pg.339)

35
Q

a. hyper nasality
b. hyponasality
c. cul-de sac resonance

  • too much sound resonating in the nasal cavity during speech
  • most perceptible on vowels
  • voiced consonants maybe nasalized
A

a. hyper nasality (pg. 339)

36
Q

a. hyper nasality
b. hyponasality
c. cul-de sac resonance

  • not enough sound resonating in the nasal cavity during speech
  • most perceptible on nasal consonants
  • can also be noted on vowel sounds
A

b. hypo nasality (pg. 339)

37
Q

true/false: hypernasality does not affect voiceless consonants because resonance is the result of sound vibration

A

true (pg.339)

38
Q

what causes hyper nasality?

A
  • VPI or a fistula, can even be caused by keeping the back of the tongue too high when articulating vowels
    (pg. 339)
39
Q

what causes hypo nasality?

A
  • upper airway obstruction due to adenoid hypertrophy or nasal blockage (pg.339)
40
Q

a. hyper nasality
b. hyponasality
c. cul-de sac resonance

-occurs when the sound resonates in the pharynx or nasal cavity but is not released due to obstruction

A

c. cul-de sac resonance (pg.339)

41
Q

what causes cul-de sac resonance?

A

caused by enlarged tonsils, which blocks the entrance to the oral cavity causing pharyngeal cul-de-sca- resonance
(pg.339)

42
Q

true/false: speech therapy can correct hyper nasality or nasal emissions due to VPI

A

False: speech therapy cannot correct hyper nasality

43
Q

true/false: patient needs to learn to use the corrected valve through auditory feedback

A

true (pg.340)

44
Q

true/false: blowing exercises, sucking exercises, velar exercises or oral-motor exercise are effective and are totally appropriate

A

False: they are NOT effective and are totally inappropriate

pg.340

45
Q

timeline for intervention and assessment for children with history of cleft lip and palate:

  • ___________: should monitor language development and start language therapy, if needed
  • ___________: should evaluate velopharyngeal function and start speech therapy, if needed
A
  • birth to three
  • three years
    (pg. 341)
46
Q

A clinician is a member of a cleft palate and craniofacial team that asks her to conduct
an objective assessment of a 6-year-old child’s velopharyngeal mechanism. The clinician
decides to do nasopharyngoscopy, in which the nasopharyngoscope is passed through the
middle meatus and back to the area of velopharyngeal closure. What will this procedure
enable the clinician to observe?

A

The child’s posterior and lateral pharyngeal walls, as well as the nasal aspect of the velum
and the adenoid pad as the child produces sentences

47
Q

You are evaluating a 10-year-old boy who was referred because of difficulties associated
with partial submucous cleft palate accompanied by a bifid uvula. He is being teased at
school for “sounding funny,” and his parents are concerned about how he talks. During your
evaluation, what can you probably expect to find?

A

Hypernasality, accompanied by decreased intraoral breath pressure, leading to difficulties
with adequate production of fricatives, affricates, and plosives

48
Q

opening in normally closed structure

A

Cleft

49
Q

Eustachian tube dysfunction in children with cleft is most related to lack of contraction of the ________________.

A

tensor veli palatini muscle.

50
Q

Where is cleft most common on lips?

A

upper

51
Q

Are cleft lips more often unilateral or bilateral?

A

unilateral on left side

52
Q

Development of upper lip and primary palate take place by the end of the ______________.

A

7th week

53
Q

Soft palate is formed by the _____________ week.

A

12th

54
Q

Hard palate fuses between __ and ____ weeks gestation

A

8-9

55
Q

Etiology of Clefts

A

Genetic abnormalities
Environmental factors
Mechanical factors

56
Q

Congenital Palatopharyngeal Incompetence (CPI) refers to what?

A

velopharyngeal closing-valve function

57
Q

Laryngeal and phonatory disorders with Cleft

A
  • -Nodules
  • -Hypertrophy and edema of the vocal folds
  • -Hoarseness
  • -Resonance disorders
58
Q

Assessment:

What allows examiner to view posterior and lateral pharyngeal walls as well as nasal aspect of velum and adenoid pad as client produces sentences?

A

Nasopharyngoscopy

59
Q

Assessment:

What can observe movements of soft palate, lateral pharyngeal wall, posterior pharyngeal walls and tongue as client produces CV’s, voiced and voiceless fricatives and selected phrases?

A

Videofluoroscopic

60
Q

Assessment:

What gives ratios of inhalation and exhalation?

A

Oral manometer

61
Q

What does a ratio of 1.0 on an oral manometer suggest?

A

adequate velopharyngeal closure

62
Q

What does a ratio of less than 1.0 on an oral manometer suggest?

A

VPI, reduced intelligibility, hypernasality

63
Q

What does a ratio of less than .89 on an oral manometer indicate?

A

VPI, reduced intelligibility, hypernasality

64
Q

Assessment:

Measures nasalance, gives ratio formed between oral and nasal sound pressures and sssesses VP function

A

Nasometer

65
Q

Surgical Management of Clefts

Initial surgery which closes cleft

a. Primary surgery
b. secondary surgery
c. Palatal surgery
d. Pharyngeal Flap
e. Pharyngoplasty
f. Lip surgery

A

a. Primary surgery

66
Q

Surgical Management of Clefts

closes unilateral or bilateral cleft of lip

a. Primary surgery
b. secondary surgery
c. Palatal surgery
d. Pharyngeal Flap
e. Pharyngoplasty
f. Lip surgery

A

f. Lip surgery

67
Q

Surgical Management of Clefts

appearance

a. Primary surgery
b. secondary surgery
c. Palatal surgery
d. Pharyngeal Flap
e. Pharyngoplasty
f. Lip surgery

A

b. secondary surgery

68
Q

Surgical Management of Clefts

closes cleft or clefts of palate

a. Primary surgery
b. secondary surgery
c. Palatal surgery
d. Pharyngeal Flap
e. Pharyngoplasty
f. Lip surgery

A

c. Palatal surgery

69
Q

Surgical Management of Clefts

secondary procedure in which flap is cut from posterior pharyngeal wall, raised and reattached to the velum. The openings allow for nasal breathing, drainage and production of nasal sounds.

a. Primary surgery
b. secondary surgery
c. Palatal surgery
d. Pharyngeal Flap
e. Pharyngoplasty
f. Lip surgery

A

d. Pharyngeal Flap

70
Q

Surgical Management of Clefts

teflon, silicone, or dacron wool is injected into posterior pharyngeal wall to make f bulge and close velopharyngeal port.

a. Primary surgery
b. secondary surgery
c. Palatal surgery
d. Pharyngeal Flap
e. Pharyngoplasty
f. Lip surgery

A

e. Pharyngoplasty

71
Q

Hyponasality due to velopharyngeal incompetence should not be treated until ___________ and _______________.

A
  • Surgical or prosthetic efficacy to improve functions

- Child is capable of velopharyngeal closure

72
Q

what are the effects of cleft lip and palate on speech?

A
  1. dental and occlusal anomalies, particularly cross bites and class III malocclusions
  2. hearing loss due to eustachian tube malfunction
  3. velopharyngeal insufficiency
73
Q

what are the effects of cleft lip and palate of feeding?

A

cleft lip usually does not affect feeding

74
Q

nasal emissions results in

A
  1. weak or omitted consonants
  2. short utterance length
  3. dysphonia
  4. compensatory articulation productions
  5. obligatory distortions
75
Q

Nasal emission resulting in weak or omitted consonants with cleft palate are due to the lack of ______________________.

A

adequate air pressure

76
Q

Nasal emission resulting in short utterance length with cleft palate are due to need to ______________________________.

A

take frequent breaths to replenish the lost airflow through the nose

77
Q

Nasal emission resulting in dysphonia with cleft palate is due to strain in ______________.

A

the entire vocal tract in efforts to achieve velopharyngeal closure

78
Q

Nasal emission resulting in compensatory articulation productions with cleft palate are due to abnormal articulation placement in an attempt to _________________________________.

A

compensate for the lack of air pressure in the oral cavity; usually produced in the pharynx where there is air pressure

79
Q

Nasal emission resulting in obligatory distortions with cleft palate are due to ________________.

A

abnormal structure, despite normal articulation placement

80
Q

what are techniques used during treatment of resonance and velopharynegal dysfunction?

A
  1. auditory awareness and auditory feedback
  2. articulation techniques to correct placement
  3. drills and frequent practice

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