Cleft terms Flashcards
Tissues that form the primary palate and fuse by
sixth week of the embryonic period
Tissues that form the palate develop and fuse between
10-12 weeks of the embryonic and fetal periods.
Morphogenesis of the face and mouth
Normal development involves the merging and fusion of five processes to complete the formation of the primitive mouth and nasal cavities
General rule for Compensatory Articulations
sacrifice place while maintaining manner of production
Common Active Maladaptive Errors:
Glottal stop Pharyngeal stop Pharyngeal fricative Pharyngeal affricate Mid-dorsum palatal stop Nasal fricative
Association
nonrandom occurrence of a pattern of multiple anomalies in two or more individuals that is not a syndrome or a sequence. Diagnosis of exclusion.
Timing of cleft lip repeair
as early as 6 weeks to 3 months
Purpose of nasl alveaolar molding
Bring cleft lip, nose and alveolus into better alignment/closer proximity prior to cleft lip repair
What did a study find that compared early cleft palate repairs to later repeaired cleft children?
Late Group-Severely restricted phonological system and More cleft speech errors than early group
What do some studies done on erformance of cleft toddlers with and without cleft lip show in regards to linguistic and nonlinguistic domains?
Cleft palate and/or lip perform more poorly but still within normal.
What do studies show about adults with cleft and IQ?
Differences in full-scale IQ, but means scores were within normal range
Submucous Cleft Palate Features
Zona pellucida Bifid uvula Bony notch in hard palate Velar “tenting” during phonation Length-may appear short Movement during phonation
Velopharyngeal Insufficiency
-anatomical or structural defect that precludes adequate velopharyngeal closure
Velopharyngeal Incompetence
a neuromotor or physiological disorder that results in poor movement of structures
Signs of Velopharyngeal Dysfunction
Hypernasality on vowels and vocalic consonants
Nasal air emission
Weak pressure consonants
Compensatory articulation patterns: Hoarseness
Reduced vocal intensity
Potential Causes of VP Dysfunction
Cleft palate Hx of submucous cleft Short velum or deep pharynx Removal of adenoids/ adenoid atrophy Maxillary advancement Hypertrophic tonsils
Screening of VP Closure
ability to produce oral pressure consonants
ability to produce nasals
audible nasal airflow
Nasal Air Emission
Inappropriate release of air pressure through nasal cavity during speech production
Only occurs on consonants
indirect objective measure that would give you the most information to bring to the team meeting, given the suspected cause of the VPI?
Pressure-flow testing
Speech errors for class II maloclussion
/s, z, sh, zh/ and dentalized bilabials
Speech errors for class III maloclussion
Sibilants may be distorted
common changes in speech that occur when moving the maxilla forward with orthognathic surgery
Improved articulation, worsened velopharyngeal function
NOT one of the typical locations of tumors within the oral cavity?
tongue-tip tumor
inexpensive (under $125) feedback tool to facilitate his learning during speech tasks to reduce hypernasality in someone who has already had a repair.
see scape
Lateral Cephs
X-ray image of velopharyngeal function
Helpful at dental clinic where you may not have access to the other two methods
Get images of velum at rest and phonating
Videofluoroscopy
- X-ray image velopharyngeal function during speech
- Size of soft palate and nasopharynx
- Adenoid status
- Velar movement
- Passavant’s ridge / posterior pharyngeal wall motion
- Tonsils
- Tongue movement
Nasopharyngoscopy
- Uses flexible endoscope inserted into nostrils through to the velopharynx
- most detail when assessing velopharyngeal function
- Excellent view of the structures and function during speech
Techniques in Cleft palate repair surgeris
- von landenbeck
- wardill-kilner V to Y pushback
- two flap palatoplasty
- furlow
von landenbeck
- Relaxing incision is made along alveolar ridge
- Mucoperiosteum is raised off the bone and separated in one layer with the velum
- Cleft margin is incised, raw edges brought together, then closed
wardill-kilner V to Y pushback
- Like the Von Langenbeck, except an incision is made at the front of the palate in the shape of a “V” that frees up the flaps of mucoperiosteum.
- allows the whole palate to be “pushed back”
- Has separate nasal layer closure and separate muscle layer closure
two flap palatoplasty
Repositions the levator without the z-plasty