- 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

Cleft terms Flashcards by Sylvia Bettencourt

Tissues that form the primary palate and fuse by

sixth week of the embryonic period

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Tissues that form the palate develop and fuse between

10-12 weeks of the embryonic and fetal periods.

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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

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General rule for Compensatory Articulations

sacrifice place while maintaining manner of production

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Common Active Maladaptive Errors:

Glottal stop
Pharyngeal stop
Pharyngeal fricative
Pharyngeal affricate
Mid-dorsum palatal stop
Nasal fricative

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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.

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Timing of cleft lip repeair

as early as 6 weeks to 3 months

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Purpose of nasl alveaolar molding

Bring cleft lip, nose and alveolus into better alignment/closer proximity prior to cleft lip repair

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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

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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.

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What do studies show about adults with cleft and IQ?

Differences in full-scale IQ, but means scores were within normal range

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Submucous Cleft Palate Features

Zona pellucida
Bifid uvula
Bony notch in hard palate
Velar “tenting” during phonation
Length-may appear short 
Movement during phonation

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Velopharyngeal Insufficiency

-anatomical or structural defect that precludes adequate velopharyngeal closure

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Velopharyngeal Incompetence

a neuromotor or physiological disorder that results in poor movement of structures

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Screening of VP Closure

ability to produce oral pressure consonants
ability to produce nasals
audible nasal airflow

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Nasal Air Emission

Inappropriate release of air pressure through nasal cavity during speech production
Only occurs on consonants

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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

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Speech errors for class II maloclussion

/s, z, sh, zh/ and dentalized bilabials

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Speech errors for class III maloclussion

Sibilants may be distorted

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common changes in speech that occur when moving the maxilla forward with orthognathic surgery

Improved articulation, worsened velopharyngeal function

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NOT one of the typical locations of tumors within the oral cavity?

tongue-tip tumor

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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

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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

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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

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two flap palatoplasty

Repositions the levator without the z-plasty

furlow

- Reconstructs levator sling and also lengthens velum | - Uses z-plasty technique

Goals of cleft palate repair

- Closure of abnormal communication between mouth and nose | - Normal speech

Cleft palate repair: deficiency of length

Must reach the posterior pharyngeal wall

Key Factors in soft palate function

- Length of the palate - Ability of palatal muscles to move - Ability of pharyngeal muscles to move

Techniques in Cleft Lip Repair

Millard Technique | Tennyson—Randall aka triagnular flap

Benefits of early cleft lip repair

- Good healing - Protects maxilla from further distortion - Feeding improves - Psychological benefit

Advantages to Later Lip Closure

- Decreased anesthetic risk - Complete evaluation of medical conditions - Technically easier - Time for presurgical orthopedics

Timing of cleft palate repair

Generally at or before 12 months

Which modified bottle does not have a one-way flow valve

Pigeon Bottle

Velocardiofacial Syndrome/22q11.2 syndrome

- most common characteristic: velopharyngeal insufficiency - conotruncal defect - vascular anomalies - wide nasal root - micrognathia - hypotonia - learning disabilities

Pierre Robin Sequence

- Very small lower jaw (micrognathia) - Posteriorly positioned tongue (glossoptosis) - Airway obstruction - May or may not have U-shaped cleft of the soft palate

sequence

an anomaly or a pattern of multiple anomalies that arise from a single known or presumed prior anomaly or mechanical factor

Muscles of the Velum

Levator veli palatini- Musculus uvulae Tensor veli palatini: . Palatoglossus:

Palatopharyngeus

- Horizontal fibers-move lateral pharyngeal walls toward midline and contribute to Passavant’s Ridge - Vertical fibers-facilitate velar positioning

Levator veli palatini

- Velar elevation (up and back) | - Minor contribution in Eustachian tube opening.

Musculus uvulae

- elevation of the vertical fibers, creating a firm, bulky midline velopharyngeal seal. * Only intrinsic muscle of the velum

Tensor veli palatini:

opens Eustachian tube

Palatoglossus:

- lower the velum | - Elevate the posterior portion of the tongue.

Muscles of the Pharynx

Superior Constrictor: | Salpingopharyngeus

Superior Constrictor:

Primary muscle responsible for lateral pharyngeal wall motion toward midline.

Salpingopharyngeus

may: Influence lateral pharyngeal wall movement toward midline Open Eustachian tube.

,aladaptive compensator error indicates what?

speech therapy is warranted not surgery.

This condition involves craniosynostosis, occasional midface hypoplasia, occasional upper airway obstruction, cleft palate, syndactyly, and developmental disability. The condition described is:

apert

Limitations of this bottle include the atypical shape and the fact that the feeder must compress the bottle throughout the entire feed:

haberman

The movement of this paired muscle results in an upward and backward motion of the velum to contact the posterior pharyngeal wall during speech and nonspeech activities. ``` Tensor veli palatini Salpingopharyngeus Palatopharyngeus Palatoglossus None of the above ```

none of the above

Why is an alveolar bone graft performed? ``` To support teeth To advance the midface To improve speech To stabilized the mandible None of the above ```

to support teeth

The feeding technique that is recommended for feeding babies with micrognathia is Feeding the baby in an elevated side-lying position Use of a NUK nipple and bottle Feeding the baby in a reclined position Breast-feeding using a supplemental reservoir system None of the above

Feeding the baby in an elevated side-lying position

This bottle has a long slit that can be rotated within the baby’s mouth to increase or decrease the flow of liquid?

haberman “Special Needs” Feeder

Why is an alveolar bone graft performed?

to support teeth

Veau I cleft palate involves:

A cleft of the soft palate only

Lateral pharyngeal wall motion during velopharyngeal closure:

Is consistent across individuals

According to Chapman (2011), Children with cleft lip and palate: a. Did not exhibit significant differences from non-cleft peers on GFTA b. Demonstrated superior performance on measures of reading and reading-related tasks compared to non-cleft peers c. Did not show associations between better early reading and better language skills d. Demonstrated associations between delayed articulation and early reading e. None of the above

Demonstrated associations between delayed articulation and early reading

A superiorly based pharyngeal flap: | Is a dynamic structure

Borrows tissue from the posterior pharyngeal wall to create a “bridge”

6. Speech intelligibility following glossectomy is NOT related to: a. The amount of tongue removed b. The general health of the patient c. The motivation of the patient d. The type of reconstruction e. None of the above

none of the above

Nasal Fricatives

:Are articulation errors and the phonemes for which they are substituted should be addressed in speech therapy

One method to determine if a fistula is symptomatic is:

A systematic speech evaluation, focusing patterns of audible nasal emission

``` Which phonemes may be used when imaging the velopharyngeal port to evaluate adequate closure: /p/, /b/, /m/ /t/, /d/, /n/ /m/, /n/, and “ng” /p/, /t/, /k/ none of the above ```

/p/, /t/, /k/

Videofluoroscopy provides valuable information about muscle activity during speech tasks, but there are limitations. Indicate which muscles that cannot be visualized during speech tasks using the lateral view of videofluoroscopy.

musculus uvula

You are working in a private practice and a child with a history of repaired cleft palate comes in seeking speech therapy services. You: A: Pass the patient off to someone who has worked with a child with a cleft because you don’t know what to do in therapy. B: Identify the articulation errors the child has and provide traditional articulation therapy. C: Encourage the family to contact the Cleft Palate Team in order to receive speech therapy there because all care must be completed at the Cleft Center. D: Think “Great! I have been wanting to try out some of those horns and whistles a coworker recommended to improve velopharyngeal function.” E: none of the above

E: none of the above

Techniques that might facilitate production of plosives include: a. using phrases that are meaningful to the client such as “pop your lips” or “make it fast.” b. occluding nostrils. c. avoiding techniques that have worked with children without clefts, since children with clefts are a unique population and respond differently to cues. d. two of the above e. none of the above

two or more

When screening VP closure, the patient is able to produce /p/, /b/, and /s/ accurately without audible nasal emission. What does this indicate? a. The individual does not have a resonance disorder. b. The individual can produce all stops and fricatives. c. The individual has some degree of VP competence. d. Further assessment must be completed before this information can be interpreted. e. None of the above

The individual can produce all stops and fricatives.

Which of the following is true? a. Inferiorly based pharyngeal flaps are typically more successful than superiorly based flap. b. Palatoglossus muscle fibers are repositioned to create a sphincter pharyngoplasty. c. Lateral pharyngeal wall movement is not critical to the success of the sphincter pharyngoplasty. d. Posterior pharyngeal wall augmentation is recommended as a stand alone treatment for very large velpharyngeal gaps e. none of the above

Lateral pharyngeal wall movement is not critical to the success of the sphincter pharyngoplasty.

Which of the following is true of surgical resection of oral cavity tumors: a. A margin of at least 3 cm is taken b. Small lesions result in small ablations c. A simple resection means that only two structures were removed or involved d. A composite resection involves at least four muscles were involved e. None of the above

None of the above

Which measure(s) allows the clinician to compare results of objective measures of velopharyngeal function to published normative data? ``` Lateral cephalometric radiograph Pressure-Flow testing Nasopharyngoscopy Goldman Fristoe Test of Articulation—Third Edition none of the above ```

Pressure-Flow testing