Craniofacial Disorders Flashcards
clefts
the result of facial tissue and the palate not fusing during prenatal development
—the facial tissue and palate typically fuse around 9 weeks of gestation
—can be due to environmental or genetic factors
—occurs 1/700 children
complete clefts
complete separation of the soft and hard palate
- extends from the lip, base of nostril, alveolar ridge, palate, and uvula
incomplete clefts
separation of the secondary palate only (alveolar ridge to uvula)
unilateral vs. bilateral clefts
- unilateral clefts occur on one side of the lip/one nostril
- bilateral clefts occur on both sides of the lip and involve both nostrils
submucosal clefts
in which the underlying structure is cleft, however the mucosa tissues of the oral cavity are intact
What does normal velopharyngeal function involve?
Normal velopharyngeal function is the ability to raise the velum to the velopharyngeal wall, effectively sealing the pathway between the nasal and oral cavity
- involved in articulation of oral sounds
- important for swallowing, gagging, vomiting, blowing, kissing, sucking, whistling
velopharyngeal dysfunction
the inability to form a complete closure of the velopharyngeal cavity, thus allowing air to escape through the nasal cavity
- caused by velopharyngeal insufficiency, incompetence, or mislearning
Why might surgery be performed to repair a cleft palate?
- difficulty swallowing
- difficulty speaking
- health hazards
—i.e. food or drink entering the nasal cavity
velopharyngeal insufficiency
when the velum and pharynx do not close properly
- anatomical
- common in individuals with a history of cleft palate, even after surgery is performed
- common in individuals with a submucosal cleft
- could be caused by irregular or enlarged tonsils/adenoids
velopharyngeal incompetence
a physiological inability to properly close the velum and pharynx
causes:
- velar/pharyngeal hypotonia: low/reduced muscle tone that makes it difficult to lift the velum
- velar paralysis or paresis: complete or partial inability to lift the velum
—from brain stem/cranial nerve damage, hemifacial microsomia (when one side of the face develops irregularly and is underdeveloped)
- dysarthria
- apraxia
dysarthria
weakness in the muscles used for speech, such that one has difficulty with articulation
apraxia
a neurological disorder which causes a difficulty in sequencing and executing voluntary motor movements
- can affect speech and cause velopharyngeal incompetence
velopharyngeal insufficiency vs. incompetence
Velopharyngeal insufficiency is anatomical (concerned with structure), whereas velopharyngeal incompetence is physiological (concerned with disorders such as paralysis or paresis that make it difficult to close the velum).
What are some effects of velopharyngeal dysfunction and incompetence?
- hypernasality (airflow escapes through nasal cavity)
- hyponasality due to obstruction in the nasal cavity
—i.e. enlarged adenoids (back of throat behind nasal cavity) or tonsils (back of mouth glands) can cause hyponasality and velopharyngeal dysfunction - cul-de-sac resonance
- mixed nasality
cul-de-sac resonance
when sound circulates in the oral, nasal, or pharyngeal cavity and gets blocked due an obstruction, therefore resulting in a “muffled” sound
nasal grimace
an abnormal constriction of the nostrils (resulting in a facial expression that looks like a “grimace”)
- used by children with velopharyngeal dysfunction or cleft palate in a subconscious/compensatory attempt to close off the VP valve
What speech irregularities might we expect in individuals with clefts or VP dysfunction?
- hypernasality: i.e. nasalised oral stops
- nasal emissions (blowing air through nose)
- difficulty with breath control (breath escapes through nasal cavity)
- compensatory articulations:
—i.e. velar stops in place of coronal or labial stops; glottal stops or [h] in place of stops
—i.e. velar or pharyngeal fricatives
—ingressive nasals or nasalised fricatives
dysphonia
commonly refers to hoarseness in the voice
—can be the result of compensatory articulations
—breathiness and irregular f0
