Craniofacial Final

Question 0

Passavant’s pad

Answer 0

Ridge of muscle on PPW. Meh.

Question 1

Four patterns of VP closure

Answer 1

Coronal: mostly velum (most common)
Circular: all participate to form sphincter
Sagittal: Lateral walls
All can include PPW

Question 2

Level of hypernasality

Answer 2

22% for turtle passage

25% for zoo passage

Question 3

Why are adenoids removed?

Answer 3

Chronic otitis media
Sleep apnea
Sinusitis

Question 4

Risk factors for hypernasality after adenoid surgery

Answer 4

Cleft or family history of cleft
Submucous cleft
History of nasal regurgitation
history of neuromotor dysfunction
Phonological delay
Marginal VP function

Question 5

Advantages of speech appliance

Answer 5

No physical risk
Earlier intervention
May stimulate VP movement
Good for those with severe artic whose speech may still be unintelligible
Good for those with mild hypernasality

Question 6

Advantages of pharyngoplasty over speech appliance

Answer 6

Single procedure with natural tissue
No follow up
Permanent
Good for noncompliant patients
Good for those with geographic difficulty
Good for those who will have orthodontia

Question 7

Three sequential views of radiographic studies

Answer 7

Lateral view: from side of head- shows velum
Frontal view: Anterior-posterior view allows for visualization of the lateral pharyngeal walls
Base or Towne’s view: also called enface- through the base of the head

Question 8

7 possible causes for VPD

Answer 8

Cleft palate/submucous cleft
Large pharynx/ short velum
neuromotor dysfunction
surgery
Functional (only difficulty with certain sounds)
hearing impairment

Question 9

Why is videofluoroscopy less popular than endoscopy?

Answer 9

Endoscopy can be done repeatedly
Can be done in clinic
Less expensive
better clarity
No radiation

Question 10

Sphincterplasty

Answer 10

Freed posterior pillar from the pharynx and ring of muscle is created to narrow nasopharynx

Question 11

Midline flap

Answer 11

Less common than sphincterplasty

Velum is split and retracted, superior pharyngeal flap is raised and inserted into velum

Question 12

Steps for classifying VP

Answer 12

Degree-open
Degree of patency: Normal: 0-5%, small: 6-15%, moderate: 116-40%, large: 41-100%
Location: central, lateral-one or both sides, transverse
Type of closure: coronal, circular, sagittal, all can occur with posterior pharyngeal wall

Question 13

Three types of lateral pharyngoplasty

Answer 13

Augmentation: implant into PPW
Sphincter repair: unilateral or bilateral
Flap repair: Inferior (Ortichochea) Inferior flap at back of pharynx with insertion of palatopharyngeus muscles
Superior: (Jackson-Silverman) Superior flap raised for intertion of palatopharyngeus

Question 14

Possible complications post-op

Answer 14

Post op bleeding
Airway obstruction
Sleep apnea
Mortality
Difficulty with intubation
Denasality
Mouth breathing

Question 15

Implications for speech appliance over surgery

Answer 15

Younger children
Unknown etiology
Severe paralysis
Severe articulation disorder
Mild hypernasality