Dysphagia and Cleft Flashcards
Clinical Bedside Swallow Evaluation
Initial assessment to observe swallowing safety (e.g., signs/symptoms of aspiration, feeding behavior).
FEES
Fiberoptic Endoscopic Evaluation of Swallowing Provides direct visualization of swallowing.
Pros: Portable, no radiation.
Cons: May not show aspiration during all phases of swallowing.
Modified Barium Study
Uses fluoroscopy to observe the swallowing process.
Pros: Detailed imaging, assesses ALL stages of swallowing.
Cons: Involves radiation.
Masako
Hold the tongue between the teeth and swallow to strengthen pharyngeal muscles.
Goal: improves pharyngeal contraction
Shaker
Lying down and lifting the head to strengthen upper esophageal muscles.
Goal: improves UES opening
Effortful
swallowing with increased effort to improve bolus clearance.
Goal: improves BOT retraction, pressure, and bolus clearance
Cleft lip
Can be isolated or combination with palate
complete or incomplete
unilateral or bilateral
lip repair: 3-6 months old
Primary Palate
structures anterior to incisive foramen (lip and alveolar ridge)
Develops @ 7 weeks gestation
Cleft Palate
complete or incomplete
unilateral or bilateral
Overt palatal cleft: visibly open
Submucous cleft: covered by mucous membrane
Palate repair: 9-12 months old
Secondary Palate
structures posterior to incisive foramen (hard palate, velum, uvula)
Develops @ 9 weeks gestation
Bifid uvula: type of secondary incomplete cleft
Cleft lip and/or palate impact on speech
VPI, hypernasality, nasal emissions of non-nasal sounds
Most impacted: high pressure sounds (oral stops and fricatives)
Strengths: low pressure sounds (nasals, liquids, and glides)
Pierre Robin Sequence - Characteristics
Micrognathia: A small or underdeveloped lower jaw.
Glossoptosis: The tongue is displaced backward, which can cause airway obstruction.
Cleft Palate: Often present or with high-arched palate.
Pierre Robin Sequence - concerns
Airway and Feeding: Respiratory problems, difficulty with feeding and sucking due to tongue positioning, and the risk of aspiration.
Speech: associated with VPI
Swallowing: Difficulty swallowing and risk of aspiration due to glossoptosis and cleft palate.
22q11.2 deletion syndrome (velocardiofacial syndrome or DiGeorge Syndrome) - characteristics
Minor cardiac and vascular anomalies
Microcephaly: long face with excess vertical growth of maxillae
Micrognathia
Nasal anomalies
Slit like eyes
Abundant scalp hair
22q11.2 deletion syndrome (velocardiofacial syndrome or DiGeorge Syndrome) - concerns
Early feeding
VPI → hypernasality; high pitched voice, speech sound errors,
language delay
hypotonia
Crouzon - characteristics
Premature fusion of the sutures in the skull (craniosynostosis), leading to abnormal head and face shape. It is often inherited.
Cranial shape:
Brachycephaly (wide, short head) or
scaphocephaly (long, narrow head).
Bulging eyes (exophthalmos)
Beaked nose
Crouzon - concerns
Risk of developmental disabilities if not treated
Upper airway obstruction
Apert - Characteristics
craniosynostosis (early fusion of skull sutures)
Cranial shape: Tall, tower-shaped skull (due to craniosynostosis).
Syndactyly: Fusion of fingers and toes.
Midface hypoplasia: Underdevelopment of the middle part of the face, causing a flattened appearance.
Apert - concerns
Speech and language disorders
Breathing/Feeding: upper airway obstruction
Cognitive Function: Intellectual disability may be present, which could affect overall communication and development.
Treacher Collins Syndrome - characteristics
characterized by underdevelopment of the facial bones, especially the cheekbones, jaw, and ears.
Micrognathia: Small lower jaw.
Hypoplasia of zygomatic bones: Underdeveloped cheekbones.
Coloboma of the lower eyelid: A gap or notch in the lower eyelid.
Ears: Microtia or absence of the outer ear, often accompanied by conductive hearing loss.
Treacher Collins Syndrome - concerns
Hearing: Conductive hearing loss is common due to ear abnormalities, which may impact language development.
Fetal Alcohol Spectrum Disorders (FASD) - characteristics
results from prenatal alcohol exposure and can lead to a variety of craniofacial, cognitive, and behavioral issues.
Pierre Robin Sequence
Short nose, flat philtrum and thin upper lip
Short palpebral fissures: Narrowed eye openings.
Microcephaly: small head
Fetal Alcohol Spectrum Disorders (FASD) - concerns
Speech: Speech delay, articulation issues and language delays.
Cognitive: developmental disabilities, learning difficulties, and behavioral concerns
Velopharyngeal Insufficiency
“I need surgery”
inability of the velopharyngeal mechanism to close during speech, leading to hypernasality and nasal emissions during speech
