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
Tx of VPI
surgical intervention (pharyngeal flap surgery), followed by speech therapy if VP incompetence (learned articulatory mistakes) persist
Important muscles:
Levator veli palatini
supports soft palette, contracts during non-nasals
Tensor veli palatini
assists in eustachian tube function; dysfunction associated with middle ear issues
Oral prep phase
voluntary
food is chewed and mixed with saliva to form bolus
structures: lips, cheeks, tongue, hard and soft palate
oral phase
voluntary
bolus is propelled to back of mouth (oropharynx) with tongue
tongue, hard and soft palate
pharyngeal phase
involuntary
bolus is directed into pharynx, soft palate elevates to close off nasopharynx, and larynx elevates to close airway
structures: pharynx, soft palate, epiglottis, larynx, hyoid bone
esophageal phase
involuntary
bolus moves down the esophagus to the stomach through peristaltic movements
structures: esophagus and lower esophageal sphincter
Therapy for Post-Cleft Surgery
Initial /p/ is a good choice because it’s a bilabial stop requiring minimal intraoral pressure—important post-surgery.
What muscles produces the opposing action to those that produce VP closure?
palatoglossus
