Dysphagia and Cleft

Question 1

Clinical Bedside Swallow Evaluation

Answer 1

Initial assessment to observe swallowing safety (e.g., signs/symptoms of aspiration, feeding behavior).

Question 2

FEES

Answer 2

Fiberoptic Endoscopic Evaluation of Swallowing Provides direct visualization of swallowing.
Pros: Portable, no radiation.
Cons: May not show aspiration during all phases of swallowing.

Question 3

Modified Barium Study

Answer 3

Uses fluoroscopy to observe the swallowing process.
Pros: Detailed imaging, assesses ALL stages of swallowing.
Cons: Involves radiation.

Question 4

Masako

Answer 4

Hold the tongue between the teeth and swallow to strengthen pharyngeal muscles.
Goal: improves pharyngeal contraction

Question 5

Shaker

Answer 5

Lying down and lifting the head to strengthen upper esophageal muscles.
Goal: improves UES opening

Question 6

Effortful

Answer 6

swallowing with increased effort to improve bolus clearance.
Goal: improves BOT retraction, pressure, and bolus clearance

Question 7

Cleft lip

Answer 7

Can be isolated or combination with palate
complete or incomplete
unilateral or bilateral
lip repair: 3-6 months old

Question 8

Primary Palate

Answer 8

structures anterior to incisive foramen (lip and alveolar ridge)
Develops @ 7 weeks gestation

Question 9

Cleft Palate

Answer 9

complete or incomplete
unilateral or bilateral
Overt palatal cleft: visibly open
Submucous cleft: covered by mucous membrane
Palate repair: 9-12 months old

Question 10

Secondary Palate

Answer 10

structures posterior to incisive foramen (hard palate, velum, uvula)
Develops @ 9 weeks gestation

Bifid uvula: type of secondary incomplete cleft

Question 11

Cleft lip and/or palate impact on speech

Answer 11

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)

Question 12

Pierre Robin Sequence - Characteristics

Answer 12

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.

Question 13

Pierre Robin Sequence - concerns

Answer 13

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.

Question 14

22q11.2 deletion syndrome (velocardiofacial syndrome or DiGeorge Syndrome) - characteristics

Answer 14

Minor cardiac and vascular anomalies
Microcephaly: long face with excess vertical growth of maxillae
Micrognathia
Nasal anomalies
Slit like eyes
Abundant scalp hair

Question 15

22q11.2 deletion syndrome (velocardiofacial syndrome or DiGeorge Syndrome) - concerns

Answer 15

Early feeding
VPI → hypernasality; high pitched voice, speech sound errors,
language delay
hypotonia

Question 16

Crouzon - characteristics

Answer 16

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

Question 17

Crouzon - concerns

Answer 17

Risk of developmental disabilities if not treated
Upper airway obstruction

Question 18

Apert - Characteristics

Answer 18

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.

Question 19

Apert - concerns

Answer 19

Speech and language disorders
Breathing/Feeding: upper airway obstruction
Cognitive Function: Intellectual disability may be present, which could affect overall communication and development.

Question 20

Treacher Collins Syndrome - characteristics

Answer 20

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.

Question 21

Treacher Collins Syndrome - concerns

Answer 21

Hearing: Conductive hearing loss is common due to ear abnormalities, which may impact language development.

Question 22

Fetal Alcohol Spectrum Disorders (FASD) - characteristics

Answer 22

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

Question 23

Fetal Alcohol Spectrum Disorders (FASD) - concerns

Answer 23

Speech: Speech delay, articulation issues and language delays.
Cognitive: developmental disabilities, learning difficulties, and behavioral concerns

Question 24

Velopharyngeal Insufficiency

Answer 24

“I need surgery”
inability of the velopharyngeal mechanism to close during speech, leading to hypernasality and nasal emissions during speech

Question 25

Tx of VPI

Answer 25

surgical intervention (pharyngeal flap surgery), followed by speech therapy if VP incompetence (learned articulatory mistakes) persist
Important muscles:

Question 26

Levator veli palatini

Answer 26

supports soft palette, contracts during non-nasals

Question 27

Tensor veli palatini

Answer 27

assists in eustachian tube function; dysfunction associated with middle ear issues

Question 28

Oral prep phase

Answer 28

voluntary
food is chewed and mixed with saliva to form bolus
structures: lips, cheeks, tongue, hard and soft palate

Question 29

oral phase

Answer 29

voluntary
bolus is propelled to back of mouth (oropharynx) with tongue
tongue, hard and soft palate

Question 30

pharyngeal phase

Answer 30

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

Question 31

esophageal phase

Answer 31

involuntary
bolus moves down the esophagus to the stomach through peristaltic movements
structures: esophagus and lower esophageal sphincter

Question 32

Therapy for Post-Cleft Surgery

Answer 32

Initial /p/ is a good choice because it’s a bilabial stop requiring minimal intraoral pressure—important post-surgery.

Question 33

What muscles produces the opposing action to those that produce VP closure?

Answer 33

palatoglossus