Examination 2 Flashcards
describe prenatal facial development for cleft
primarily during the embryonic period which ends around 8 weeks of gestation and the early fetal period follows immediately
3-4 weeks
structures undifferentiated- not an identifiable face
5-6 weeks
face is apparent
7-8 weeks
nose, eyes, mouth fully recognizable
3-4 mo
point out rapid growth
where could a cleft occur
see handout/drawing; any of the junctures- cleft of the lip,palate, etc
Lip cleft
unilateral or bilateral, off to side, true hare lip at midline is rare
palate- complete
2 palatal shelves totally separated
palate-incomplete
2 palatal shelves partially fused
sub mucous cleft
tissue covers cleft, bifid uvula may suggest same with bluish line and body notch; speech may be hyper nasal if soft palate doesn’t have enough tissue mass so the velopharyngeal port may not be adequately closed= air escapes up
what are the best ways to test for a sub mucous cleft
to feel around, take pen light into nasal cavity into mouth and see movement
describe the eval procedure for cleft, specifically the oral cavity exam
note where is/was cleft, note complete or partial/unilateral or bilateral, note/eval repair and function of the lips, dental ridge, hard palate and palatal closure
which speech sounds are a problem
bilabial, labiodental, alveolar, interdental
how many teeth do adults have
32 (8 incisors (4central and 4 lateral), 4 cuspids, 8 bicuspids and 12 molars)
how many teeth do children have
20 (8 incisors, 4 cuspids, and 8 deciduous molars)
where does cleft always occur? between which teeth
between lateral incisors and cuspids
why do we need to note the condition of the teeth
we need good, healthy teeth to attach prosthetics to
what is a normal bite
normal occlusion-alignment of teeth, buccal cuspids of upper teeth fit outside lower teeth
what is a cross bite
anything different from normal- one arch may be larger than other arch; the upper arch may be small enough to fit inside the largest lower arch
what bite would you expect in cleft
2nd pic
what do we mean by an open bite
top teeth do not touch lower teeth- problems with s, alveolar sounds-t
define a closed bite
top teeth completely cover lower
mesial
to the midline
distal
away from midline
buccal
cheek-outside of tooth that touches cheek
lingual
side of tooth that touches tongue
occlusal
the top of the teeth
how do you know if a patient is getting vp closure
movement, testing of eee and ooo when nose is plugged to see if air is escaping
normal occlusion
if individual teeth in the 2 arches are properly aligned and the upper and lower dental arches meet in a fairly symmetrical manner
neutrocclusion
class 1 malocclusion- when dental arches are properly aligned at molars but individual teeth are misaligned
distocclusion
class 2- the mandible is set back, the first mandibular molars are retracted by at least one tooth from first maxillary molars
mesiocclusion
class 3- the mandible is jutting forward, the first mandibular molar is advanced at least one tooth beyond the first maxillary molar
what is meant by VP insufficiency
not enough tissue to create a palate that will close
VP incompetence
enough tissue, but not enough competence in using tissue
What is the Iowa Pressure Teset designed to test?
articulation test designed to assess speech of people with clefts - subtest of temple barley test of articulation
nasal emission
discharge of air through nose during production of non nasal speech sounds -silent or audible
nasal resonance
resonance (modification of sound by other structures through which it passes) influenced heavily by the nose
how do you test for nasal emission
by holding a mirror under nostrils and seeing if mirror is fogged by warm air escaping through the nose
would we expect language issues with cleft
not all children with cp need formal and intensive intervention for language problems, so not necessarily. slight lang delays might be corrected by home programs designed to stimulate language
would we expect hearing issues with cp
yes bc of high frequency of hearing loss in kids with cp, problems with otitis media (middle ear) conductive hearing loss
surgery schedule?
10 pounds/10 weeks- traditional ; 10 months, traditional by 6 months=lip; 1 year=soft palate; 3-5 year=hard palate; some do everything by 6 months
