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Nature of Disorders of Speech, Voice, Fluency and Swallowing > L10 Craniofacial Anomalies > Flashcards

L10 Craniofacial Anomalies Flashcards

1
Q

when does facial formation occur

A

between the 4th and 8th week of pregnancy

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2
Q

what are the five prominences that form the face

A
  • one frontonasal prominence
  • two maxillary prominences
  • two mandibular prominences
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3
Q

what part of the face does the frontonasal prominence form

A

forehead, nose and central part of each lip

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4
Q

what part of the face do the maxillary prominences form

A

upper jaw, lower half of cheecks, and the skin muscles and nerves of these areas

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5
Q

what part of the face do the mandibular prominences form

A

lower jaw, lower half of cheecks and skin muscles and nerves of these areas

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6
Q

are fusion lines visible

A

no, apart from the philtral columns, which are a normal part of the upper lip

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7
Q

by what week of pregnancy has the palate formed

A

week 11

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8
Q

what part of the palate develops first

A

the primary palate (anterior part lying in front of incisive foramen)

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9
Q

how does the secondary palate form

A

The palatal shelves elevate and fuse in the midline to form the complete palate

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10
Q

basic cause of cleft lip and palate

A

a failure of complete fusion of the various prominences

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11
Q

does unilateral cleft lip usually require SLT

A

not for speech, maybe for feeding as a neonate

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12
Q

cleft lips and palates affecting speech

A
  • Unilateral cleft lip and palate
  • Bilateral cleft lip and palate
  • Cleft of hard and soft palate
  • Cleft of soft palate
  • Sub mucous cleft palate
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13
Q

what is a sub mucous cleft palate

A

Oral mucosa is intact but the underlying muscles of the soft palate are abnormally inserted into the posterior margin of the hard palate resulting sometimes in impaired soft palate function.

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14
Q

three classic signs of sub muscous cleft palate

A
  • Bifid uvula
  • Palatal notch - palpable V shaped notch in the posterior boarder of the hard palate which you can feel.
  • Zona pellucida (not always present) - translucent central zone due to muscle diastasis.
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15
Q

syndromes associated with cleft lip and palate

A
  • Treacher Collins
  • Aperts
  • Van der Woude
  • Prader-Willi
  • Beckwith-Wiedeman
  • 22q11 Deletion Syndrome
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16
Q

other names for 22q

A

DiGeorge Syndrome and/or Velocardiofacial Syndrome

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17
Q

catch-22

22q

A

C - Cardiac defect
A - “Abnormal” facial features
T - Problems with the thymus gland and reduced immunity
C - Cleft palate/Palatal abnormalities
H - Hypocalcaemia, calcium deficiency
22 - Deletion of chromosomal material on chromosome 22

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18
Q

communication profile of 22q children

A
  • VPD
  • Glottal articulation/clicks/pharyngeal fricatives
  • Childhood apraxia of speech (CAS)
  • Dysarthria
  • Language delay (mainly expressive)
  • Voice disorders
  • Lanryngotracheal abnormalities
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19
Q

other features of 22q

A
  • Intellectual disability
  • Psychiatric diagnosis e.g. schizophrenia
  • Anxiety issues
  • Autistic Spectrum Disorder
  • Attention Deficit Hyperactivity Disorde
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20
Q

when does surgery for primary repair of cleft lip occur

A

-6 months in 1 or 2 stages

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21
Q

when does the surgery for primary repair of cleft palate occur

A

6-12 months of age in 1 or 2 stages

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22
Q

when does secondary speech surgery occur

A

after 3 years of age

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23
Q

when does lip revision surgery occur

A

after 4 or 5 years, but usually child is closer to 10

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24
Q

when does alveolar bone graft surgery occur

A

when the child is 10/11

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25
Q

what is alveolar bone graft surgery

A

when a piece of one from hip brought to mouth for support of adult dentition

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26
Q

when does orthognathic surgery occur

A

wen the person is at least 17

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27
Q

what other surgeries can be done for a child with cleft

A
  • Palate re-repair (intra-velar veloplasty)
  • Pharyngeal flap pharyngoplasty
  • Buccinator flap palatal lengthening.
  • Pharyngoplasty
28
Q

what is an oronasal fistula

A

A hole or opening in the palate after cleft palate repair

29
Q

what causes oro-nasal fistula

A
  • Caused by breakdown of tissue during the healing process post surgery
  • Can open after maxillary expansion or growth
30
Q

what is a residual cleft

A

Unrepaired cleft of hard palate or alveolus which is deliberately left open to be closed later

31
Q

when does a residual cleft occur

A
  • Occurs when a child has a very wide palate and there’s not enough tissue to repair the whole cleft
  • Happens very rarely
32
Q

normal feeding process

A
  • Combination of compression and suction to extract milk from bottle.
  • Compression - positive pressure on teat i.e. when teat is placed between the tongue and palate.
  • Suction - negative pressure created within the oral cavity i.e. lower jaw drops and tongue and nasal cavity is sealed off resulting in an enlarged sealed chamber.
  • Compression helps to push milk out of teat and suction results in milk being extracted from teat.
33
Q

do all babies with cleft have feeding issues

A
  • Babies with a cleft lip or small cleft of the soft palate may feed without difficulty.
  • Babies with larger clefts may have difficulty feeding due to not being able to create suction.
34
Q

common difficulties with cleft

A
  • Poor oral suction
  • Weak suck
  • Difficulty holding soother in mouth
  • Poor intake with lengthy feeding times
  • Nasal regurgitation
  • Intake of excessive air due to cleft
  • Fatigue (expend excess energy)
  • Poor weight gain (too much time spent on feeding)
35
Q

do children with cleft have a higher chance of hearing loss

A
  • yes
  • high incidence of otitis media with effusion in cleft children
  • OME causes conductive hearing loss
36
Q

how is OME treated

A

with grommits

37
Q

effects of cleft on dentition

A
  • Cleft palate can produce variations in number, enamel formation and eruption of teeth in the affected area, with the lateral incisor being most affected.
  • Alterations of tooth development in other areas can also occur:
    • missing, fused or peg-shaped teeth
    • delay in tooth formation and eruption of secondary teeth
    • teeth are generally smaller than those in the non-cleft population
38
Q

do cleft dental anomalies have an effect on speech

A
  • a minimal one
  • e.g a missing lateral incisor can cause the tongue to protrude through the space resulting in minor articulation errors
39
Q

what is class III occlusion

A

when the upper jaw grows to a lesser extent than the lower jaw, meaning the lower jaw protrudes

40
Q

class II occlusion impacts on speech

A
  • here is a lack of maxillary space and so the tongue may have insufficient space to function. Therefore
    anterior tongue tip sounds can be produced by the blade of the tongue, causing lateralisation and palatalisation of consonants.
  • In severe Class III malocclusions it may be difficult to achieve labiodental placement for /f/ and /v/, resulting in bilabial fricatives or dentolabial fricatives.
41
Q

how is class II occlusion treated

A

surgically corrected by a maxillary osteotomy

42
Q

what does the velopharyngeal port do during the production of nasal sounds

normal velopharyngeal function

A

remains open

43
Q

what does the velopharyngeal port do during the production of oral sounds

normal velopharyngeal function

A

closes

44
Q

weak pressure consonants

A

/w, l, j, ɹ,h/

45
Q

oral pressure consonants

A

/p, b, t, d, k, g, f, v, s, z, ʃ, ʒ, ʧ, ʤ/

46
Q

what is velopharyngeal dysfunction

A

Occurs when the velum (soft palate) doesn’t close at the base of the nasal cavity the way that it should

47
Q

what does VPD stand for

A

velopharyngeal dysfunction

48
Q

what classification of VPD does cleft cause

A

Velopharyngeal insufficiency (stuctural)

49
Q

examples of cleft VPI

A
  • Unrepaired cleft palate (overt or submucous)
  • Post surgical insufficiencies (short palate, post adenoidectomy)
50
Q

three kinds of non cleft VPD

A
  • velopharyngeal insufficiency (structural)
  • velopharyngeal incompetency (neurogenic)
  • velopharyngeal mislearning
51
Q

examples of non cleft velopharyngeal insufficiency

A
  • Mechanical interference (eg. excessive tonsils or posterior pillar webbing)
  • Palatopharyngeal disproportion (deep pharynx)
    • Common in 22q children
  • Ablative palatal lesions (eg. cancer, traumatic injury)
  • Shrinking adenoids
52
Q

examples of non cleft Velopharyngeal Incompetency

A
  • Congenital or acquired primary motor/neuromotor control (dysarthria)
  • Motor association/motor programming (apraxia)
53
Q

examples of velophryngeal Mislearning

A
  • Phoneme specific nasal emission
  • Persisting post operative nasal emission (with adequate closure ability
  • Compensatory misarticulations
  • Deafness/hearing impairment
54
Q

effect of VPD on resonance

A

hypo/hyper nasality

55
Q

measurement of hypernasality

A

Temple Street Scale of Nasality and Nasal Airflow (Sweeney, 2000 & 2011)

a)mild: evident but acceptable.

b)mild-moderate: unacceptable distortion , evident on close vowels

c)moderate: evident on close and open vowels.

d)moderate – severe: evident on all vowels and some consonants.

e)Severe: evident on all vowels and most voiced consonants

56
Q

measurement of hyponasality

A

Temple Street Scale of Nasality and Nasal Airflow (Sweeney, 2000 & 2011)

a)mild: evident, but acceptable.

b)moderate: all vowels reduced nasality

c)severe: total denasal production of nasal consonants

57
Q

what are nasal airflow errors

A

errors which occur when there is an inappropriate escape of air through the nose during speech.

58
Q

two types of nasal airflow errors

A
  • nasal emission (perceived as a frictional sound)
  • nasal turbulence/snorting
59
Q

how are active cleft speech characteristics treated

A

speech therapy

60
Q

how are passive cleft speech characteristics treated

A

monitoring/surgery/prosthetics

61
Q

what are active cleft speech characteristics

A

articulation is altered in response to previous or present abnormal structure (Golding-Kushner 1995)

62
Q

what are passive cleft speech characteristics

A

when articulation is normal but the abnormal structure results in distortion of the speech sound (Golding-Kushner 1995)

63
Q

examples of anterior cleft speech characteristics

active

A
  • Denasalisation
  • Lateralisation
  • Palatalisation
64
Q

examples of posterior cleft speech characteristics

active

A
  • Backing to velars
  • Backing to uvulars
  • Double articulation
65
Q

examples of non-oral cleft speech characterstics

active

A
  • Pharyngealisation
  • Glottalisation
  • Active nasal fricatives
66
Q

examples of passive cleft speech characteristics

A
  • Weak/nasalised consonants
  • Nasal realisations of fricatives and/or plosives
  • Absent pressure consonants
  • Gliding of fricatives and affricates
67
Q

how to tell if a nasalised fricative is active or passive

A

**Nose holding test:** is it a passive or active nasal fricative - Hold child’s nose and ask them to produce affected fricative eg. /s/

  • Passive: makes /s/ sound stronger
  • Active: blocks the sound altogether

Nature of Disorders of Speech, Voice, Fluency and Swallowing (12 decks)

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