Lecture 3 Flashcards by Bailey Bingham

What is the purpose of velopharyngeal valving?

1) Ventilation of the middle ear
2) Regulation of oral-nasal airflow
3) Prevention of nasal regurgitation
4) Prevent pre-deglutative aspiration
5) Contributes to bolus propulsion during swallowing
6) Oral-nasal balance for speech articulation

How well did you know this?

Not at all

Perfectly

When we do laryngoscopy we put the scope through the inferior nasal meatus, to see velopharyngeal action we go through the ____________

middle nasal meatus

How well did you know this?

Not at all

Perfectly

The hard palate begins at the end of the _______ and continues to the _______

alveolar ridge

Velum

How well did you know this?

Not at all

Perfectly

The hard palate is made up of the ________ bone and the _________ bone

palatine process of the maxillary bone

Horizontal part of the palatine bone

How well did you know this?

Not at all

Perfectly

The _______ primary function is to open the eustachian tube. It’s secondary function is the lateral stretch of the velum.

tensor veli palatini

How well did you know this?

Not at all

Perfectly

The ____ is the most important elevator of the velum (pulls up and back)

Levator veli palatini

How well did you know this?

Not at all

Perfectly

The ____ forms the anterior faucial pillar. It lowers the soft palate when the tongue is stable.

Palatoglossus

How well did you know this?

Not at all

Perfectly

The ____ forms the posterior faucial pillar. It narrows the nasopharynx and lowers the soft palate.

Palatopharyngeus

How well did you know this?

Not at all

Perfectly

The _____ wraps around posteriorly and constricts the pharyngeal lumen in the upper pharynx.

Superior pharyngeal constrictor

How well did you know this?

Not at all

Perfectly

The ____ is superiorly attached to the sphenoid bone and the lateral cartilage of the eustachian tube. Inferiorly it fans out and forms the palatine aponeurosis.

Tensor veli palatini

How well did you know this?

Not at all

Perfectly

The ________ goes down and around the hamulus pterygoideus which changes its direction of pull from vertical to horizontal.

Tensor Veli Palatini

How well did you know this?

Not at all

Perfectly

The Tensor veli palatini is innervated by ____

CN V

How well did you know this?

Not at all

Perfectly

T or F: The Tensor Veli Palatini is the sole elevator of the velum

False- Levator veli palatini

How well did you know this?

Not at all

Perfectly

The _______ forms the levator sling inferiorly and is attached to the temporal bone and the medial cartilage of the Eustachian tube superiorly

Levator Veli palatini

How well did you know this?

Not at all

Perfectly

What is the primary and secondary function of the Levator Veli palatini?

primary = raise velum
secondary = ET opening

How well did you know this?

Not at all

Perfectly

The Levator veli palatini is innervated by ___

pharyngeal plexus (pharyngeal branch of vagus and glossopharyngeus)

How well did you know this?

Not at all

Perfectly

The ______ attaches to the oral surface of the palatine aponeurosis superiorly and the lateral posterior dorsum of the tongue inferiorly.

Palatoglossus

How well did you know this?

Not at all

Perfectly

What is the function of the palatoglossus?

lower the velum
dorsal elevation of the tongue
anterior faucial arch

How well did you know this?

Not at all

Perfectly

T or F: The palatoglossus is innervated by the CN V

False -by pharyngeal plexus (pharyngeal branch of vagus)

How well did you know this?

Not at all

Perfectly

The palatopharyngeus attaches superiorly to the _______ and inferiorly to _________

palatine aponeurosis

lateral pharyngeal wall and posterior thyroid cartilage

How well did you know this?

Not at all

Perfectly

What is the function of the palatopharyngeus?

medial displacement of the lateral pharyngeal walls
lowering velum
forms posterior/ second faucial arch

How well did you know this?

Not at all

Perfectly

The palatopharyngeus is innervated by ______

pharyngeal plexus

How well did you know this?

Not at all

Perfectly

What is the pharyngeal plexus?

A network of intersecting nerve fibers composed of branches of CN IX and CN X
- and some argue Cranial portion of CN XI

How well did you know this?

Not at all

Perfectly

The function of the superior constrictor? Innervation?

pharyngeal narrowing (naso and upper oropharyngeal segment)
Pharyngeal plexus

How well did you know this?

Not at all

Perfectly

______ orginates from the pterygoid plate and the lateral fringe of the velum and runs along the pharyngeal walls to the median pharyngeal raphe.

Superior Constrictor

______ is a muscle pair which runs parallel to the velar midline into the mucous membrane of the uvula

Musculi Uvulae

What is the function of the musculi uvulae? | Innervated by?

- intrinsic flexion and shortening of the velum - forms velar eminence (seen in men) Pharyngeal plexus

T or F: The musucli uvulae is commonly absent or minuscule in cleft palate

True

The _______ origninates from the ET and inserts into the posterior aspect of the palatopharyngeus muscle.

Salpingopharyngeus

What is the function of the salpingopharyngeus? | Innervated by?

- Raising of pharynx and larynx - ET opening Pharyngeal plexus

T or F: The Salpingopharyngeus is always present

False - may or may not have one

List the 7 velopharyngeal muscles

1) Tensor veli palatini 2) Levator veli palatini 3) Palatoglossus 4) Palatopharyngeus 5) Superior pharyngeal constrictor 6) Musculi Uvulae 7) Salpingopharyngeus

What is the Cave vagus reflex?

During transnasal and transoral endoscopy, overexcitation of the plexus pharyngeus may lead to tachycardia, tachypnoe and even HEART ARREST

T or F: Velopharyngeal closure is a continuum

True

The male nasopharynx is larger and wider than females. As a consequence males need to elevate the velum higher and more posteriorly. What provides the extra elevation needed to close off a deep nasopharynx??

Musculi Uvulae (forms velar eminence - visible as a knee)

A child needs less movement in order to acheive velopharyngeal closure. Why?

- nasopharynx is small and narrow | - adenoid pad on posterior pharyngeal wall is very large (gets stretched out as we grow)

List the 4 velopharyngeal closure patterns:

1) Coronal 2) Sagittal 3) Circular 4) Circular with Passavant's ridge

The ______ closure pattern uses mainly velar elevation.

coronal

The ______ closure pattern involves the lateral pharyngeal walls moving towards the midline.

Sagittal

The ______ closure pattern involves combined velar elevation and lateral wall approximation.

Circular

The ______ closure pattern involves combined velar elevation and lateral wall approximation and increased activity of the superior pharyngeal constrictor muscle to support VP closure.

Circular with passavants ridge

Which closure pattern is only seen in people with cleft palate?

Circular with passavant's ridge | - deviation due to musucle attempt to close the velopharyngeal sphincter.

How is a passavant's ridge formed?

Isolated contraction of a hypertrophic segment of the superior pharyngeal constrictor muscle

T or F: Hyponasality has airflow through the nasal cavity

false - hypernasality

List the 4 resonance disorders:

1) Hypernasality (functional and organic) 2) Hyponasality (functional-rare and organic) 3) Mixed Nasality (cul de sac) 4) Alternating nasality

2 associated symptoms of resonance disorders are:

- Nasal emission | - Nasal turbulance

List the 3 levels of analysis for VP function:

1) morphological 2) Functional analysis 3) Perceptual and acoustic analysis

There are ______ and ______ methods of inspection of morphological and functional analysis

direct and indirect

List the direct methods of inspection:

1) direct visual inspection 2) endoscopy (flexible or rigid) 3) multiview videofluoroscopy 4) MRI

List the indirect methods of inspection:

1) Tongue anchor technique 2) mirror test 3) Gutzmann's I-a-test 4) Aerodynamic measurements 5) EMG 6) Haskins Velotrace

The most common way to look at VP function is ____

flexible endoscope (Direct method)

The multiview fluoroscopy is a _____ method of inspection. The three views are _______ , _______ and ______.

direct method | sagittal, frontal and base

Golding- Kushner et al. developed a way of standardizing the reporting of _________ and _________. You are supposed to actually measure but most people estimate.

nasopharyngoscopy and multiview videofluoroscopy

Air flow measurements are an _____ method of inspection.

indirect

Describe tongue anchor technique

stick out tongue and puff cheeks. If you can't breath through nose VP closure. Indirect method.

Describe Gutamann's I-a-test:

- Have the patient say [i} and [a]. - Normal VP closure means no difference when you plug the nose. - Can be used to help differentiate b/w hypo and hyper nasal - Indirect method

Describe the mirror test:

See if mirror fogs during oral speech. Indirect method.

Describe aerodynamic measures:

Indirect method. Pressure-flow estimation of velopharyngeal orifice area.

After morphological and functional analysis is _______

perceptual and acoustic analysis

Nasalance =

(nasal SPL / Oral + Nasal SPL) x 100

Acoustic analysis could involve . . .

``` nasometer oronasal system (aka speech tutor) ```

What are suggested materials for nasalance measuresments:

- The Zoo Passage (non-nasal reading passage) | - The Nasal Sentences (lots of nasals)

The Zoo Passage assesses __________. The Nasal Sentences assess _________.

- Extent of hypernasality | - Extent of hyponasality

The Zoo passage contains _____ nasal phonemes. Rainbow Passage contains ___% nasal phonemes while the Nasal Sentences contain ___ % nasal phonemes.

0 11.5% 35%

T or F: Hypernasality is visible on a spectrogram

True - nasal extraresonanzen at 700Hz

Otitis medias is common in all cleft palate. One study found fluid in the middle ear of ___% of cleft patients.

90%

Why might otitis media and the eustachian tube and be implicated in cleft?

Overlap in palatal muscles?

Four therapies for Otitis media:

Antibiotics Syringotomy Myringotomy Palatoplasty (indirect effect)