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SLP > Structural > Flashcards

Structural Flashcards

0
Q

Most common palate repair surgeries

A

V-Y veau Walder Kilner
Von Langenbeck

Furlow… Double opposing z plasty
Vomer flap

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1
Q

What age do we repair cleft palate with surgery?

A

9-12 mos

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2
Q

The V-Y helps VP closure by

A

Elongating palate

Elevation of soft palate

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3
Q

Secondary surgery, only for severe VPI

A

Pharyngeal flap

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4
Q

Pharyngeal flap requires

A

Lateral wall movement

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5
Q

Pharyngeal flap risks

A

Stunted facial growth
Sleep apnea
Hyponasality

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6
Q

Prosthesis devices

A

Speech bulb/obdurator
Palatal obdurator
Palatal lift

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7
Q

What % cleft palate have conductive hearing loss?

A

96%

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8
Q

Therapy for cleft patient is appropriate if… (5)

A 
Compensatory artic problems
Inconsistent or mild nasal rustle (small gap)
Phoneme specific nasality
Nasality is due to dysarthria or apraxia
Improves with trial therapy
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9
Q

Muscle for velum raising and vp closure

A

Levator veli palatini

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10
Q

Muscle for auditory canal tube opening

A

Tensor veli palatini

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11
Q

What does the uvulus muscle do?

A

Shortens velum
Lifts and pulls velum back
Helps with VP closure

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12
Q

What does the palatoglossus do?

A

Aids in velar lowering
And/or
Tongue elevation

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13
Q

What does the palatopharyngeus do?

A

Constricts and elevates pharynx. Helps with swallowing

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14
Q

Babbling and clefts…

A

Less babbling

Delayed reduplicated babbling

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15
Q

Cleft and consonant inventories

A

Avoid pressure consonants
Avoid anterior sounds
Fewer overall

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16
Q

Compensatory artic patterns

A

Glottal stops and glottal fricatives

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17
Q

Common phonological processes with cleft

A

Backing

Nasal assimilation

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18
Q

Improve with artic faster if cleft is repaired prior to age

A

10

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19
Q

Hypernasality most noticeable on …

A

Vowels

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20
Q

Decreased utterance length due to…

A

Air leaks, poor pressure… Causes more respiratory effort, resulting in more frequent breaths

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21
Q

Face is developing in what week?

A

4-10th

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22
Q

Combo of genetic and environmental factors called…

A

Multifactorial inheritance

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23
Q

Incidence cleft lip with or without palate

A

1 in 1000 live births

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24
Q

Delayed dentition leads to

A

Delayed chewing

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25
Q

Pharyngeal swallow develops at…

A

10th to 11th week gestation

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26
Q

Palate fuses at what week gestation?

A

10-11th

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27
Q

Suckling ability (anterior to posterior motion) at what week

A

18-24 weeks gestation

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28
Q

Most can suckle and swallow enough to maintain nutrition by age…

A

8-8.5 months gestation

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29
Q

Mix of suckle and suck can be seen in infants as young as…

A

6-9 months

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30
Q

Feeding concerns include…

A 
Weak suck
Not enough nutrition taken
Nasal regurgitation
Long feeding over 20-30 mins
Fatigue
Poor weight gain
Parental anxiety affects bonding
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31
Q

SLP roles

A

Counsel parent, education
Swallowing
Artic and language
Cleft team coordinator

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32
Q

Best feeding position

A

Upright with chin tuck

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33
Q

Tips on feeding…

A

Weigh infant daily
In/out diary
Frequent burping

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34
Q

When to do cleft lip surgery?

A

Rule of 10s… 10 g Hgb?, 10 weeks, 10 lbs
As early as 6-8 weeks

2-3 months

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35
Q

Most common cleft lip surgery

A

Millard technique…
Cut as you go
Preserves philtral dimple and cupids bow
Scar is along philtral

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36
Q

Post cleft lip surgery feelings…

A

By syringe for 10 days
Velcro arm restraints
Avoid nipples which might damage sutures
Suture line care and cleaning

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37
Q

Speech problems persist after palate surgery in what percent of cases?

A

25%

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38
Q

If speech problems persist, secondary physical management (prosthesis) is usually needed by what age?

A

4 to 8 years

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39
Q

Post-op concerns for palate surgery

A

Swelling obstructs airway
Pain management and over sedation.. Meds given 7-10 days
Change in oral nasal airway dynamics

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40
Q

Feeding post palate surgery

A

Liquid diet
Soft foods 3 weeks post op
Bottles avoided
Arm restraints

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41
Q

We may help VP ——- but not VP ———-

A

Incompetence, but not insufficiency

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42
Q

Feedback used in therapy

A

Biofeedback
Nasometer
CPAP therapy

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43
Q

Compensations in glottis and strain may lead to

A

Voice disorders… Dysphonia, nodules

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44
Q

Hypo nasality may be seen on…

A

Vowels, nasal consonants

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45
Q

Soft voice syndrome, due to

A

Large nasal resonance absorbs acoustic energy - quiet vowels
Loss of pressure through VP port, hard to get loud
As a compensatory strategy for hyper nasality

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46
Q

In compensatory artic

A

Manner usually maintained
Placement is moved back
Create pharyngeal rather than oral pressure

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47
Q

Nasal sniff may be used for phoneme…

A

/s/

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48
Q

3 syndromes

A

Pierre robin sequence
Velocardiofacial syndrome
Stickler syndrome
Apert syndrome

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49
Q

Cleft classifications

A

Lip, palate
Unilateral, bilateral
Complete, incomplete
Primary, secondary palate

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50
Q

What is the ratio of left, right, bilateral cleft incidence

A

6 left - 3 right - 1 both

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51
Q

Where pink part of lip meets skin

A

Vermillion- cutaneous border

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52
Q

Hard and soft palates are part of the —- palate

A

Secondary

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53
Q

Layers of flat broad tendons…

A

Aponeusosis

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54
Q

Nasal cavity roof

A

Ethmoid bone

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55
Q

Nasal floor

A

Maxilla

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56
Q

Nasal lateral walls

A

Nasal bone
Nasal Conchae
Maxilla
Palatine bone

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57
Q

Nasal septum boundaries

A

Vomer
Ethmoid … Perpendicular plate
Cartilage

58
Q

Name for nose hairs

A

Vibrissae

59
Q

Fx of nasal conchae

A

Increase surface area
Increase turbulence
Reclaim heat from exhaled air

60
Q

Hard palate

A

Anterior 2/3
Mucosa covered bone
Press food against in chewing

61
Q

Soft palate

A

Posterior 1/3
Muscle covered by mucosa
Ends in uvula
Closes VP port in swallow

62
Q

Name for bony hard palate growth

A

Torus palatinus/mandibulus

63
Q

3 phases prenatal development, basic

A

1 and 2 are embryonic

3 is fetal

64
Q

1st embryonic stage

A

Weeks 0-4
Cellular proliferation and migration
Some differentiation

65
Q

2nd embryonic stage

A

Weeks 5-8
Differentiation of all organs… Morphogenesis
Very vulnerable stage

66
Q

3rd, fetal stage

A

Growth and maturation

67
Q

How many face primordia?

A

5

68
Q

Face primordia develop in week — and fuse in weeks —-

A

Develop in week 4

Fuse in weeks 5-8

69
Q

Ectodermal swellings filled with mesodermal and neural crest cells

A

Primordia

70
Q

Name the facial primordia

A

1 Frontonasal prominence
2 mandibular prominences… From branchial arch 1
2 maxillary prominences… From branchial arch 1

71
Q

Primitive mouth

A

Stomodeum

72
Q

Ruptures to form oral opening

A

Oral plate lining

73
Q

Thickened plate in ectoderm where sensory organ will develop, ie nose

A

Placode

Nasal placode
Lens placode
Start out laterally located

74
Q

At 4 weeks in utero

A

Stomodeum, lining ruptures to be mouth
Nasal placodes laterally
Frontal prominence centrally above

75
Q

At 5 weeks in utero

A

All major primordia can be distinguished
Mandible forms lower arch
Maxillary arch is lateral
At 5.5 wks, nasomedial and nasolateral processes that form nose

76
Q

Paired arches like gills

A

Branchial arches and grooves

77
Q

1st branchial arch

A

Mandibular arch below Stomodeum
Lower lip, mandible, muscles of chewing, front of tongue
Incus and malleus of middle ear (form meckels cartilage)

78
Q

2nd branchial arch

A 
Hyoid arch
Side and front of neck
Styloid process
Upper part ... Lesser Cornu... Of hyoid bone
Stapes of middle ear
79
Q

3rd branchial arch

A

Greater Cornu of hyoid bone , bottom part

Part combines w 2nd arch to make hyoid and posterior tongue

80
Q

4th branchial arch

A

Thyroid cartilage

81
Q

5th branchial arch

A

Cricoid and arytenoid cartilages

82
Q

At 6 weeks in utero

A

Maxillary process more prominent
Growth of nasal processes
Formation of primary palate
Fusion of median, lateral nasal processes and paired maxillary prominences

83
Q

7th week in utero

A

Inferior tips of medial nasal processes expand laterally to form inter maxillary process

Tips of maxillary swellings meet the inter maxillary process and fuse

84
Q

Cleft lip is a failure of fusion between…

A

Maxillary swellings and inter maxillary process

85
Q

8th and 9th week in utero

A

Medial walls of maxillary process produce palatine shelves
Shelves grow down, parallel to lateral surface of tongue
End of week 9… Rotate up to horizontal position
Fuse w each other and primary palate to form secondary palate

86
Q

Earliest ultrasound ID of clefting at…

A

13 weeks

87
Q

Nares developed by week

A

Anterior nasal choane, 6th week

88
Q

Tongue moves down, allowing

A

Palatal shelves to move up and tilt
Back to front
Toward midline

89
Q

Palatal shelves are free of tongue by week…

A

8

90
Q

Palatal shelves contact anteriorly by end of week…

A

8

91
Q

Fusion of Palatal shelves moves from

Contact of Palatal shelves moves from

A

Font to back

Back to front

92
Q

Uvula merges to soft palate by week

A

12, 1st trimester

Also this is the end of Palatal fusion

93
Q

3 components of VP mechanism

A

Lateral pharyngeal wall
Posterior pharyngeal wall
Velum

94
Q

Muscle that medializes lateral pharyngeal walls

A

Superior constrictor

95
Q

For nasals, velum is…

A

Lowered

96
Q

Swallowing muscles

A

Tensor veli palatini

Levator veli palatini

97
Q

Respiration muscles

A

Palatoglossus

Palatopharyngeus

98
Q

Innervated by cranial nerve…

A

10, vagus

99
Q

Front 1/4 of velum is…

A

Tensor veli palatini

100
Q

Back 3/4 of velum is the

A

Levator veli palatini

101
Q

Is the uvulus paired?

A

Yes

102
Q

Antagonist to levator veli palatini, covers mid 50% of velum

A

Palatopharyngeus

103
Q

3 pharyngeal constrictors

A

Superior … Smallest
Middle
Inferior… Largest

104
Q

Saingopharyngeus muscle

A

Not always present, little relevance, weak muscle

105
Q

Motor nerves of velum

A

5, 7, 9, 10, 11

106
Q

Sensory nerves of velum

A

10, 11

107
Q

VP especially important for pressure sensitive sounds, like…

A

Stops, fricatives, africates

108
Q

Not in all ppl, posterior wall movement during speech…

A

Passavant’s ridge

109
Q

Coronal closure

A

Movement of velum and posterior pharyngeal wall

Not lateral

110
Q

Sagittal closure

A

Movement of lateral pharyngeal walls

Little front,back

111
Q

Circular closure pattern

A

All sides

Often Passavant’s ridge

112
Q

VP insufficiency caused by

A

Anatomical defects…
Cleft history, short velum, deep pharynx, irregular adenoids, big tonsils

After surgery…
Maxillary advancement, Adenoids tony, treatment of tumor there, spine surgery through mouth

113
Q

VP incompetence caused by

A 
Poor muscle fx after cleft repair
Hypotonia
Velar paresis due to cranial nerve injury
Dysarthria
Myasthenia gravis
Apraxia
114
Q

Both VP incompetence and insufficiency are types of

A

VP inadequacy

115
Q

PSNAE

A

Phoneme specific nasal air emissions

116
Q

When Sound resonates in pharynx or nasal cavity and is not released due to obstruction

A

Cul de sac resonance

117
Q

Nasal rustle is due to

A

Turbulence

Accompanied by nasal grimace often

118
Q

How does nasal air emission affect consonants

A

Weakens them

119
Q

Striped Y

A 
1, 5 floor of nose
2,6 lip
3,7 alveolar ridges
4,8 premaxilla to incisive foramen
9, 10 hard palate
11 soft palate
12 congenital incompetence wo clefts
13 protruding premaxilla
120
Q

Very mild incomplete lip cleft, looks like a scar

A

Forme fruste

121
Q

Incidence cleft palate only

A

1 in 2000 births

122
Q

Race and clefts

Gender

A

Asian, white, black

Male, female … Except isolated cp

123
Q

% of cleft types

A

50 cl and cp…… More unilateral
30 cp alone
20 cl alone, most unilateral

124
Q

Viral risk that causes cleft

A

Rubella

125
Q

Risk increases with

A

Dad’s age

126
Q

Separates primary and secondary clefts

A

Incisive foramen

127
Q

Lip abnormality, not really a cleft

A

Microform

128
Q

Thin bridge of soft tissue across cleft lip

A

Simonart’s band

129
Q

Sub mucosal cleft signs

A

Bifid uvula
Bony notch into the hard palate
Zona pellucida… Velum mucosa looks thin

130
Q

Fusion of bone sutures is called

A

Ossification

131
Q

Inter frontal suture timeline

A

Starts closing after 1 year, usually done by age 7

132
Q

Premature fusion of sutures

A

Craniosynostosis

133
Q

Craniosynostosis syndromes

A

Apert syndrome…. Coronal
Crouzon syndrome… Coronal and saggital
Pfeiffer syndrome….all sutures

134
Q

Speech concern outweighs

A

Maxillary growth constriction

135
Q

Cheiloplasty

A

Cleft lip repair

136
Q

Which palate surgery elongates the palate?

A

V-Y repair

137
Q

Orthodontics to prep for surgery

A

Nasoalveolar molding

138
Q

Bone grafting

A

From iliac crest of pelvic girdle
Primary… Infancy
Secondary… 8-11 years
Because it doesn’t grow

139
Q

Furlow z plasty

A

Length at expense of width
Thickens velum

May be secondary surgery

140
Q

More likely to be syndromic if

A

Cleft palate only

141
Q

Ratio of nasal sound energy to total sound energy

A

Nasalance

142
Q

Red flags, post surgery

A

Lack of consonant inventory growth
No oral stops 3 months post
Compensatory errors continue

SLP (10 decks)

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