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key notes about cleft
- diagnosed as early as 6 weeks in utero
- can see cleft lip in ultrasound but not cleft palate
cleft lip
- separation of upper lip through nasal or oral cavity, or tooth-bearing part of maxilla
cleft palate
- hole in roof of mouth
- can be from hard to soft palate
submucous cleft
- HIDDEN hole in roof of mouth
- skin fused but bone didn't
- MD won't touch it
- trouble with feeding
- have hypernasality (nasal emissions)
- not detected til 2-3 years
least to most severe clefts
- SUBIUB
- submucous CP
- unilateral incomplete CL
- bilateral CL
- incomplete CP
- unilateral cleft L/P
- bitlateral cleft L/P
velopharyngeal insufficiency
- velo = velum
- pharyn = pharynx
- back of throat
- cannot raise velum therefore does not have proper closure
- air comes out of nose AND mouth
- even after surgery it won't be perfect
velopharyngeal dysfunction
- caused by surgery
- take too much of velum out
- ex. tonsilectomy
etiologies
- genetics
- environment
- inherent of a certain syndrome
etiology: environment
- mom's diet: need correct nutrients
- mom's lifestyle: smoking/drinking, prescription drugs, exposure to toxins, clean drinking water
surgical repair
- all done by plastic surgeon
- not every baby is a candidate
cleft lip repair
- at about 3 months if baby can withstand general anesthesia
cleft palate repair
- at about 10-12 months
- 1st reason: prevent food and liquid from exiting nose (close the hole!)
- 2nd reason: speech (need a working palate)
who is apart of the interprofessional team
- SLP (knows about swallowing and oral mechanism)
- audiologist (everything is connected, eustachian tube = ear infections)
- pediatrician
- pediatric dentist
- orthodontist
- ENT
- plastic and oral surgeon
- **social worker
- **child psychologist
SLPs role: birth to adolesence
- feeding therapy
- counseling
- assessment of speech, language, and resonance
- speech/resonance therapy
- working with reference group
feeding therapy
- working with mom from get-go
- how to use feeding tube
counseling
- may be a shock to parents
- they start playing the blame-game
assessment of speech, language, and resonance
- how much hypernasality they have
working with reference group
- talk with MD and tell them what we are working on in therapy and how client is doing in that
cleft palate and language
- delays not only in speech, but in receptive (understanding), and expressive (communicating) language
areas of weakness
- MLU
- TNW
- expressive syntax
- these decrease with age
social and emotional impact
- teasing and bullying (even from adults!)
- won't want to go anywhere where speaking is required
- body image issues (scars)
- loneliness and isolation
