Speech Pathology Exam 3

Frontal Bone

Forms anterior brain case and roof of orbital and nasal cavities

• Orbital

• Squamous

Ethmoid Bone

Forms anterior base of cranium and part of nasal skeleton

• Delicate and complex

• Projects down from between orbital plates and contributes to walls of orbital and nasal cavities

Sphenoid

Forms part of base and lateral walls of cranium and vault of pharynx

• Articulates with cranial and most facial bones

• Major parts:

  • body

  • greater wings

  • lesser wings

  • pterygoid plates

Occipital bone

Forms part of the posterior and interior cranial surfaces

• Landmarks:

  • Foramen magnum

  • Condyles

    • On inferior surface, lateral to foramen magnum where skull joins with superior facets of atlas (first vertebrae)

  • Basilar portion

    • Inferior

    • Anterior to foramen magnum

  • Squamous portion

Temporal Bone

Forms side of cranium as well as part of base, Houses middle and inner ear

• Squamous portion
  • Forms anterior and superior portion
  • Zygomatic process—anterior
  projection
  • Mandibular fossa—TMJ
  • Tympanic portion
  • Surrounds external auditory meatus
  • Inferior to squamous portion and
  anterior to mastoid process
  • Styloid process (inferior extension)
  • Contains external auditory meatus
  • Mastoid portion: posterior

Parietal Bones

Forms vault and part of side wall of the cranium

• Sagittal suture

• Right and left

Mandible

Largest and strongest facial bone

• Appear U-shaped

• Major speech contribution

  • supports lower teeth

  • forms point of attachment for tongue and other structures

  • minimal jaw movement during speech

Maxillae

Upper jaw, second largest facial bone

• major speech contribution

  • bounds the mouth

  • attaches muscles and soft tissues important for speech

  • makes up hard palate, nose, and upper dental ridge

Nasal bones

Forms bridge of nose

Lacrimal bones

Form part of medial wall of orbital cavities

Palatine bones

Contribute to the formation of three cavities

• floor of lateral walls nasal cavities

• posterior roof of oral cavity

• floor of orbital cavity

Zygomatic bones

Cheekbones, contributes to the lateral wall and floor of orbital cavity

Inferior nasal conchae

Makes up the inferior-most part of the lateral nasal wall

Sinuses

Purpose:

• provides better balance

• act as resonating chambers

• expands areas served by nose in warming, moistening, and filtering income air

Types:

• frontal

• maxillary

• Ethmoid

• Sphenoid

Lips and cheeks

Lips:

• Rima oris: mouth opening

• upper/lower

• Labial frenula

• nasal philtrum

• function: sounds production, swallowing phases

Cheeks:

• assist in speech sounds/chewing

Class 1 Occlusions

Upper and lower teeth align but teeth don’t touch when closed (open bite)

Class 2 malocclusion

Over bite: appearance of receding chin and decrease in lower facial height

Class 3 malocclusion

Under bite: increased facial height prognathic jaw

Hard Palate

• formed by palatine processes of the maxillae, palatine bone

• rugae

• midline raphe

Alveolar arch

• Hard palate becomes progressively thinner toward midline (vault)

• Extent of vault varies, dependent of status of dentition

• Houses teeth

Velum

• Muscles continuous with superior constrictor muscles

• Can be elevated, lowered, tensed

• 3-23% muscle tissue (midpoint of palate)

• Also: connective tissue, epithelial, vascular, etc.

Tonsils

• Tonsillar fossa

• Waldeyer’s ring

• Adenoids (pharyngeal tonsil)

• Palatine tonsil

• May affect nasal resonance
  and/or move tongue forward

  
  

Levator labii superior

Elevates portion of upper lip

Levator anguli oris

Elevates corner of upper lip

Zygomatic

Draws corner of mouth up and back

Risorius

Retracts corner of mouth; compresses cheek

Buccinator

Retracts corner of mouth; compresses cheek

Depressor anguli oris

Depresses corner of mouth

Depressor labii inferior

Depresses lower lip

Mentalis

Protrudes lower lip, wrinkles chin

Orbicularis oris

Closes mouth, puckers/round lips

Platysma

Depresses mandible and corner of mouth

Temporalis

Raises and retracts mandible

Masseter

Raises mandible against maxilla

Internal pterygoid

Raises and protrudes mandible

Digastric

Raises hyoid and depresses manidle

Mylohyoid

Elevates hyoid and tongue

Geniohyoid

Pulls hyoid up and forward

External Pterygoid

Depresses mandible forward and sideways

Muscles for raising

Internal pterygoid, masseter, temporalis

Muscles for lowering

External pterygoid, geniohyoid, digastric, mylohyoid, genioglossus

Muscles for protrusion

External pterygoid, internal pterygoid

Muscles for retraction

Temporal, mylohyoid, digastric

Lateral

External pterygoid, temporal

Levator veli palatini

Raises soft palate to meet posterior pharyngeal wall

Tensor veli palatini

Tenses soft palate, opens Eustachian tube during swallow

Uvula

Raises and shortens uvula

Glossopalatine

Raises posterior portion of tongue, constricts isthmus of fauces, depresses side palate

Phayngopalatine

Depresses soft palate, aids in elevating larynx and pharynx, constricts faucial isthmus

Source-Filter Theory

Says speech production is a two-stage process involving generation of a sound source that is then shaped or filtered by the resonant properties of the vocal tract

Oral Preparatory Phase

1. Velum lowered

   1. Port is open

2. Bolus food goes in mouth and is chewed (mastication) 🤯 → forms bolus 

Oral Transport phase

1. Velum partially lowered

   1. Port is partially open

2. Bolus is moved to the back of the mouth by the anterior part of the tongue 

3. Swallow not triggered

   1. 2 Pockets food may fall into before swallow is triggered:

      1. Pyriform sinuses 

      2. Valleculae

         1. Space between base of the tongue and epiglottis 

Pharyngeal Phase

1. Velum raised 

   1. Port is closed

   2. Stop breathing (apnea) on an exhale so if food goes down wrong tube it gets pushed out by the air 

2. Larynx closes by lifting the larynx superiorly and anteriorly and is closed by the epiglottis 

   1. VFs are closed 

3. Bolus is moved to the anterior faucial arch and swallow is triggered, moved from oral to pharyngeal space and enters the esophagus 

Esophageal Phase

1. Velum lowered 

   1. Port is open 

2. UES cuts off pharynx form the esophagus by relaxing

3. LES cuts off esophagus and stomach 

4. Bolus moves from UES and esophagus to the stomach/LES

Thin Liquids

Clear juice, water, tea, coffee

Thick Liquids

Nectar, Honey, Pudding

Solids

Puree, mechanical soft, regular

Fiberoptic endoscopic evaluation of swallow (FEES)

• Video endoscopy threaded through nasal cavity, sits above velum to visualize larynx and pharynx (and USE) during swallow

Modified Barium Swallow Study

• Various consistencies of liquids and solid are mixed with
  barium (radioactive)

• X-ray video during swallow of radioactive substance

• Allows visualization of penetration and aspiration

• Can visualize residue in valleculae and pyriforms

• Usually lateral view of swallow to see A-P function, but
  can have anterior positioning (to visualize bilateral
  structure/function)

Bolus

Mass of chewed food

Mastication

Chewing

Deglutition

Chewing and swallowing

Penetration

Food enters area above the true vocal folds

Aspiration

Food enters areas below true vocal folds

Dysphagia

Any difficulty or problems with deglutition

Elevators

Masseter, Temporalis, Internal (medial) pterygoid

Depressors

External (lateral) pterygoid, Mylohyoid, Digastric, Geniohyoid, Genioglossus

Anterior Faucial arches

Palatoglossal (connects from the palate to the arch)

Posterior Faucial arches

Palatopharyngeal (connects from the palate to the pharynx)

Hypernasality

Too much nasality, velum isn’t raising (closing) when it should, so there is too much air in the nose (could be due to cleft palate)

Hyponasality

Too little nasality (could be due to congestion)