Speech Disorders Module 2

Hard Palate

The bony front part of the roof of the mouth, which separates the oral cavity from the nasal cavity. It plays a crucial role in speech production and articulation.

Soft Palate

The soft tissue at the back of the roof of the mouth, which aids in closing off the nasal passages during swallowing and is essential for certain speech sounds.

Pharynx

The muscular tube that connects the mouth and nasal passages to the esophagus and larynx, playing a key role in swallowing and speech production.

Velopharyngeal Mechanism

The system involving the soft palate and pharyngeal walls that controls airflow between the oral and nasal cavities, critical for proper speech production.

Embryonic

tissue related to the early stages of development in an organism, particularly in relation to the formation of structures like the palate.

Mandibular Processes

The paired structures that form the lower jaw during embryonic development, contributing to the formation of the mandible and lower lip.

Maxillary Processes

The paired structures that contribute to the formation of the upper jaw and parts of the face during embryonic development.

Frontonasal Process

The embryonic structure that contributes to the formation of the forehead and nose, playing a crucial role in facial development.

Maxilla

Upper jaw, fuses medially during embryogenesis to form the maxillary bone, which supports the upper teeth and contributes to the formation of the hard palate.

Mandible

The lower jawbone that holds the lower teeth in place and is the only movable bone of the skull.

Philtrum

The vertical groove between the base of the nose and the upper lip, formed during embryonic development.

Philtrum Ridge

The raised area on either side of the philtrum that contributes to lip shape and facial aesthetics.

Faucial Pillars

The vertical folds of tissue located at the back of the oral cavity that form the boundary between the oral cavity and the oropharynx, playing a role in swallowing and speech.

Median Palatine Suture

The fibrous joint that connects the two palatine processes of the maxilla, running down the center of the hard palate.

Incisive Foramen

The opening in the bone located at the anterior part of the hard palate, allowing for the passage of nerves and blood vessels.

Alveolus

The bony socket in the jaw that holds the roots of the teeth, playing a crucial role in dental health and oral function.

Nasal Septum

The cartilage and bone structure that divides the nasal cavity into two nostrils, playing a key role in respiratory function and airflow.

Premaxilla

a small, triangular-shaped bone located at the front of the upper jaw

Velopharyngeal Valving

The mechanism that controls the airflow between the nasal cavity and the oral cavity during speech and swallowing, crucial for producing certain speech sounds.

Velopharyngeal Port

The opening between oral and nasal cavities, important for speech, blowing, whistling, sucking, swallowing, vomiting

Important for all vowels and most consonants

Velopharyngeal Incompetence (VPD)

Velopharyngeal valve does not close consistently and completely during the production of oral sounds, results in abnormal resonance, airflow and articulation

Craniofacial Anomalies

Malformations that affect the head and face, and often cause speech problems.

Complete Cleft Lip

Separation of upper lip tissue into the nostril floor

Incomplete Cleft Lip

Minor “V” shaped notch in vermilion  border

Complete Cleft Palate

Hard palate and Soft Palate are deformed

Incomplete Cleft Palate

Soft palate is only deformed

Overt Submucous Cleft

Muscular cleft in the region of the soft palate. It is covered by thin layer of mucosal membrane.

Sometimes not detected until later in childhood

Some signs that it is present are:

• Bifid uvula

• Bluish color/furrow in the middle of the soft palate zona pellucida

• Notch that can be felt in hard palate

Occult Submucous Cleft

Upon oral mechanism evaluation, the palate appears normal; Lacks the classic triad; However, the muscle fibers are abnormally oriented (as in a submucous cleft).

Microform Cleft Lip

a mild form of cleft lip that appears as a notch or slight indentation in the lip

Causes of Speech Disorders Secondary to Cleft

• Nasal Obstruction

• Short Upper Lip

• Dental/Occlusal Abnormalities

• Palatal Fistula

• Hearing Loss

• Tonsils and Adenoids

• Velopharyngeal Dysfunction

Obligatory Error

Caused by structural abnormalities, requires physically management or surgery to correct

Compensatory Errors

Learned maladaptive articulations, can be treated with speech therapy

Eustachian tube

The tube that connects the middle ear to the nasopharynx, helping to equalize air pressure in the ear and drain fluid from the middle ear

Tensor Veli Palatini

Tenses palate, it helps open the Eustachian tube to equalize pressure

Conductive Hearing Loss

cause of speech disorders secondary to clefts, pressure equalizing tubes often used to help

Hypernasality

most perceptible on vowels, sounds like /s/, /b/, /k/, results from too much sound resonating through the nose, certain letters and sounds should not have air escaping through the nose during speech, almost always requires surgical or prosthetic management

Hyponasality

results from too little air escaping through the nose (sounds like talking with a stuffy nose), most perceptible on nasal consonants, but also vowels

Cul-de-sac resonance

where sound gets trapped within a cavity in the vocal tract (like the throat or nose), causing speech to sound muffled and low in volume due to a blockage at the exit of that cavity

Mixed Nasality

when a person has hypernasal resonance on sounds that should not be nasalized and they are hypo nasalized on the other sounds

Nasal Fricatives

Compensatory articulation, directs air through their nose instead of their mouth

Pharyngeal Plosives

stopped air flow between tongue and posterior pharyngeal wall

Pharnyngal fricatives/affricate

Turbulent air flow between tongue and posterior pharyngeal wall

Glottal stop

 Vocal folds adduct and open (like a grunt)

Nasal Emission

air audibly goes through the nose, Air from nose during speech due to leak in VP valve, Occurs in pressure-sensitive consonants such as plosives, fricatives, and affricates, particularly voiceless

Dysphonia

Hoarseness, Raspy or strained voice, weak voice, voice fatigue

Oral Mechanism Evaluation

Dentition and occlusion, Oral cavity size for tongue movement and placement, Presence of fistulae, Signs of submucous cleft, Movement and symmetry of the uvula, Size of the tonsils, Signs of upper airway obstruction (mouth breathing), Signs of oral motor dysfunction (movement and coordination of articulators), Use /ae/ not /ah/ (mouth opens bigger!)

Perceptual Ratings

Best way to assess is during connected speech. An alternative test includes asking client to produce a sentence full of oral sounds (e.g., Stop the bus) with the nose unoccluded and then occluded.

Nasal Emission Tests

Seescape, Straw (put a straw in the child’s nose and see if you hear the noise), Mirror (Put a mirror under a kid’s nose and see if it fogs up)

Instrumental Procedures

Nasometry, nasopharyngoscopy, some centers use pressure flow studies

Videofluoroscopy

Direct, Allow view of valve, especially elevation of velum and length of pharyngeal wall, Radiation exposure; not good for small openings

Nasoendoscopy

Examines the nasal cavity, including the sinuses, Commonly used by ear, nose, and throat (ENT) specialists, Can be performed with moderate sedation and local anesthesia

Nasopharyngoscopy

Direct, Good for viewing small VP openings and vocal folds, Invasive/uncomfortable, use of nasal spray, Can be used to assess the soft palate and velopharyngeal dysfunction (VPD), Can be used to evaluate voice disorders

Aerodynamic Instrumentation

Indirect, Measures air pressure in VP functions, Cannot see VP valve

Seescape

detects nasal emissions

Nasometer

Measures acoustic energy from oral and nasal cavities, Gives an objective nasalance score: ratio of oral/total (nasal plus oral) energy

Craniofacial Team

Speech therapy, Dental and orthodontic treatment, prosthetic appliances, surgery

Dental/Orthodontic Treatment

Maxillary expansion device (preschool), Bone graft to alveolus (~ 7 yrs), Maxillary advancement surgery (14–19 yrs old)

Surgical Repair

Cleft lip: Generally repaired in 1-2 stages at 2.5-6 months of age Goal: optimal aesthetic outcome; Cleft palate: Generally repaired around 9-12 months, may require secondary Goal: functional, normal speech (Good resonance, Adequate intra-oral pressure)

Prosthetic Appliances

Use of palatal lift, palatal obturator, or speech bulb obturator

Speech Therapy

Considered ineffective and inappropriate as a means to correct VPD when there is inappropriate nasality or nasal emission due to abnormal physiology. Therapy is effective and appropriate for: Compensatory articulation problems secondary to VPD that cause nasal emission, Misarticulations that cause nasal air emission or hypernasality that is phoneme specific, Hypernasality or variable resonance due to apraxia, Hypernasality or nasal emission following surgical correction

Pharyngeal Flap

Suture flap from posterior pharyngeal wall to velum

Pharyngeal Augmentation

Inject substance into posterior pharyngeal wall

Sphincter Pharyngoplasty

Suture posterior faucial pillars to posterior pharyngeal wall

Furlow Z-Plasty

Lengthen velum

Palatal Lift

useful for inadequate muscle control

Palatal Obturator

useful for nasal regurgitation during feeding

Speech Bulb

useful for speaking and swallowing, aiming to improve function, speech, and, ultimately, quality of life for the patient

Velocardiofacial Syndrome

Often called Digeorge syndrome, has VPD, minor cardiac anomalies, microcephaly, long face, small jaw, thin upper lip, wide nasal bridge, Delayed speech and language development, Learning disabilities

Robin Sequence

Small jaw that is also posteriorly placed, Posteriorly placed tongue, Horseshoe shaped palatal cleft

Stickler Syndrome

Groups of hereditary conditions characterized by flattened face, eye problems, hearing loss and joint problems, Genetic mutations affect production of collagen, Pierre Robin Sequence common

Hemifacial Microsomia

Also known as Facio-Auriculo-Vertebral Spectrum and Goldenhar syndrome, Unilateral hypoplasia of face, Hearing loss

Crouzon Syndrome

Wide-shaped skull, Wide-spaced eyes, Protruding eyes, Small maxilla: Hyponasality, Cleft palate, Hearing loss, Learning difficulties

Treacher Collins Syndrome

Underdeveloped cheekbones, maxilla and mandible, Downward slant of eyes, Robin sequence common, Cleft palate and VPD

Micrognathia

a condition where the lower jaw (mandible) is significantly smaller than normal

Retrognathia

a dental and skeletal condition where the lower jaw (mandible) is positioned too far back in relation to the upper jaw (maxilla)

Glossoptosis

a condition where the tongue falls backward and obstructs the airway

Distraction Osteogenesis

a surgical technique that involves gradually separating two segments of bone to create new bone in the gap

Hypertelorbitism

Wide-spaced eyes

Exorbitism

Protruding eyes