PMI Exam 1

Nasal Septum

The cartilage and bone structure that divides the nasal cavity into two nostrils, helping to support the nose and regulate airflow.

Turbinates & Meatuses

Bony structures in the nasal cavity that help to warm and humidify the air, as well as regulate airflow through the nostrils.

Orbicularis Oris

Muscles that surrounds the mouth & lips, responsible for movements such as puckering and closing the lips.

Hard Palate

The bony structure forming the roof of the mouth, separating the oral cavity from the nasal cavity, and providing support for the teeth. Alveolar Ridge.

Soft Palate

The muscular structure located at the back of the roof of the mouth, helping to close off the nasal passages during swallowing and speaking. Velum.

Primary Palate

The initial structures in embryonic development that form the upper jaw and the anterior part of the hard palate, contributing to the formation of the mouth and nasal cavities.

Secondary Palate

The bony structure that forms the hard palate and the soft palate, completing the separation of the oral and nasal cavities during development.

Sling

Main muscle that moves the velum.

Ring

helps constrict the velum and then pops it upwards.

Palatoglossus

Depresses the velum.

Bulge

Makes a tight seal against the roof of the mouth during speech.

Coronal VP Closure

most common. includes the velum & PPW

Saggital VP Closure

Least Common. LPWs & Velum

Circular VP Closure

All structures involved.

Primary Cleft Classification

Most often seen on the left side. Unilateral Incomplete, Unilateral complete, Bilateral complete. Can include both the lip and the alveolar ridge.

Secondary Cleft Classification

Incomplete cleft, complete cleft, Unilateral complete cleft/palate, bilateral cleft/palate. Includes hard palate, velum, and uvula.

Environmental Factors of of Clefts

teratogens, environment, drugs, viruses, maternal nutrition, physical interference.

Pierre Robin Sequence

Hypoplastic mandible (primary anomaly), glossoptosis, tongue obstructs palatal fusion, U-shaped palate

Disorders & syndromes with PRS

feeding problems, sometimes can have hearing issues, hypernasal speech

External Ear Abnormalities

Aural atresia —> complete absence of EAC. Microtia —> underdeveloped pinna. Middle Ear HL.

Middle Ear Abnormalities

Absent ossicles, hypoplasic ossicles & tympanic membrane. Conductive HL

Kids Eustachian Tube

more horizontal. doesn’t aide for drainage (ear infections). PE tubes

Adults Eustachian Tube

More vertical, suited for drainage

Nose abnormalities

Anterior —> deviated or narrow septum. Posterior —> small choana or enlarged adenoids. Hyponasality.

Maxilla

Crossbite, underbite, airway restriction, Hyponasality. Treatment is surgery.

Short upper Lip

cleft repair, congenital abnormality

Macro/Microstomia

Clefts, congenital syndrome. Microstomia could result in mumbling

Macroglossia

large tongue. could affect speech, swallowing, and nasal breathing. airway obstruction could be a concern.

Microglossia

small tongue. Alveolar erros, maybe a little swallowing issues when younger

Lobulated tongue

uncommon, no real affect on speech

Ankyloglossia

tongue tie. Unless they’re severe, they don’t have an affect on speech. Could see issues with infant feeding and swallowing (anterior ties)

Palatal Fistula

hole in the palate. Breakdown of palate repair or growth after repair. Nasality issues, nasal regurgitation

Palatine tonsils

can grow anteriorly, posteriorly, and/or medially. Visible in the throat

Adenoids

behind the nasal passages. If enlarged: hyponasality, OSA, temporary Conductive HL

Lingual tonsils

under the tongue. If enlarged: can affect speech and swallowing. Rare.

Laryngomalacia

floppy larynx. softening of the tissues around the larynx. Can cause loud breathing

Vocal fold paralysis

mainly unilateral. can cause quiet and breathy speech. Can get botox as treatment

laryngeal web

soft tissues form over the anterior portion of the larynx. Can have noisy speech (strider). Babies will have a weak sounding cry

Nodules

can sound very hoarse. Surgical removal and then vocal rest.

Class I malocclusion

“normal”. no speech issues, maybe some grinding of the teeth at night

Class II malcocclusion

large overbite. trouble with chewing. tongue sits further back (lateral lisp). backing of sounds (depends on the location of the mandible). Mandible is too far BACK compared to the maxilla

Class III maloclussion

mandible is too far FORWARD (underbite). issues with labiodentals (fronting). Depends on severity

Air flow of voiced sounds

lungs, vocal fold vibrate, sound, resonance. Vowels and voiced consonants.

Air flow of voiceless sounds

lungs, glottis, airflow, increased air pressure, pressure consonants (voiceless)

determiners for normal resonance in speech

velopharyngeal valve function & size/shape of resonating cavities

Hypernasality —> Cleft & Craniofacial team

structural issue. TOO MUCH sound in the nasal cavity, most obvious on vowels. /b/ will sound like /m/. /s/ will sound like /n/

Hyponasality —> ENT

structural issue or if your sick. Velopharyngeal opening, then velum due to submucous cleft, large palatal fistual

Cul-de-sac —> ENT

patrick mahomes, glottis issue. Sound is trapped in cavities of vocal tract. Can only be fixed via medical intervention

Oral Cul-de-sac

sound is partially blocked from exiting the oral cavity. Potential cause could be microstomia

Nasal Cul-de-sac

sound is partially blocked from exiting the nasal cavity. Commonly seen with cleft lips/palates when there is both VPIs & blockage due to small nostrils

Pharyngeal Cul-de-sac

Sound remains in the oropharynx during speech. usually caused by large palatine tonsils that block the exit of the oropharynx into the oral cavity

Mixed resonance

any combination. Causes VPI & obstruction. Causes Apraxia

Velopharyngeal incompetence

poor MOVEMENT. Velum could be hypotonic

Velopharyngeal insufficiency

STRUCTURAL issue. velum could be too short

Inaudible nasal emission

large opening

Audible nasal emission

medium opening

Nasal rustle

small opening. smaller opening = more pressure = more sound distortion

Obligatory

structure is ABNORMAL. articulation placement is NORMAL. treatment is surgery

Compensatory

structure is ABNORMAL. articulation placement is ABNORMAL. treatment is surgery then speech therapy