cleft palate

Label

Label

What types of sounds might be easier for those with cleft palate/lip

Liquids and glides

What type of speech do those with cleft palate have

Distorted speech

Why do those with cleft palate have distorted speech

Bc air is escaping through the nostrils

What types of sounds will be easy for those with cleft palate

Nasals

Babies with cleft palate where will their feeding go

Up their nose

Label

3 classifications of cleft lip/palafe

Cleft of the primary palate (anterior of foramen)

Clefts of the secondary palate (posterior of foramen)

Incisive foramen is dividing apart

How might cleft palate affect phonation

Usually would not be affected but level of vocal folds can be damaged bc of a lot of glottal stops. Could sound hoarse and breathy

How might cleft palate affect resonance

Hyper nasal bc everything comes out of nose

How might cleft palate affect articulation

High pressure sounds will be difficult

/m/ /n/ sounds easy or hard for cleft palate

Easy

/p/ /b/ /t/ /d/ /k/ /g/ /f/ /v/ how will these be easy or hard for cleft palate

Hard

/h/ /l/ /r/ easy or hard cleft palate

Could be way

/s/ /z/ th sh easy or hard for cleft palate

Hard

Vermillion in lips is

Color of lips

Faucial pillars

Curtain like structures that assist in velopharyngeal and lingual movement

Palatine tonsils

Between anterior and posterior faucial pillars

Lingual tonsils

Lymphoid tissue at base of tongue and extends to epiglottis

Oropharyngeal isthmus

Opening of oral cavity to pharynx

What is needed for pharyngeal closure

Movement of velum, posterior pharyngeal wall, and lateral pharyngeal wall are needed

Velar movement - nonpneumatic activities

Swallowing gagging vomiting

Velar movement - pneumatic activities

Blowing singing speech

Pharyngeal closure - lateral pharyngeal walls move

Medially

Pharyngeal closure - posterior pharyngeal wall movement

Moves anteriorly

What muscles are involved in velopharyngeal closure

Levator veli palatini

Superior pharyngeal constrictor

Muscular uvulae

Palatoglossus muscles

Tensor veli palatini

Levator veli palatini

A sling. Two sides come together. Main muscle for velar elevation

Superior pharyngeal constrictor

Medial displacement of lateral pharyngeal walls

Musculus uvulae

Contracts during phonation and creates bulge on velum which adds stiffness

Palatoglossus muscles

Depresses velum

Tensor veli palatini

Opens the Eustachian tube for middle ear drainage, contributes little or nothing with velopharyngeal closure

Lips and alveolus embryological development

6-7 weeks of gestation, starts at incisive foramen

Hard palate embryological development

8-9 weeks of gestation

Velum and uvula embryological development

12 weeks gestation

Cleft lip w or w out palate African population

Approx. 1 in 2200

Cleft lip w or w out palate Caucasian

Approx. 1 in 1200

Cleft lip w or w out palate Asians

Approx. 1 in 800

Cleft lip w or w out palate Native Americans

Approx. 1 in 300

CPO incidence of clefting

Approx. same occurrence across all racial groups

Which is more common left or right cleft lip

Left

Which is more frequently occurring unilateral or bilateral cleft

Unilateral

Most cases of cleft lip are ___, that is with no associated syndromes or other birth defects.

Isolated

___ explains 20-50% of clefts

Genetics

External agents of cleft

Smoking, alcohol, too much vitamin A, drugs (Valium), retinoic acid (acne)

__ __ can indicate a submucous cleft

Bifid uvula

Submucous cleft palate is a congenital defect which means it

Happens at birth

Submucos cleft involved the muscles of

Of the velum and bony surfaces of hard palate

Diagnosis of submucous cleft (one or more of these)

Bifid uvula, zona pellucida (blue area in hard palate, notch in posterior border of hard palate

Bifid uvula may (4 characteristics)

May be split down middle w two pendulous structures

May appear as one structure with line down the center

May have simple indentation at posterior border

Uvula may appear small and underdeveloped-hypoplastic

Zona pellucida blue area

Bluish coloring caused by thin mucosa w lack of normal underlying muscle mass

Zona pellucida inverted V

Velum may appear to be an inverted V, especially during phonation. V shape due to abnormal insertion of Levator palatini muscle in the posterior section of hard palate, rather than middle of velum.

Notch in posterior border of hard palate

Can indicate submucous cleft.

Occult submucous cleft is only apparent by

Viewing nasal surface of velum through nasopharyngoscopy

Occult submucous cleft is only pursued if patient has

Velophyangeal insufficiency or hypernasality and no cleft can be observed by oral and tactile examination

Effect of submucous cleft on function

Possible velopharyngeal dysfunction

Possible resulting speech problems

Possible nasal regurgitation when swallowing especially during first year

Increased risk for middle ear infections due to abnormal insertion of tensor veli palatini muscle, which can cause Eustachian tube dysfunction

When to treat submucous cleft

Speech and feeding affected

Why is feeding difficult for a baby with cleft lip

Compromised lip seal

Able to breastfeed and bottle feed w assistance

Why is feeding difficult for a baby with cleft palate

Difficulty creating suction/pressure needed to express milk

Breastfeeding is very difficult

Modifications are required for bottle feeding

Feeding issues related to cleft palate

Poor intake

Nasal regurgitation

Excessive air intake

Disruption in bonding between caretaker and infant

What are 2 feeding guidelines help for a baby with cleft palate

Modify nipple

Modify bottle

What is a feeding obturator

Acrylic plate which fits over the hard palate, providing a seal between nasal/oral cavity

Some disadvantages of feeding obturator

Hard to place since infant has no teeth

Irritation of oral tissue

Expensive

Hygiene

Why is cup drinking important for an infant with CP up to 10 months of age

After surgery, for healing, the pressure of drinking through a bottle could cause the sewn up part to open again

Methods of severe cases of CP

Nasogastric tube

Orogastric tube

Gastrostomy tube

Prior to 6 months, where are vocalizations produced

Pharynx and glottis

What differences are observed by 6 months for early vocal development for typical kids

Begin to produce anterior labial and alveolar consonants

Glottal stop production reduced

Speech production for infants with CP

Alveolar sounds not observed

Produce fewer total consonants

Glottal production persists

Nasals, glides, liquids may be produced easily

3 indicators of velopharyngeal dysfunction

Anatomical or structural defects that affect velopharygneal closure

Neuro motor or physical disorder

Inappropriate articulation patterns

What types of anatomical/structural defects can indicate velopharyngeal dysfunction

History of CP or submuc cleft

Short velum

Types of neuromotor or physical disorders that may indicate velopharyngeal dysfunction

Poor movement of velum/muscles function (Levator veli palatini)

Dysarthria

Apraxia

Velopharyngeal dysfunction leads to 2 types of errors

Compensatory errors and obligatory errors

Compensatory errors

SLPs work w these continuous errors after CP gets fixed

Obligatory errors

SLPs cannot work w these errors due to the anatomical issue of CP. surgeon needs to be involved first

Nasal air emission

Air leaks through nasal cavity during high pressure sounds

Example of nasal emission instead of saying sun

Thun

Glottal stop + example

Produced in larynx

Substitutes stops and sometimes fricative & affricates

Daddy - ?a?y

Pharyngeal stop + example

Further back than k and g

Substitutes for k and g sound

Tongue base meets with posterior pharyngeal wall

Pharyngeal fricative + example

Substitutes mostly w fricatives and affricates

Sounds like x - sun - xun

Pharyngeal affricate

Combination of pharyngeal fricative and glottal stop

Substitutes for affricates ch and j

Nasal fricative

Substitution for fricatives or affricates

All nasal, sun- no s at all

Mid dorsum palatal stop

Produced in the approximate place for “y” sound(/j/)

Substituted for /t/ /k/ /d/ /g/

Dysphonia + characteristic

voice disorder which common cause is vocal nodules

Breathiness, hoarseness, low intensity

Why children with history of CP or VP dysfunction have increased risk for dysphonia

All substitution errors they make are at the vocal fold level which causes the VFs to constantly bump into each other and can lead to dysphonia