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What part of ear can be effected from a cleft palate?
Tympanic membrane (syndrome increases 40-60%)
External ear parts
Pinna
External auditory canal
Middle ear parts
Tympanic membrane
Ossicles
Eustachian tube
Inner ear parts
Cochlea
Semicircular canals
Children with fetal alcohol syndrome sometimes have a flat…
Philitrum
Aperture means
Opening
Nasal septum
Quadrangle septal cartilage
Perpendicular plate of the ethmoid
Vomer
Perpendicular structure that fits in median palatine suture groove (tongue in groove)
Upper lip parts
Philitrum
Philtral ridges/columns
Cupid’s Bow
White roll
Vermilion
Tubercle
Vermilion
Colored parts of lips
White roll
Around the lips where you would put lip liner
Orbicularis
The muscle that surrounds the mouth
during a cleft palate surgery, the upper fibers are affected and muscles need to go back there
Hard palate
Separates the nasal cavity and oral cavity
Serves as roof of mouth and floor of nose
Hard palate: Palatal vault
Dome on upper part of oral cavity
Hard palate: Alveolar ridge (alveolus)
Provides bony support for teeth and a place for articulation of lingual-alveolar sounds
Hard palate: mucoperiosteum
Part of mucus membrane
Thin tissue that covers the hard palate and consists of mucous membrane and periosteum
Mucous membrane
lining of stratified squamous epithelium and laminate propria
Periosteum
Thick, fibrous tissue that covers bone
Hard palate: rugae
Ridges that run horizontally in the front part of the palate
Hard palate: incisive papilla
Projection of mucosa at area of incisive foramen (just behind central incisors)
Hard palate: palatine (median) raphe:
Line from incisive foramen to uvula
Hard palate: Foramen
Hold or opening in a bony structure to allow blood vessels and nerves to pass through to the mucosa
Incisive foramen
In the area of alveolar ridge, just behind the central incisors
The starting point of embryological development
Hard palate: premaxilla
Triangular-shaped bone
Bordered by the two incisive sutures and the incisive foramen
Contain all four maxillary incisors (central and lateral)
Palatine process of maxilla
Forms anterior 3/4th of the maxilla
Two plates separated by median (intermaxillary palatine suture)
Nasal aspect of palatine suture forms groove for lower portion of vomer (nasal septum)
Hard palate: horizontal plates of the palatine bones
Posterior portion of the hard palate
Bordered by the transverse palatine suture lines
Meet in midline at the median palatine suture
Ends with the posterior nasal spine (bony projection)
Hard palate: torus palatinus (palatine torus)
Normal variation
Seen in some Caucasians of Northern European descent
Prominent longitudinal ridge on oral surface along intermaxillary suture line normal variation and usually not the cause of a problem
Hard palate: sphenoid and temporal bones
Medial and lateral pterygoid plates
Pterygoid hamulus
Both provide bony attachment for velopharyngeal musculature
Medial and lateral pterygoid plates
Part of pterygoid process of sphenoid bone
On far end of palate
Pterygoid hamulus
Inferior end of pterygoid plate
Soft palate: velum
Consists of muscles and mucosa (no bone)
Attaches to hard palate
Median palatine raphe continues to uvula
Uvula attaches to the posterior border
Surface cant be seen through nasopharyngoscopy
Soft palate: velum: palatine (velar) aponeurosis
Consists of fibrous, connective tissue
Is an anchoring point for velar muscles
Provides stiffness
Uvula
Teardrop-shaped pendulum
Consists of mucosa, glandular, and adipose tissue
Very vascular (it would bleed a lot)
Has no known function
Pharyngeal structures
Pharynx, adenoid pad, Eustachian tube
Pharynx (throat) parts
Posterior pharyngeal wall
Eustachian tube
Tonsils
Epiglottis
Different types of Tonsils
Adenoid (pharyngeal tonsil)
Tonsils (palatine tonsils)
Lingual tonsil (at the base of tongue)
Epiglottis
Prevents aspiration by covering trachea opening
Sections of pharynx
Nasopharynx: above the velum
Oropharynx: below the velum
Hypopharynx: below the base of the tongue
Posterior pharyngeal wall
Adenoid pad
Mass of lymphoid tissue
Located on posterior pharyngeal wall, just behind the velum
More prominent in children than adults (shrinks around age 8)
Children have velo-adenoidal closure
Eustachian tube
Connects the middle ear with the pharynx
At horizontal angle in children around age 6
At a 45 degree angle in adults
Pharyngeal opening is lateral and slightly above velum
Structures near eustachian tube
Torus tubarius: ridge located posterior to Eustachian tube
Salpingopharyngeal folds: originate from torus tubarius and course down to the lateral pharyngeal wall
Anatomical position
Face forward, palms out
Prone
Lying face downward
Supine
Lying face upward
Anterior
Front (toward)
Posterior
Back (toward)
Superior
Towards the head of the body
Inferior
Away from the head
Lateral
toward the side (or away from the axis of symmetry)
o Divides into two parts
Medial
Towards middle of body
Proximal
Closer to torso
Distal
Farther from torso
Bilateral
Equal/effecting both sides of the body
Ipsilateral
on the same side as…(referent)
Contralateral
on the opposite side of the body as…(referent)
Ventral
Toward bottom of brain
Along/toward the belly surface of body
Dorsal
Toward top of brain
Along/toward the vertebral surface of body
Abduction
Away from midline
Adduction
Towards midline
Lingual
Branch of the mandibular nerve (line underneath tongue)
Labial
Junction of upper and lower lips lateral to mouth angle (V shaped thing on top and bottom of gums)
Superior means the same thing as
Dorsal
Inferior means the same thing as
Ventral
Dorsal means the same thing as ___ when referring to the brain
Superior
Structures of the velopharyngeal valve
Velum, lateral pharyngeal walls, posterior pharyngeal walls
Movement of the velopharyngeal valve
Open during nasal breathing for air to go in nasal cavity
Closes like a sphincter during speech
regulates and directs the transmission of sound energy and airflow into the oral and nasal cavities
Velum during nasal breathing
Rests against the back of the tongue
Results in a patent (open) pharyngeal airway for unobstructed movement of air between nasal cavity and lungs
Velar movement
Moves in a superior and posterior direction
up and back
Has a type of “knee” action
Moves toward posterior pharyngeal wall
Velar dimple
Velar dimple
Point on the oral surface where the levator veil palatini muscles interdigitate; is visible during phonation
Lateral pharyngeal wall movement
Moves medically (middle)
Usually close against the velum
Sometimes close in midline behind the velum
Both walls move during closure
Often dont move the same
Lateral walls appear to bow outward during speech
Posterior pharyngeal wall movement
Moves anteriorly toward the velum
toward the front a little
Has a very little role
Passavant’s ridge: bulge of muscle on PPW during speech; occurs in some normal and abnormal speakers
helps with closure; disappears during nasal breathing
Often on people with clefts
Velopharyngeal function
Requires coordinated movement of the following structures:
velum
LPW
PPW
If ones not working, then wont properly close
Closes like a sphincter
Separates the nasal cavity from the oral cavity
Regulates and directs transmission of sound energy and airflow into the oral and nasal cavities
Particularly important for production of “pressure-sensitive” consonant sounds (plosives, fricatives, and affricates) and all vowels
Levator veli palatini muscle (velar “sling”)
Velum closes against PPW
Elevates velum during VP closure @ 45 degree angle
Superior constrictor muscle (pharyngeal ring)
Constriction of LPW around velum VP closure
Palatoglossus muscle (anterior faucial pillar)
Depressing velum causing VP opening for nasal sounds
Musculus uvulae muscle (bulge on nasal surface)
Provides bulk on nasal surface of velum during VP closure
Tensor veli palatini muscle (for Eustachian tube function)
Open Eustachian tube to enhance middle ear aeration and drainage during swallowing
Pharyngeal plexus
A network of nerves that lies along the posterior wall of the pharynx and consists of the pharyngeal branches of the glossopharyngeal nerve (CN IX) and vagus nerve (CN X)
VP closure: Coronal pattern
Velum and PPW
VP closure: Sagittal pattern
LPWs move medically
Least common
VP closure: circular pattern
All structures move
Sometimes includes Passavant’s ridge
Nonpneumatic activites
Activities done without airflow
Velum closed high in the pharynx and LPWs close tightly along their length
necessary to allow substances to pass through oral cavity without nasal regurgitation
Swallowing, gagging, vomiting
Pneumatic activities
Activities that utilize airflow and air pressure as a result of VP closure
positive pressure: whistling, blowing, speech
Air coming out
Negative pressure: sucking, kissing
Air coming in
Timing of closure
Valve closes before phonation begins or sound will be hyper nasal
can’t build up any pressure, air will come out nose
Closure is maintained until a nasal consonant or the utterance is ended
Height of closure
Closure tends to be higher and tighter with high vowels and high-pressure consonants, especially voiceless consonants
Closure can be effected by rate and fatigue (ALS, MS)
VL consonants have more pressure than voiced
vocal folds have to vibrate and takes off pressure
Firmness of closure
Gap of 5 mm (20 mm2) is the threshold for hypernasality (5 pencil tips) (will hear it here)
Even very small gaps cause audible nasal air emission
Rate and fatigue
Velar movement, height, and firmness of closure can decrease with rapid rate and muscular fatigue
can cause increase in the perception of hypernasality
Tired children are “whiny” which is just nasal, since their rate of closure is slower
Changes with growth and age
Velum increases in thickness and length: “Velar stretch”
Maturation results in an increase in oral-motor coordination
Facial skeleton, including hard and soft palate, moves down and forward as we grow
Posterior pharyngeal wall changes in inclination and bends forward. More efficient closure
Closure changes from just below the velar eminence to on top of the velar eminence.
Gradual involution of adenoid tissue occurs, particularly around puberty
Subsystems of speech
Respiration: pharyngeal dysfunction can cause an alteration of respiration during speech because the loss of airflow through the nose causes the individual to take more frequent breaths to replenish the air
Phonation: may be altered if the individual compensates for inadequate oral airflow for VL sounds by substituting pronated sounds
prosody (stress and intonation)
VP function
resonance
Articulation
When saying “ah” phonation stops
When you run out of air
Reparation procedure
Air pressure is required to initiate and sustain phonation
Vocal folds close
Subglottic air pressure builds
Vocal folds break open and begin to vibrate
Pressure is released
Respiration
Breathing for vegetative purposes is different then for speech
Inspiration and expiration are controlled based on utterance length and phrasing (take in as much air is required for the utterance)
There is a need to control breathing and phrasing
Need to maintain breath support for phonation and sound production throughout the utterance
Provides airflow, which converts to intraoral air pressure for articulation
Is important for pressure-sensitive sounds
Most intraoral air pressure
Voiceless consonants
High-pressure sounds
Plosives (p, b, t, d, k, g)
Fricatives (f, v, s, z, ʃ, Θ, ð)
Affricates (ʧ, ʤ)
Low pressure sounds
Liquids (l, r)
Glides (w, j)
No pressure sounds
Nasals (n, m, ŋ)
Phonation
Vibration of the vocal folds produces sound for speech
Needed for all vowels and some consonants
Must be able to start and stop phonation quickly throughout an utterance
“A cup” start-stop-start-stop
Oral sound VP function
Velopharyngeal valve is closed.
This allows acoustic energy and airflow to enter oral cavity.
It is important for the production of most consonant sounds (particularly plosives, fricatives, affricates) and all vowels.
Nasal sound VP function
Velopharyngeal valve is open.
This allows most of the sound energy to enter the nasal cavity
It is important for nasal sounds (m, n, ŋ).
Articulation: vowels
Produced by altering oral resonance
Formant frequencies affected by:
Position of tongue, jaw, and lips
Size and shape of oral cavity
Acoustics and vowel perception affected by formant frequencies
Note 
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