Anatomy of Articulation and Resonance

Vocal tract

nasal passages, oral cavity, larynx

What connects the nasal passages, oral cavity, larynx?

Pharynx

Articulation

process of joining or moving two elements together

Articulation for speech

process of bringing two or more structures together to form the sounds of speech, combinations of movements form differently shaped spaces in the vocal tract, phoneme quality is determined by the size and shape of those space

Mobile articulators

mandible (lower jaw including teeth), lips, tongue, velum, vocal folds 

Immobile articulators: maxillae (upper jaw including upper teeth), hard palate, alveolar ridge

Bones of the face

mandible, maxillae, nasal bones, palatine bones, vomer, zygomatic bone

Bones of the cranium

frontal, parietal, occipital, temporal, ethmoid, sphenoid

Mandible

considered unpaired.

important features: ramus, coronoid process, condylar process, mylohyoid line, mental symphysis, dental alveoli (alveolar process)

Maxillae

bones of upper jaw and parts of nose, palate, etc. Processes are named for the structures with which they articulate.

Identify: palatine process, incisive foramen, canine fossa, intermaxillary suture, premaxillary suture 

Nasal bones

bridge of your nose, make up superior anterior nasal surface (form upper margin of nasal cavity)

Palatine bones

posterior to maxillae, perpendicular/vertical plate (posterior wall of nasal cavity), horizontal plate (make up rest of pard palate posterior ¼ section of hard palate)

Vomer

inferior/posterior to nasal bone, makes up part of nasal septum

Zygomatic bone

forms the cheekbones, anterior portion attaches muscle that elevate the upper lip.

(Zygomatic arch: temporal process of zygomatic bone and zygomatic process of temporal bone)

Frontal bone

unpaired.

Coronal suture forms boundary with parietal bone.

Articulates with zygomatic bone at zygomatic process.

Parietal

paired.

Coronal suture forms boundary with frontal bone.

Sagittal suture joins left & right parietal bones.

Lambdoidal suture forms boundary with occipital bones.

Occipital

unpaired.

Forms the skull base.

Lambdoidal suture forms boundary with parietal bones.

Foramen magnum allows medulla/spinal cord to exit skull.

Condyles are the surfaces that articulate w/ atlas bone. 

Temporal

Squamous portion (lower margin includes EAM, zygomatic process)

Tympanic portion (includes anterior and inferior walls of EAM, styloid process)

Mastoid portion (posterior part of the bone, mastoid process)

Petrous portion (houses cochlea and semicircular canals, internal auditory meatus)

Ethmoid

[ethmos = strainer]

unpaired bone

Cosre of skull & face

Cribiform plate separates nasal cavities from brain

Has many processes (nasal conche, etc)

Perpendicular plate part of bony nasal septum

Sphenoid bone

unpaired bone.

Butterfly shaped [corpus, greater wings, lesser wings, pterygoid plates (fossa between medial & lateral house attachment points for muscles of mastication and tensor veli palatini)]

Temporomandibular Joints

synovial (mobile) joint, condyle of mandible fits into cavity in temporal bone separated by an articular disk, joint is surrounded by fibrous capsule and lubricated with synovial fluid

Oral cavity

lips to faucial pillars, floor of mouth to hard/soft palate

Faucial pillars

transition between oral cavity & pharynx, two sets: anterior & posterior, palatine tonsils between ant. & post.

(shadow monster)

Buccal cavity/sulci

space between teeth and cheeks

role in oral resonance

phoneme (ex: lateral fricative)

collects food in disordered feeding 

Nasal cavities/passages

formed by maxillae, palatine bones, nasal bones, vomer, perpendicular plate of ethmoid (nasal septum), ethmoid (roof of nasal cavity, and mucosa) 

Anterior, mid-portion, posterior 

Functions: filter/warm/humidify air, immune system, speech-related (necessary for nasal sounds, natural part of resonance in non-nasal) 

Anterior cavity (nasal)

nares

Mid-portion cavity (nasal)

nasal conchae aka turbinates

nasal meatus: passage between conchae

Posterior cavity (nasal)

nasal choanae connection to nasopharynx

Pharyngeal cavity (pharynx)

Vertical tube ~12 cm long (lower boundary = vocal folds) 

Shape altered: velopharyngeal muscles, pharyngeal constrictor muscles, muscles for laryngeal elevation and depression 

Includes nasopharynx, oropharynx, laryngopharynx 

Nasopharynx

from velum choanae, houses pharyngeal tonsils (adenoids)

Oropharynx

from hyoid to velum

laryngopharynx

from VFs to hyoid

Micrognathia

developmental condition of small mandible or retrognathia, not enough room for tongue on floor of mouth 

• may cause tongue to move up into the maxillary/palatine are during development resulting in cleft palate, even if not cleft it may still result in functional articulation problems 

Cleft lip cause/risk

premaxillary suture fails to fuse in utero (weeks 6-12), may or may not include alveolar process of the maxilla 

Cleft lip effect of articulation/swallowing

infant feeding (difficulty making seal around nipple of breast/bottle. articulation affected mildly compared to cleft palate, good outcomes with surgical repair, orthodontics, etc.

resonance not usually affected.

Maxillary deficiency/hypoplasia causes/risk

repaired cleft palate

fetal alcohol syndrome

Crouzon syndrome 

Maxillary deficiency/hypoplasia treatment

maxillary advancement surgery post-adolescent 

Bell’s Palsy define

facial paralysis (usually temporary) resulting from damage or trauma to the facial nerve (CN-VII) 

Bell’s Palsy cause/risk

unknown, possibly due to virus

Cleft lip with/without cleft palate: twice as many ____ as ____

twice as many males as females

Isolated cleft palate:

____ as common as lip

twice as many ____ as ____ 

half as common as lip

twice as many females as males 

CL +/- CP are more common in ____ than Black or Latino pop 

White

Cleft Palate cause/risk

no single cause.

Genetic factors (20% of cases).

Environmental in utero: smoking, maternal diabetes, medications while pregnant 

Cleft Palate Treatment

numerous surgeries, orthodontics 

Furlow's Palatoplasty:

"double–opposing z-plasty, used to lengthen tissue by borrowing tissues from width of velum to add length 

Pharyngeal Flap:

most common procedure used for VP insufficiency, effective for midline gaps, flap is raised from the posterior pharyngeal wall and sutured to velum 

Pharyngeal Wall Augmentation

filler is injected ton the VP opening (filler could be hydroxyapatite, cartilage, fascia, fat, silicone, and protoplast) 

Sphincter Pharyngoplasty

Narrowing the VP opening by rearranging myomucosal flaps raised from the posterior tonsillar pillars. Posterior pharyngeal walls are attached, Patient with poor PPW movement and smaller VP ports benefit more from this procedure 

Occlusion:

the process of bringing upper and lower teeth (maxillary and mandibular into alignment) 

Class 1 Occlusion

normal orientation of mandible and maxillae, 1^st molar of mandibular arch is one-half tooth advanced relative to 1^st maxillary motor, needed for mastication and articulation

Class 2 Malocclusion

relatively retracted mandible, first mandibular molars are RETRACTED at least one half tooth from first maxillary molars

Class 3 Malocclusion

relatively advanced mandible, first mandibular molars are ADVANCED more than one half tooth from first maxillary molars

Overbite:

How far your upper front teeth vertically overlap your lower front teeth when your jaw is closed

Overjet:

How far your upper front teeth horizontally protrude or stick out forward past your lower front teeth

Palatal lifts:

helps a weak or paralyzed soft palate move into proper position

Palatal Obturator:

closes and opening or gap in the palate

Speech Bulb:

Fills the space between the soft palate and the pharyngeal walls (used when soft palate too short)

Velopharyngeal Dysfunction (VPD):

general term for disorder of the VP valve that implies faulty VP closure 

Velopharyngeal Insufficiency (VPI):

abnormal structure.

Anatomical cause: Short palate, deep pharynx, post-adenoidectomy or pharyngeal tumor resection.

Treatment includes surgical reconstruction 

Velopharyngeal Incompetence (VPI):

abnormal function.

Physiological cause: Reduced movement of soft palate, pharyngeal hypotonia, velar paralysis or paresis.

Treatment includes surgery, prostheses, or speech therapy 

Resonance disorders:

opening, inconsistent movement, or obstruction that changes the way air flows through nasal and oral cavities during speech

Hypernasality:

 too much nasal resonance (ex: submucous cleft)

Hyponasality:

too little nasal resonance (ex: hypertrophic adenoids)

Cul-de-sac resonance:

sound "trapped" in one of the cavities (oral, nasal, pharyngeal)

How velopharyngeal dysfunction can affect oral pressure consonants and produce compensatory articulation patterns? 

Speech sounds requiring build-up of intraoral pressure most affected (stops, fricatives, affricates).

Place of articulation – all paces possible 

Hypernasality and/or nasal air emissions 

Replacement of oral consonants with 

• mid-palatal or glottal stops 

• pharyngeal or nasal fricatives

Sinuses:

air filled cavities lined with respiratory epithelial cells (mucosal membranes). Produce mucus, cleared through ciliary action.

Drains into nasal passages 

What are the four sinuses?

• Frontal 

• Maxillary (largest) 

• Ethmoid 

• Sphenoid

Function of Sinuses

• Mechanical protection/filter 

• Immune function 

• Humidify and warm inhaled air 

• Lighten skull wight 

• Provide a cushion against facial trauma 

• Enhance voice resonance

Eustachian tube:

connects nasopharynx with middle ear (courses slightly up from nasopharynx to ear, but more horizontal course in children) 

• Closed in relax state, can be opened with pharyngeal/velar muscles (tensor veli palatini)

Eustachian Tube Function:

aeration/air pressure equalization of middle ear 

Surface features of the lips and nose

• Columella 

• Philtrum 

• Philtril ridge 

• Cupid's bow

Orbicularis oris

• Function: brings corners of lips together, contributes to: lip rounding, constricts oral opening, protrusion of lips, press lips against teeth 

• Attachments: corners of lips 

• Course: around the lips 

• Nerve: CN VII (Fascial nerve)

Risorius

• Function: retracts lips at corners, supports feeding & smiling/grinning 

• Attachments: fascia of the masseter muscles, into corner of the moth and lower lip 

• Course: forward (post/ant) 

• Nerve: CN VII (Fascial nerve)

Buccinator

• Function: flattens cheek, assists in retraction of corners of mouth (keeps food on molars, helps constrict oropharynx) 

• Attachments: pterygomandibular ligament, corners of mouth (orbicularis oris) 

• Course: forward, deep to the risorius 

• Nerve: CN VII (Fascial nerve)

Muscles that elevate the upper lip:

levator labii (superioris and superioiris alaque nasi), Zygomatic minor, Zygomatic major, Levator anguli oris

Lavator labii (superioris and superioiris alaque nasi)

• Function: elevated upper lip 

• Attachments: Maxilla (superioris: infraorbital margin, superioiris alaque nasi: frontal process), mid-lateral region of upper lip 

• Course: down 

• Nerve: CN VII (Fascial nerve)

Zygomatic minor

• Function: elevates upper li 

• Attachments: facial surface of zygomatic bone, mid-lateral upper lip 

• Course: down and medial 

• Nerve: CN VII (Fascial nerve)

Zygomatic major

• Function: elevates and pulls bac (retracts) angles of mouth 

• Attachments: lateral to zygomatic minor, corner of lips 

• Course: down and medial 

• Nerve: CN VII (Fascial nerve) 

Levator anguli oris

• Function: draws corners of lips up and medial 

• Attachments: from canine fossa of maxilla to insert into corners of upper and lower lips 

• Course: deep to levator labii sup., down and lateral 

• Nerve: CN VII (Fascial nerve) 

Depressor labii inferioris

• Function: pulls lower lip down 

• Attachments: mandible at oblique, lower lip 

• Course: up into lower lip 

• Nerve: CN VII (Fascial nerve)