Treatment of Cleft palate

What is the surgical goal?

To improve:
-Feeding
-Speech
-Dentition
-Facial profile
-Aesthetics

What are the types of surgeries?

-primary surgery
-secondary surgery

What is the primary surgery?

close the cleft

What is the secondary surgery?

improve function + appearance

What does surgical success depend on?

-Location
-Size
-Type of procedure
-Experience of surgeon
-Coordination of team members

What rule to you use in the timing of cleft lip repair?

-rules of 10s
-at least 10 weeks
-at least 10 pounds
-hemoglobin of 10gm/dL

When are lip repairs usually done?

10-12 weeks

What are types of cleft lip repair techniques?

-Millard repair
-tennison-randall repair

How you determine which cleft lip repair do you do?

-Severity
-Size
-Location
-Surgical preference

What is a cleft palate repair also called?

palatoplasty

What are factors you have to consider with a cleft palate repair?

-speech development
-cleft anatomy
-growth disturbances

What is considered an early cleft palate repair?

6-15 months

What is considered an late cleft palate repair?

15-24 months

Must evaluate ________ ______ and time their surgery appropriately

speech development

Cleft palate surgery itself is much more ____________ than lip repair

complicated

What are some cleft palate repair techniques?

-von langenbeck repair
-wardill-kilner repair
-furlow z-palatoplasty

Furlow Z -palatoplasty is done a lot when the _______ _________ is also involved

primary palate

Immediately following surgery can the infant suck?

ABSOLUTELY no sucking

__________ ________/__________ provided until cleared by the surgeon

Adaptive bottles/spoons

only clear liquids for _________ following surgery

4 hours

How do you feed the baby post-surgery?

Tip the bottle toward side of cheek and pour

Should you practice no suction feeding before surgery?

yes

What is important with spoon feeding after surgery?

-flat spoon
-allows puree to slide off spoon into baby's mouth

What are some dietary restrictions for feeding post-surgery?

-No foods with sharp edges
-No chewy foods
-No sticky foods
-No soup
-No nuts

What is the secondary surgery for VPIns and VPInc?

Pharyngoplasty

What is pharyngoplasty?

surgical procedure of the pharynx designed to correct VPI

What are some anatomical problems that the pharyngoplasty might address?

-scarring from palatoplasty shortens velum and reduces closure
-adenoid pad shrinks as child gets older

What are some Neuro problems that the pharyngoplasty might address?

velum has adequate length but poor mobility

When does the secondary surgery usually occur?

-age 3

You need to wait to do anything with their resonance until what?

child can produce connected speech

Why do you need to wait until the child can produce connected speech?

-because you don't know what's wrong yet so how could you fit it
-you don't know if any difference they have will cause an issue

You should try to intervene as early as possible, so the child doesn't develop __________ _________

compensatory behaviors

What are some VPI repair techniques?

-furlow Z-palatoplasty
-pharyngeal augmentation
-sphincter pharyngoplasty
-pharyngeal flap

What is a potential complication for a secondary surgery?

pharyngeal edema

What can pharyngeal edema lead to?

-Hyponasality
-Snoring
-Sleep apnea

Is sleep apnea permanent post-surgery?

no, usually temporary but must be monitored

What is a surgery for craniofacial differences?

orthognathic surgery

What is an orthognathic surgery? give an example

-surgery of upper or lower jaw
-mandibular advancement

What can orthognathic surgery help?

-appearance
-articulation
-resonance

Are prosthetics often required due to improvement?

not often

When might a prosthetic be used?

surgery is not an option

Why might surgery not be an option?

-don't have insurance
-can't afford
-might not have assess
-medical fragile state

Prosthetics may be used on a __________ or more _______ basis

-temporary
-permanent

What are the types of prosthetics?

-Dental appliances
-Facial prostheses
-Feeding obturators

What are prosthetics specifically for speech?

-palatal lift
-feeding obturator
-speech bulb obturator

What is a palatal lift?

-Removable device
-that elevates the velum
-holds it in place against the posterior pharyngeal wall for speech

What is a feeding obturator?

Prosthetic appliance that can be used to assist in feeding

What is a speech bulb obturator?

-Removable device
-that fills the nasopharyngeal gap to close off nasal cavity from the oral cavity for speech

Are speech bulbs commonly used?

no

Who can speech bulb obturator be important for?

patients who have undergone radiation or sustained traumatic injury to the palate

prostheses will improve structures, but ________ ________is often needed to improve function

speech therapy

Is a surgery going to cure everything?

no

When do you refer to craniofacial team for further evaluation?

-when there is no progress
-if you are worried that a structure might be affected

What is the goal of speech therapy after surgery?

correct placement (and sometimes manner) of production

Does speech therapy that is done after a surgery use different technique than therapy with speech sound disorders?

They use similar techniques

With speech therapy what should you do first?

-determine the phonemes you want to target first
-stimulability
-greatest impact on intelligibility
-work on your anterior sounds before posterior

If someone is really struggling with achieving voiced oral sounds, what should you do?

use nasal and /or voiceless cognate

What should you establish first?

placement of production

Begin in ______ position of words, then determine if _______ or _______ position easier

-initial
-medial
-final

Is it important to repeat stuff?

YES, MOTOR LEARNING

Do you use oral motor exercises (Blowing, sucking, gagging) for children with a cleft?

NOOOO not effective

Children with cleft have a __________ _______, not a _________

-structural problem
-weakness

Do you do nonspeech exercises (whistling, swallowing, cheek puffing) for children with clefts?

NO