Chapter 5 - Facial, Oral, and Pharyngeal Abnormalities

Atresia

closure of a normal opening

Aural atresia

closure of the auditory canal

Microtia

small auricle

Treatment for issues in external and middle ear include

surgery

bone conduction hearing aids

During _____________, the tensor veli palatini muscle contracts to open the Eustachian tube.

Swallowing and yawning

Purpose of opening the Eustachian tube

Provides ventilation for middle ear

Equalizes middle ear pressure with environment

Allows fluids to drain

acute otitis media is usually caused by

lack of drainage of fluid, causing growth in bacteria

Middle ear effusion can cause

conductive hearing loss

speech and language delay

Otitis media can lead to

mastoiditis

sensorineural hearing loss

treatment for chronic otitis media

Antibiotics

Myringotomy (small incision) and placement of PE (pressure equalizing) ventilation tubes in tympanic membranes

treatment for malformations of the inner ear

hearing aids

cochlear implants

Anterior obstruction of the nasal cavity causes ______ whereas posterior obstruction of the nasal cavity causes _______________

nasal cul-de-sac resonance

hyponasality

Maxillary retrusion causes ________ due to _________

hyponasality

shallow phaynx

short upper lip can

Affect production of bilabial sounds (p, b, m)

Result in labiodental placement as a substitute

stomia

mouth

Microstomia

Can have a slight affect on articulation

May cause oral cul-de-sac resonance, with muffled, low volume sound

frenum

a narrow fold of mucous membrane connecting a moveable part to a fixed part

Lingual frenulum

Frenulum under the tongue, stabilizes tongue movement

Ankyloglossia

A congenital condition where the lingual frenulum is either abnormally short or has an anterior attachment near the tip of the tongue; commonly known as “tongue tie”

Functional characteristics of Ankyloglossia

With mouth open, patient cannot touch roof of mouth with tongue tip.

Patient can’t protrude the tongue tip past the edge of the mandibular incisors (or the lower gingiva).

With protrusion attempts, tongue is indented in midline. (Looks heart-shaped at the tip.)

Ankyloglossia functional concerns

Feeding

Dentition

Speech

Cosmetic concerns

Social function

Ankoglossia is likely or unlikely to cause speech problems?

unlikely

Complications of frenulectomy

Scarring that causes further restriction

Destabilization of the tongue: Patient may complain that the tongue feels loose

frenulectomy may be warranted for

early feeding, bolus manipulation, dental, cosmetic, or social concerns.

fistula

an abnormal opening in an anatomical structure

Palatal (oronasal) fistula

Abnormal opening in the palate

Causes of palatal fistula

A breakdown of surgical repair

Stress on the overlying mucosa due to maxillary expansion or growth

Palatal fistula effects

speech, nasal regurgitation

anterior/big are more symptomatic than posterior/small

Palatal-dorsal stop

compensatory production associated with palatal fistulas where the tongue closes the opening

Waldeyer’s Ring

Consists of a complex of lymphoid tissue that encircles the pharynx

Tonsils (palatine tonsils)

Adenoids (pharyngeal tonsils)

Lingual tonsil

Plays a role in the mucosal immune system

Tonsillar Hypertrophy

Prominent in prepubescent children

Usually atrophy around puberty

Tonsil and adenoid hypertrophy (abnormal enlargement) common in young children

Tonsillar Hypertrophy can cause

Pharyngeal cul-de-sac resonance

Nasal emission, if a tonsil intrudes into the pharynx, thus limiting lateral wall motion or interfering with VP closure

Anterior tongue position and fronting of velars (k, g, ŋ)

Difficulty swallowing a bolus

Nasal and/or oral airway obstruction

Obstructive sleep apnea (OSA)

Adenoid Hypertrophy can cause

Hyponasality

Nasal emission/rustle if irregular, thus affecting the VP seal

Middle ear effusion and conductive hearing loss if it obstructs the Eustachian tube opening

Skeletal malocclusion, if the jaw is always open for oral breathing

Nasal airway obstruction

Obstructive sleep apnea (OSA)

Lingual Tonsil Hypertrophy

Rarely occurs, except in Down syndrome

Can cause pharyngeal cul-de-sac resonance

Laryngeal abnormalities

Congenital laryngeal anomalies:

Laryngomalacia

Laryngeal web

Laryngoesophageal cleft

Vocal fold paralysis

Acquired:

vocal nodules

Treatment of upper airway obstruction / OSA

Tonsillectomy and/or adenoidectomy

Tracheostomy

Uvulopalatopharyngoplasty (UPPP) (U Triple P)

Continuous positive airway pressure (CPAP)

Tonsillectomy

Has no negative effect on speech or resonance, except in very rare circumstances

May improve speech production (production of velars)

May eliminate oral cul-de-sac resonance

Adenoidectomy

Should eliminate hyponasality

May cause VPI due to the increase in nasopharyngeal space

Risk greatest with history of cleft palate or submucous cleft

CPAP (Continuous Positive Airway Pressure)

Prevents pharyngeal collapse while sleeping