Cleft Palate + Craniofacial

Purpose of VP closure during speech

To produce all oral sounds

What happens to sound when there is a gap in VP closure?

Sounds become hypernasal

What nasal sounds occur when the VP port is open?

/n/, /m/, + /ƞ/

5 causes of clefts

• Chromosomal disorders

• Genetics disorders

• Drugs

• Viruses

• Teratogens

• Nutritional deficiencies, or maternal obestity

• Mechanical interference

Age in embryologic development that the lip + palate fuse

• Lip closures → around 7 weeks of gestation

• Palate fusion → around 9 weeks of gestation

Complete cleft

Cleft extends into the nasal cavity or the entirety of the primary + secondary palate

5 problems that can occur due to cleft palate

• Velopharyngeal insufficiency (speech + resonance affected)

• Feeding problems + nasal regurgitation

• Eustachian tube malfunctions

• Hypernasality + Nasal emissions

• Glottal stops

Glottal stop

A consonant formed by the audible release of the airstream after complete closure of the glottis (vocal chords)

Pierre Robin Sequence

• Micrognathia = underdeveloped mandible

• Retracted + elevated tongue into the pharyngeal airway

• Cleft of the hard + soft palate

• Heart problems

• Digital anomalies

• Conductive hearing loss

• Developmental delays

• Severely delayed language

Treacher Collins Syndrome

• Underdeveloped cheekbones

• Underdeveloped mandible

• Malformation of external ear + ear canal

• Conductive hearing loss

• Cleft palate

• Projection of scalp onto the cheek

• Normal intellectual + language development

Velocardiofacial Syndrome

• Small stature

• Broad, flattened nose + underdeveloped cheekbones

• Heart problems

• Delayed onset of expressive language + persistent language difficulties

• Cognitive behavior is concrete sometimes with preservative behaviors

• May not be detected until later in life

Apert Syndrome

• Craniosynostosis = premature closing of skull structures with forehead disfigurement

• Syndactyly + webbing of fingers + toes with bone fusion

• High, narrow palate; cleft only 30% of the time

• Conductive hearing loss

• Expressive language development typically delayed

• Intellectual disability

Velopharyngeal insufficency

Anatomical (structural) defects -not enough tissure

Velopharyngeal incompetence

Neurophysiological (movement) disorder- not enough movement

Hypernasality

Abnormal nasal resonance during the production of oral sounds

Common speech production errors that occur due to hypernasality

Vowels, fricatives, affricates, stops, plosives

Obligatory errors

Occur when structure is insufficient to support accurate articulation

Can only be eliminated by correcting structure

Compensatory errors

Occur when articulation placement is altered in an effort to maintain normal manner, due to abnormal structure

The client acquires them as a means of compensatory strategies to make up for the fact that their anatomy does not allow them to produce a sound correctly

Velopharyngeal mislearning

Learned misarticulations that cause nasal emissions + sometimes hyper nasality despite normalized/ repaired velopharyngeal structure

6 things that are assessed during a clinical exam

• Case history + interview

• Oral-motor exame

• Clinical observation + perceptual judgements

• Instrumental assessment

  • Articulation assessments

  • Nasometry

What method allows for measurement of the acoustics of speech?

What methods allow for observation of the structures?

3 main treatments for cleft + VPI

• Surgery

• Prosthetics

• Speech therapy

Ages that lip + palate are typically repaired

• Lip = 3 months

• Palate = 10 months

Palatal obturator

A removable device that covers an open palatal defect

Used for treatment of a symptomatic fistula or open cleft

Speech bulb

A removable device that fills in velopharyngeal space

Used for treatment of velopharyngeal insufficiency

Why would a child wear nose plugs during therapy or at home?

If the child is hypernasal, they can use the plugs to stop the air from coming out of their nose to stop the nasal air emission

The goals of therapy

Correct speech sound placement + production

Movements of the velum, posterior pharyngeal wall, + lateral pharyngeal walls during VP closure

The lateral + posterior pharyngeal wall squeeze + contract to make the VP port smaller, + the velum to rise up

Incomplete cleft

Cleft does not extend into nasal cavity or only affects the hard + soft palate, not the alveolar ridge

Nasometry

• Method allows for measurement of the acoustics of speech

• Individuals score is compared with normative data from standardized passages

• (wear over their nose)

Videofluroscopy

• Methods that allow for observation of the structure

• Radiological technique used to obtain real-time moving images of internal structures

Nasopharyngoscopy

• Methods that allow for observations of the structures

• Minimally invasive procedure that allows direct visual observation + analysis of the velopharyngeal mechanism during speech