Cleft Palate Exam

feeding, speech, dentition, facial profile, aesthetics

the goals of cleft surgery include

primary surgery

surgery to close the cleft

secondary surgery

surgery to improve the function and appearance

location, size, experience of the surgeon, type of procedure, coordination of team members

the success of a surgery depends on what factors

at least 10 weeks old, at least 10 lbs, and a hemoglobin of 10gm/dL

what is the rule of 10s

cleft lip surgery

what surgery follows the rule of 10s

10-12 weeks

repair of a cleft lip typically occurs around

millar repair and Tennyson-randall repair

list two names for cleft lip repair techniques

palatoplasty

what is another name for a cleft palate repair

speech development, cleft anatomy, growth disturbances

what are some factors to consider in the timing of cleft palate repair

6-15 months

when does an early cleft palate repair take place

15-24 months

when does a late cleft palate repair take place

cleft palate repair

which is more complicated, cleft palate repair surgery or a cleft lip repair surgery

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

name some types of cleft palate repair

absolutely no sucking

what is biggest “no” regarding feeding post-surgery

adaptive bottles/spoons

what are some tools that can be used by parents to feed their children post cleft repair surgery

no foods with sharp edges, chewy foods, sticky foods, soup, nuts

what are some foods that are not allowed to be eater post-surgery

pharyngoplasty

surgical procedure of the pharynx designed to correct VPI

scarring from a palatoplasty shortened the velum and reducing closure

why may someone need a pharyngoplasty due to an anatomical problem

the velum has adequate length but poor mobility leading lack of closure

why may someone need a pharyngoplasty due to a neurological problem

3 years old

around what age does a pharyngoplasty take place

pharyngeal augmentation, pharyngeal flap, sphincter pharyngoplasty

list two common VPI repair techniques

hyponasality, snoring, sleep apnea

what are some potential complications of a phayngoplasty

orthognathic surgery

surgery of upper or lower jaw

dental appliances, facial prostheses, feeding obturators, speech bulb obturators, feeding obturator, palatal lift

Name some types of prosthetics

palatal lift

removable device that elevates the velum and holds it in place against the posterior pharyngeal wall for speech

feeding obturator

prosthetic appliance that can be used to assist in feeding

stimulability, greatest impact on intelligibility, work on anterior sounds before posterior sounds

what are some things to remember when working in speech therapy for cleft palate rehabilitation

oral-motor exercise and non speech exercises

what are two types of exercise to avoid during speech therapy

growth and development

the main concerns with infant feeding are

nutritive

sucking that is for feeding

non nutritive

sucking that is not for feeding but instead for social regulation and emotional development

rooting reflex

tactile stimulation to the mouth leads to this which aids in search for the nipple

jaws, cheeks, tongue, lips

sucking requires active use of these parts

positive pressure

as the tongue elevates and squeezes the nipple against the alveolar ridge and creates this

negative pressure

as the tongue moves back the jaw drops and the oral cavity enlarges this results in _ which leads to milk being expelled into the mouth

aspiration

the coordination of the suck-swallow-breathe synchrony prevents

1-4 sucks to 1 swallow to 1 breath

what is the ratio for the suck to swallow to breath ratio

poor oral suction, nasal regurgitation, coughing/choking, lengthy feeding times

what are some feeding issues structural issues may lead to

cleft lip

cleft _ has little to no impact on feeding

negative pressure cannot be created. milk escapes into the nasal cavity, feeding times are longer

what are some feeding difficulties due to cleft palate