Myofunctional

Cleft Lip and Palate, Craniofacial Anomalies, Genetic Syndromes

What are **microforms**?

Minimal expressions of clefts, including a hairline indentation of the lip or just a notch on the lip.

What is a **submucous** cleft?

The surface tissue of the soft and hard palate fuses but the underlying muscle or bone does not.

Explain a submucous cleft of the **soft palate**:

There is a midline deficiency or lack of muscular tissue, as well as incorrect positioning of the muscle. A bifid uvula may also be present.

Explain a submucous cleft of the **hard palate**:

There is a bony defect in the midline or center of the bony palate.

Explain **Velopharyngeal Insufficiency**:

An **anatomy** problem (Velum is too short, or pharynx is too deep/wide).

Palate is not sufficient to receive closure.

Cannot fix this with speech therapy so **requires surgery** or a prosthetic.

Explain **Velopharyngeal Incompetence**:

A **physiology** problem.

Problem with the function of the palate or constriction of the lateral walls.

Could be from a variety of reasons (Neurological, fatigue, mislearning, etc.).

What is the most common **cause** of hearing loss in children with CL/P?

Otitis Media

True or False: Eustachian tube dysfunction is present in the pediatric CL/P population.

True

What types of speech sound difficulties do children with CL/P have?

Difficulty with unvoiced sounds, pressure consonants, sibilants (/s/, /z/), high pressure stops (/b/, /p/), and fricatives (/f/, /v/).

Children with CL/P have specific difficulty with these classes if velopharyngeal closure is inadequate.

Affricates, fricatives, and plosives.

What is the surgical technique of a **cleft** **lip** repair called?

Millard Repair/Millard Rotation Advancement Repair

Describe the **Von Langenbeck** technique for a cleft palate repair:

Used almost 60% of the time.

The levator muscle is not typically addressed.

High incidence of VP insufficiency.

Describe the **V-Y Pushback** (Wardill-Kilner) technique for a cleft palate repair:

Similar initial incisions to the Von Langenbeck technique, but results in an open area that is Y shaped.

Pushes tissue back to elongate the palate.

The levator muscle is not addressed.

High incidence of anterior fistulas.

Describe the **Furlow Z-Palatoplasty** technique for a cleft palate repair:

Gold standard.

Used to lengthen the tissue.

Involves reconstruction of the levator sling.

10-20% of VPI.

May be used as a secondary technique to redo the palate when the original repair used a different approach.

Describe the **Pharyngeal Flap** technique for VPI repair:

Most commonly used procedure for correction of VPI.