Ch. 8 Flashcards by stacy jones

Cleft palate and craniofacial anomalies can have an impact on the various functions.
Abnormalities of the ____, ____, and ____ particularly affect the ____ and ____ of ____

Cleft palate and craniofacial anomalies can have an impact on the various functions.
Abnormalities of the ear, nose, and throat particularly affect the quality and intelligibility of speech.

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Chapter 8Facial, Oral, and Pharyngeal Anomalies

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External Ear

____—_____ of a normal _____
____ (____) _____—closure of the _____ _____
_____—small _____
Treatment can include _____ and/or _____ _____ hearing aids.

Atresia—closure of a normal opening
Aural (auditory) atresia—closure of the auditory canal
Microtia—small auricle
Treatment can include surgery and/or bone conduction hearing aids.

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Middle Ear

_____ may be ____, _____, or _____.
_____ _____ may be absent or hypoplastic.
_____ _____ malformations cause ______ hearing loss.
Treatment can include surgery and/or bone conduction hearing aids.

Ossicles may be absent, hypoplastic, or ankylosed.
Tympanic membrane may be absent or hypoplastic.
Middle ear malformations cause conductive hearing loss.
Treatment can include surgery and/or bone conduction hearing aids.

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Eustachian Tube Function

At \_\_\_\_, Eustachian tube is \_\_\_\_.
During \_\_\_\_\_ (and \_\_\_\_), \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ muscle contracts to \_\_\_\_\_ Eustachian tube.
Opening of Eustachian tube:
Provides \_\_\_\_\_ for \_\_\_\_ ear
\_\_\_\_\_ middle ear \_\_\_\_\_ with environment
Allows \_\_\_\_ to drain

At rest, Eustachian tube is closed.
During swallowing (and yawning), tensor veli palatini muscle contracts to open Eustachian tube.
Opening of Eustachian tube:
Provides ventilation for middle ear
Equalizes middle ear pressure with environment
Allows fluids to drain

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Eustachian Tube Malfunction

Children under age ____ are predisposed to Eustachian tube malfunction, causing ____ ear ____ and ____ ____ ____.
Eustachian tubes lie in a ____ plane, which ____ drainage.
____ ____ ____ muscles are directed at an unfavorable angle for function.
Children with cleft palate or submucous cleft are at greater ____ due to abnormality of tensor muscles.

Children under age 6 are predisposed to Eustachian tube malfunction, causing middle ear effusion and acute otitis media.
Eustachian tubes lie in a horizontal plane, which impairs drainage.
Tensor veli palatini muscles are directed at an unfavorable angle for function.
Children with cleft palate or submucous cleft are at greater risk due to abnormality of tensor muscles.

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Eustachian Tube Malfunction CONT.

____ collect within the ____ ear (middle ear ____) due to the ____ pressure and cannot ____.
_____ can ascend tube and grow in fluid, leading to an ____ _____ (____ _____ ____).

Fluids collect within the middle ear (middle ear effusion) due to the negative pressure and cannot drain.
Bacteria can ascend tube and grow in fluid, leading to an ear infection (acute otitis media).

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Eustachian Tube Malfunction CONT.

Middle ear \_\_\_\_ can cause:
\_\_\_\_\_ hearing loss
\_\_\_\_ and \_\_\_\_\_ delay
Otitis media can cause serious potential complications,  including:
\_\_\_\_
\_\_\_\_\_ hearing loss due to \_\_\_\_

Middle ear effusion can cause:
Conductive hearing loss
Speech and language delay
Otitis media can cause serious potential complications,  including:
Mastoiditis
Sensorineural hearing loss due to toxins

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Treatment for Chronic Otitis Media

_____
_____ (small _____) and placement of ____ (____ ____) tubes in tympanic membranes
Often done prophylactically for children with history of ____, usually with lip repair at _____ months
____

Antibiotics
Myringotomy (small incision) and placement of PE (pressure equalizing) tubes in tympanic membranes
Often done prophylactically for children with history of CLP, usually with lip repair at 3 months
Adenoidectomy

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Inner Ear

____ can occur in the ____, _____ system, and _____ nerve, causing a _____ hearing loss.
Treatment includes:
_____ _____(s)
_____ _____(s)

Malformations can occur in the cochlea, vestibular system, and auditory nerve, causing a sensorineural hearing loss.
Treatment includes:
Hearing aid(s)
Cochlear implant(s)

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Audiologic Care

The American Cleft Palate-Craniofacial Association (ACPA) has specific recommendations for audiologic management for children born with cleft lip/palate or other craniofacial anomalies.
Patients should see an _____ and _____ periodically through adolescence.

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Facial Structures

_____
_____
_____ Nerve

Nose
Maxilla
Facial Nerve

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Nose

____ cavity compromised by _____ cleft deformities
_____ septum
Common with _____ cleft lip/palate
Deflects to the _____ side of the _____
_____ _____ _____
_____ _____ secondary to _____ repair
____ _____ or enlarged _____ blocking the _____

Nasal cavity compromised by midline cleft deformities
Deviated septum
Common with unilateral cleft lip/palate
Deflects to the cleft side of the nose
Pyriform aperture stenosis
Stenotic nares secondary to lip repair
Choanal atresia or enlarged adenoids blocking the choana

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Nose CONT.

_____ obstruction of the _____ cavity
Can be due to _____ _____, _____ _____ _____, or _____ _____
Causes nasal ____-____-_____ resonance

_____ obstruction of the ____ cavity
Can be due to _____ _____/_____ or enlarged _____
Causes _____

Anterior obstruction of the nasal cavity
Can be due to deviated septum, pyriform aperture stenosis, or stenotic nares
Causes nasal cul-de-sac resonance
Posterior obstruction of the nasal cavity
Can be due to choanal stenosis/atresia or enlarged adenoids
Causes hyponasality

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Maxilla

Can cause:
\_\_\_\_-\_\_\_\_\_ deficiency 
Anterior \_\_\_\_ with Class \_\_\_\_\_ malocclusion
\_\_\_\_\_ and \_\_\_\_\_ airway restriction
\_\_\_\_\_

Can cause:
Mid-face deficiency 
Anterior crossbite with Class III malocclusion
Pharyngeal and nasal airway restriction
Hyponasality

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Facial Nerve (VII)

_____ syndrome with _____ paralysis
Causes a “_____-_____” facies

Moebius syndrome with facial paralysis

Causes a “mask-like” facies

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Facial Nerve (VII) Paralysis

Facial nerve paralysis causes a lack of facial _____ and _____ movement.
It affects _____ and sometimes _____ sounds.
_____ movement is usually _____.
Individuals may learn to compensate by producing _____ sounds with the ____.

Facial nerve paralysis causes a lack of facial expression and lip movement.
It affects bilabial and sometimes labiodental sounds.
Tongue movement is usually unaffected.
Individuals may learn to compensate by producing labial sounds with the tongue.

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The Oral Cavity

____
____
____
____

Lips
Mouth
Tongue
Palate

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Upper Lip

____ lip may be ____ after cleft repair due to:
Basic ____ from the cleft lip
_____ effects of the ____ from the lip repair
Relative lip _____ due to protruding ____

Upper lip may be short after cleft repair due to:
Basic dysmorphology from the cleft lip
Contractile effects of the scar from the lip repair
Relative lip shortening due to protruding premaxilla

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Upper Lip

Short upper lip can…
Cause difficulty with ____ competence at rest
Affect production of _____ sounds (____,____,____)
Result in _____ placement as a substitute

Short upper lip can…
Cause difficulty with bilabial competence at rest
Affect production of bilabial sounds (p, b, m)
Result in labiodental placement as a substitute

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Mouth

____ (large)
____ (small)
____ (mouth)

Macro (large)
Micro (small)
Stomia (mouth)

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Macrostomia

Associated with facial clefts and syndromes, especially _____ _____, due to extension of _____ into _____
Usually does ____ affect speech

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Associated with facial clefts and syndromes, especially hemifacial microsomia, due to extension of mouth into cheek
Usually does not affect speech

Microstomia

Can have a slight affect on _____
May cause oral ____-_____-____ resonance, with _____, ____ volume sound

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Can have a slight affect on articulation

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

Tongue

____
_____
_____ tongue (thick chunks of tissue)
_____

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Macroglossia
Microglossia
Lobulated tongue
Ankyloglossia

Macroglossia Tongue is very _____ relative to the oral cavity size. Macroglossia is associated with _____ _____ and _____-_____ syndrome.

Tongue is very large relative to the oral cavity size. | Macroglossia is associated with Down’s syndrome and Beckwith-Wiedeman syndrome.

Macroglossia CONT. ``` Large tongue causes: _____ protrusion ______ obstruction _____-______ posture ______ open bite ______ ```

``` Large tongue causes: Lingual protrusion Airway obstruction Open-mouth posture Anterior open bite Drooling ```

Macroglossia CONT. Effects on speech It interferes with _____ _____ sounds (_____-_____ and _____). _____-______ production is common. It causes _____ (and occasionally lateral) distortion. Oral ____-_____-____ resonance is often noted.

Effects on speech It interferes with tongue tip sounds (lingual-alveolars and sibilants). Palatal-dorsal production is common. It causes frontal (and occasionally lateral) distortion. Oral cul-de-sac resonance is often noted.

Microglossia Tongue is ____ in size, especially relative to oral cavity size. Microglossia _____ causes speech problems.

Tongue is small in size, especially relative to oral cavity size. Microglossia rarely causes speech problems.

Lobulated Tongue Seen in some syndromes, such as _____ ______ (OFD) Usually has _____ significant effect on speech

Seen in some syndromes, such as orofaciodigital syndrome (OFD) Usually has no significant effect on speech

Ankyloglossia ("Tongue-Tie") Ankyloglossia is a ____ anomaly. _____ _____ under tongue is too _____ and/or attaches close to the _____ of the tongue (rather than a third of the way back).

Ankyloglossia is a congenital anomaly. Lingual frenulum under tongue is too short and/or attaches close to the tip of the tongue (rather than a third of the way back).

Causes of Tongue-Tie _____ Very _____ Often not symptomatic

Unknown Very common Often not symptomatic

Functional Characteristics With mouth open, patient cannot touch ____ of mouth with tongue tip. Patient cannot protrude tongue past ____ edge of lower gingiva. With protrusion attempts, tongue is indented in _____ and looks heart-_____, thus limiting normal lingual movements.

With mouth open, patient cannot touch roof of mouth with tongue tip. Patient cannot protrude tongue past incisal edge of lower gingiva. With protrusion attempts, tongue is indented in midline and looks heart-shaped, thus limiting normal lingual movements.

Ankyoglossia and Speech Common belief: Because tongue tip cannot move well, it therefore affects` speech. However, there is no evidence in literature that ankyloglossia causes speech defects.

Common belief: Because tongue tip cannot move well, it therefore affects` speech. However, there is no evidence in literature that ankyloglossia causes speech defects.

Ankyloglossia and Speech CONT. Common sense approach Maximum need for _____: /____/ Maximum need for _____: /____/ and /____/ These sounds can usually be produced, even with significant tongue tip restriction, so speech is usually not affected. Spanish /____/ may be affected, however.

Common sense approach Maximum need for elevation: /l/ Maximum need for protrusion: /θ/ and /ð/ These sounds can usually be produced, even with significant tongue tip restriction, so speech is usually not affected. Spanish /r/ may be affected, however.

Indications for Frenulectomy Difficulty _____ Can affect _____ to a nipple Restricts movement of a _____ and clearing of food from _____ and _____ Causing separation of gingiva between lower mandibular incisors ______ concerns Difficulty “____ _____” Rarely for speech, except if there is _____-_____ dysfunction

Difficulty feeding Can affect latching to a nipple Restricts movement of a bolus and clearing of food from sulci and molars Causing separation of gingiva between lower mandibular incisors Cosmetic concerns Difficulty “French kissing” Rarely for speech, except if there is oral-motor dysfunction

Palate Abnormal palatal _____ can cause: Lingual _____, resulting in _____ or _____-_____ articulation Abnormal _____ due to small cavity size

Abnormal palatal arch can cause: Lingual crowding, resulting in anterior or palatal-dorsal articulation Abnormal resonance due to small cavity size

Palatal (Oronasal) Fistula _____—an abnormal _____ in the _____ Fistula occurs in the line of the cleft, often in the following areas: Junction of the _____ and _____ palate Junction of _____ and ______ segments Fistula can be due to breakdown of _____ repair. Small, asymptomatic fistula can open with maxillary expansion or growth.

Fistula—an abnormal opening in the palate Fistula occurs in the line of the cleft, often in the following areas: Junction of the hard and soft palate Junction of premaxilla and lateral segments Fistula can be due to breakdown of surgical repair. Small, asymptomatic fistula can open with maxillary expansion or growth.

Palatal Fistulas: Effect on Speech Effect on speech depends on _____ and _____. Small fistula can cause: No effect on speech because airflow is _____ to opening _____ air emission on sounds with tongue _____ elevation Medium-sized fistula can cause: Consistent nasal emission Compensatory ______ productions To close the fistula with the _____ during speech To produce the sound behind the fistula and _____ leak Large fistula can cause: ______ and consistent _____ _____

Effect on speech depends on size and location. Small fistula can cause: No effect on speech because airflow is horizontal to opening Nasal air emission on sounds with tongue tip elevation Medium-sized fistula can cause: Consistent nasal emission Compensatory articulation productions To close the fistula with the tongue during speech To produce the sound behind the fistula and air leak Large fistula can cause: Hypernasality and consistent nasal emission

Palatal Fistulas Usually repaired with _____ graft around age _____–_____ Could consider an _____ or earlier repair if affects speech sound development

Usually repaired with bone graft around age 6–7 | Could consider an obturator or earlier repair if affects speech sound development

Tonsils and Adenoids _____ _____—consists of a complex of _____ tissue that encircles the _____ _____ (_____ tonsils) _____ (_____ tonsils) _____ tonsil Plays a role in the mucosal immune system

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

Hypertophic Tonsils and Adenoids Prominent in _____ children Usually _____ around puberty Tonsil and adenoid _____ (abnormal enlargement) common in young children

Prominent in prepubescent children Usually atrophy around puberty Tonsil and adenoid hypertrophy (abnormal enlargement) common in young children

Hypertrophic Tonsils Can cause… Pharyngeal ____-_____-_____ resonance _____ _____, if a tonsil intrudes into the _____, thus limiting _____ wall motion or interfering with _____ closure _____ of velars, if it displaces the tongue down and forward Difficulty _____ a bolus

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 Fronting of velars, if it displaces the tongue down and forward Difficulty swallowing a bolus

Hypertrophic Adenoids Can cause _____ Nasal _____/_____ if irregular, thus affecting the firmness of ____ closure _____ _____ _____, _____ _____, and _____ hearing loss if it obstructs the Eustachian tube opening Chronic _____ Airway obstruction causing an obligatory _____ breathing, _____ tongue position, _____, and sleep _____ Skeletal _____, if the ____ is always _____ for ____ breathing

Can cause Hyponasality Nasal emission/rustle if irregular, thus affecting the firmness of VP closure Middle ear effusion, otitis media, and conductive hearing loss if it obstructs the Eustachian tube opening Chronic pharyngitis Airway obstruction causing an obligatory mouth breathing, anterior tongue position, snoring, and sleep apnea Skeletal malocclusion, if the jaw is always open for oral breathing

Lingual Tonsil Hypertrophy Rarely occurs, except in _____ _____ Can cause _____ ____-____-_____ resonance

Rarely occurs, except in Down syndrome | Can cause pharyngeal cul-de-sac resonance

Upper Airway Obstruction Upper airway obstruction can cause: _____ _____ (also seen with tonsillar hypertrophy): An ____-mouth posture and anterior _____ position A ____ and _____ position of the ____ Facial ____ _____ ____ (“____ eyes”) and _____ eyes Appearance of _____ nostrils

Upper airway obstruction can cause: Adenoid facies (also seen with tonsillar hypertrophy): An open-mouth posture and anterior tongue position A forward and downward position of the mandible Facial elongation Suborbital coloring (“black eyes”) and puffy eyes Appearance of pinched nostrils

Upper Airway Obstruction CONT. ``` Upper airway obstruction can cause: ____ breathing issues _____ (a heavy _____ ____) breathing Chronic _____ breathing _____ snoring, and _____ _____ ____ (_____) ```

Upper airway obstruction can cause: Nasal breathing issues Stertorous (a heavy snoring sound) breathing Chronic mouth breathing Loud snoring, and obstructive sleep apnea (OSA)

Pharynx May be deep due to _____ base anomalies, causing _____ May be shallow due to _____ _____, causing _____ and obstructive sleep apnea (OSA) May have medial displacement of internal carotid arteries VCFS

May be deep due to cranial base anomalies, causing VPI May be shallow due to maxillary retrusion, causing hyponasality and obstructive sleep apnea (OSA) May have medial displacement of internal carotid arteries VCFS

Treatment of Upper Airway Obstruction _____ and/or _____ _____ _____ (UPPP) _____ _____ _____ _____ (_____)

Tonsillectomy and/or adenoidectomy Tracheostomy Uvulopalatopharyngoplasty (UPPP) Continuous Positive Airway Pressure (CPAP)

Tonsillectomy Except in very rare circumstances, has no _____ effect on speech or resonance May improve _____ production May improve _____

Except in very rare circumstances, has no negative effect on speech or resonance May improve speech production May improve resonance

Adenoidectomy May improve _____ _____ May improve _____ May cause _____ due to the _____ in _____ space Risk for VPI low in the general population Greatest risk with history of cleft palate or submucous cleft

May improve speech production May improve resonance May cause VPI due to the increase in nasopharyngeal space Risk for VPI low in the general population Greatest risk with history of cleft palate or submucous cleft

Tracheostomy Done to relieve _____ that is life threatening Often indicated for _____ anomalies, such as _____ stenosis, _____ stenosis, laryngeal _____ or _____ associated with _____ _____ sequence

Done to relieve obstruction that is life threatening Often indicated for congenital anomalies, such as subglottic stenosis, tracheal stenosis, laryngeal web or glossoptosis associated with Pierre Robin sequence

UPPP Procedure _____ snoring. Sleep apnea usually _____. Aggressive UPPP has been known to cause _____ and _____ difficulties.

Procedure improves snoring. Sleep apnea usually persists. Aggressive UPPP has been known to cause swallowing and speech difficulties.

CPAP _____-term resolution for _____ apnea Consists of a _____ mask and ____ _____ generator Prevents _____ collapse while sleeping

Long-term resolution for obstructive apnea Consists of a face mask and air pressure generator Prevents laryngeal collapse while sleeping

Summary Speech-language pathologists and otolaryngologists should form a partnership to _____ and _____ the disorders related to _____ anomalies.

Speech-language pathologists and otolaryngologists should form a partnership to diagnose and treat the disorders related to oropharyngeal anomalies.

Ch. 8 Flashcards

(54 cards)