Chapter Eight Flashcards by Becky Chesney

Oral, Facial, and Pharyngeal Anomalies

Cleft palate and craniofacial anomalies can have an impact on the various ______.

Abnormalities of the _______particularly affect the _____ and _____of speech.

functions

ear, nose, and throat

quality; intelligibility

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External Ear

Atresia—

Aural (auditory) atresia—

Microtia—

closure of a normal opening

closure of the auditory canal

small auricle
Treatment can include surgery and/or bone conduction hearing aids.

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Middle Ear

Ossicles may be …

________may be absent or hypoplastic.

Middle ear malformations cause …

Treatment can include ….

absent, hypoplastic, or ankylosed.

Tympanic membrane

conductive hearing loss

surgery and/or bone conduction hearing aids.

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Eustachian Tube Function

At rest, Eustachian tube is ____.

During swallowing (and yawning), _______muscle contracts to open Eustachian tube.

Opening of Eustachian tube:

Provides …
Equalizes ….
Allows …

closed

tensor veli palatini

ventilation for middle ear
middle ear pressure with environment
fluids to drain

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Eustachian Tube Malfunction

Children under age ___are predisposed to Eustachian tube malfunction, causing ___________

Eustachian tubes lie in a ____ plane, which impairs _____.

________muscles are directed at an unfavorable angle for function.

Children with __________ are at greater risk due to abnormality of ______.

6; middle ear effusion and acute otitis media.

horizontal; drainage

Tensor veli palatini

cleft palate or submucous cleft; tensor muscles

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Eustachian Tube Malfunction

Fluids collect within the middle ear (________) due to the ….

Bacteria can ascend tube and ______ in fluid, leading to an ear infection (acute otitis media).

middle ear effusion; negative pressure and cannot drain.

grow

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Eustachian Tube Malfunction

Middle ear effusion can cause:
1.
2.

Otitis media can cause serious potential complications, including:
1.
2.

Conductive hearing loss
Speech and language delay
Mastoiditis
Sensorineural hearing loss due to toxins

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Treatment for Chronic Otitis Media

1.
2.
3.

1.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

3.Adenoidectomy

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Inner Ear

Malformations can occur in the cochlea, vestibular system, and auditory nerve, causing a _______hearing loss.

Treatment includes:
1.
2.

sensorineural

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 _______

Patients should see an _____and _____periodically through _____.

cleft lip/palate or other craniofacial anomalies.

audiologist ; otolaryngologist; adolescence

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Facial Structures

Nose

Maxilla

Facial Nerve

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Nose

Nasal cavity compromised by _________

Deviated septum:
Common with ______

Deflects to the _____of the nose

_________stenosis

_______secondary to lip repair

_______or enlarged _____blocking the choana

midline cleft deformities

unilateral cleft lip/palate

cleft side

Pyriform aperture

Stenotic nares

Choanal atresia; adenoids

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Nose

_____obstruction of the nasal cavity

Can be due to
1.
2.
3.

Causes ______resonance

_____ obstruction of the nasal cavity

Can be due to ______or enlarged adenoids

Causes _______

deviated septum,
pyriform aperture stenosis, or 3.stenotic nares

nasal cul-de-sac

Posterior

choanal stenosis/atresia

hyponasality

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Maxilla

Can cause:

Mid-face deficiency

Anterior crossbite with Class III malocclusion

Pharyngeal and nasal airway restriction

Hyponasality

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Facial Nerve (CN VII)

_______with facial paralysis

Causes a…

Moebius syndrome

“mask-like” facies

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Facial Nerve (CN VII) Paralysis

Facial nerve paralysis causes a ….

It affects _____and sometimes ______sounds.

Tongue movement is usually _____

Individuals may learn to compensate by …..

lack of facial expression and lip movement.

bilabial; labiodental

unaffected.

producing labial sounds with the tongue

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The Oral Cavity

Lips

Mouth

Tongue

Palate

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Upper Lip

Upper lip may be ____after cleft repair due to:

1.
2.
3.

short

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…

1.
2.
3.

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

Macro (large)

Micro (small)

Stomia (mouth)

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Macrostomia

Associated with facial clefts and syndromes, especially _______, due to …

Usually does not affect ____

hemifacial microsomia; extension of mouth into cheek

speech

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Microstomia

Can have a ____affect on _____

May cause

slight ;articulation

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

Tongue

Macroglossia

Microglossia

Lobulated tongue

Ankyloglossia

Macroglossia

Tongue is…

Macroglossia is associated with _______and _____.

very large relative to the oral cavity size.

Down’s syndrome; Beckwith-Wiedeman syndrome

Macroglossia ``` Large tongue causes: 1. 2. 3. 4. 5. ```

Lingual protrusion Airway obstruction Open-mouth posture Anterior open bite Drooling

Macroglossia Effects on speech: It interferes with... ________is common. It causes _______ distortion. ________is often noted.

tongue tip sounds (lingual-alveolars and sibilants). Palatal-dorsal production frontal (and occasionally lateral) Oral cul-de-sac resonance

Microglossia Tongue is... Microglossia...

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

Lobulated Tongue Seen in some syndromes, such as _____ Usually has ...

"thick chunks of tissue on tongue" orofaciodigital syndrome (OFD) no significant effect on speech

Ankyloglossia (_______) Ankyloglossia is a ______ _______under tongue is ______ and/or attaches close to the tip of the tongue (rather than a third of the way back).

(“Tongue-Tie”) congenital anomaly. Lingual frenulum; too short

Causes of Tongue-Tie

Unknown Very common Often not symptomatic

Functional Characteristics With mouth open, patient cannot ______. Patient cannot ______ With protrusion attempts, tongue is ______and looks _______, thus limiting normal lingual movements.

touch roof of mouth with tongue tip protrude tongue past incisal edge of lower gingiva. indented in midline; heart-shaped

Ankyloglossia 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.

Ankyloglossia and Speech Common sense approach: 1. 2. These sounds can usually be produced, even with significant ______, so speech is usually not affected. _____may be affected, however.

Maximum need for elevation: /l/ Maximum need for protrusion: /θ/ and /ð/ tongue tip restriction Spanish /r/

Indications for Frenulectomy Difficulty ______ Can affect _____ Restricts movement of a ______ and... Causing ______between lower mandibular incisors ______concerns Difficulty _____ Rarely for speech, except if there is _______

feeding latching to a nipple bolus and clearing of food from sulci and molars separation of gingiva Cosmetic “French kissing” oral-motor dysfunction

Palate | Abnormal palatal arch can cause:

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

Palatal (Oronasal) Fistula Fistula— Fistula occurs in the _____, often in the following areas: Junction of the _____ Junction of _____ Fistula can be due to breakdown of ______. Small, asymptomatic fistula can open with ______.

an abnormal opening in the palate line of the cleft hard and soft palate premaxilla and lateral segments surgical repair maxillary expansion or growth

Palatal Fistulas: Effect on Speech Effect on speech depends on ____and _____. Small fistula can cause: 1. 2. Medium-sized fistula can cause: Large fistula can cause: 1.

size and location 1. No effect on speech because airflow is horizontal to opening 2. Nasal air emission on sounds with tongue tip elevation 1. Consistent nasal emission 2. Compensatory articulation productions a) To close the fistula with the tongue during speech b) To produce the sound behind the fistula and air leak 1.Hypernasality and consistent nasal emission

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

bone graft; 6–7 obturator;

Tonsils and Adenoids _________—consists of a complex of lymphoid tissue that encircles the pharynx Tonsils (______) Adenoids (________) ______tonsil Plays a role in the ______

Waldeyer’s Ring palatine tonsils pharyngeal tonsils Lingual mucosal immune system

Hypertrophic Tonsils and Adenoids Prominent in ______ Usually _____around puberty Tonsil and adenoid ______ (abnormal enlargement) common in _______

prepubescent children atrophy hypertrophy; young children

Hypertrophic Tonsils

Image

Hypertrophic Tonsils Can cause…

1. Pharyngeal cul-de-sac resonance 2. Nasal emission, if a tonsil intrudes into the pharynx, thus limiting lateral wall motion or interfering with VP closure 3. Fronting of velars, if it displaces the tongue down and forward 4. Difficulty swallowing a bolus

Hypertrophic Adenoids Can cause: _______ _______if irregular, thus affecting the ______of VP closure ______, ______, and _______if it obstructs the Eustachian tube opening Chronic _____ Airway obstruction causing: ______, if the jaw is always open for oral breathing

Hyponasality Nasal emission/rustle; firmness Middle ear effusion; otitis media; conductive hearing loss pharyngitis obligatory mouth breathing, anterior tongue position, snoring, and sleep apnea Skeletal malocclusion

Lingual Tonsil Hypertrophy Rarely occurs, except in _____ Can cause _______

Down syndrome pharyngeal cul-de-sac resonance

Upper Airway Obstruction 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 Upper airway obstruction can cause: ____breathing issues: 1. 2. 3.

Nasal 1. Stertorous (a heavy snoring sound) breathing 2. Chronic mouth breathing 3. Loud snoring, and obstructive sleep apnea (OSA)

Pharynx May be ____due to ______, causing VPI May be _____due to _____, causing _______and _______ May have medial displacement of _____VCFS

deep; cranial base anomalies shallow; maxillary retrusion hyponasality and obstructive sleep apnea (OSA) internal carotid arteries

Treatment of Upper Airway Obstruction: 1. 2. 3. 4.

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

Tonsillectomy Except in very rare circumstances, has no negative effect on ______ May improve ______ May improve ______

speech or resonance speech production resonance

Adenoidectomy May improve _____ May improve ______ May cause ____due to the increase in n_____ space Risk for VPI ____in the general population Greatest risk with ____________

speech production resonance VPI; asopharyngeal low history of cleft palate or submucous cleft

Tracheostomy Done to... Often indicated for ....

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

UPPP Procedure improves _____. Sleep apnea usually _____. Aggressive UPPP has been known to cause _______.

snoring persists swallowing and speech difficulties

CPAP Long-term resolution for _____ Consists of a _____ and ______ Prevents _______

obstructive apnea face mask and air pressure generator laryngeal collapse while sleeping

Summary _______and _______should form a partnership to diagnose and treat the disorders related to oropharyngeal anomalies.

Speech-language pathologists ; | otolaryngologists