CRANIOFACIAL Flashcards
(179 cards)
1
Q
define cleft
A
abnormal opening or fissure in an anatomical structure
2
Q
what does a cleft often lead to
A
poor development of associated structures
3
Q
cleft cause
A
usually congenital due to abnormal fusion of parts during development
4
Q
where do clefts commonly occur
A
lip & palate
5
Q
how common are orofacial clefts
A
most common congenital difference of the face in the world
2nd most common birth difference in US
4th most common birth difference in the world
6
Q
subsystems of speech
A
respiration
phonation
resonance
articulation
prosody
7
Q
what speech subsystems are most affected by cleft lip & palate
A
articulation
resonance (nasality)
8
Q
pharynx
A
muscular tube connecting oral & nasal cavities to larynx & esophagus
9
Q
adenoid tonsils
A
pharyngeal tonsil
may assist w/ vp closure due to location on posterior pharyngeal wall
involution prior to puberty
10
Q
palatine tonsils (ones u usually get removed) & lingual tonsils (@ base of tongue)
A
contain lymphoid tissue & assist in fighting infection particularly from 0-2
prone to hypertrophy in younger children
atrophy almost completely by 16
11
Q
hard palate
A
separates nasal cavity & oral cavity by bony plates
roof of mouth & floor of nasal cavity
12
Q
alveolar ridge
A
front of hard palate
provides bony support for teeth
13
Q
incisive foramen or fossa
A
hole or opening in hard palate to allow blood vessels & nerves to pass through
in alveolar ridge behind central incisors
starting point of embryological development
14
Q
rugae
A
hard palate
ridges that run horizontally
15
Q
incisive papilla
A
hard palate
projection of mucosa at area of incisive foramen
16
Q
palatine raphe or suture
A
hard palate
line from incisive foramen to uvula
17
Q
torus palatinus (palatine torus)
A
hard palate
normal structural variation
prominent longitudinal ridge on oral surface along median palatine raphe/suture
18
Q
velum (soft palate)
A
consists of muscles & mucosa - no bone
attaches to posterior border of hard palate
19
Q
uvula
A
tear drop structure at back of velum
consits of mucosa & tissue
very vascular - veins
no known function
20
Q
palatine aponeurosis
A
thin fibrous sheet of connective tissue in back of hard palate
21
Q
velopharyngeal valve function requires coordinated movement of what structures
A
velum
lateral pharyngeal walls
posterior pharyngeal wall
22
Q
VP function - velum
A
velum in superior & posterior direction
“knee” action
moves toward posterior pharyngeal wall
23
Q
VP function - lateral pharyngeal walls
A
moves medially
usually close against the velum
sometimes close in midline behind velum
24
Q
VP function - posterior pharyngeal wall
A
moves anteriorly toward the velum
25
passavants ridge
bulge of muscles seen in PPW
26
what does the velum do
It closes off the nasal cavity when it raises
It prevents food and liquid from moving out the nose
It facilitates production of nasal and non-nasal sounds
27
role of VP in speech
valve that provides 3D closure of structures
closes off nasal cavity from oral cavity to regulate & direct transmission of sound energy & airflow in the oral & nasal cavities
28
what kind of sounds is VP important for
pressure sensitive consonants & all vowels
fricatives
29
VP function for oral sounds
VP valve is closed
allows acoustic energy to enter oral cavity
30
VP function for nasal sounds
VP valve open
allows most of sound energy to enter nasal cavity
31
T/F: VP valve must open & close quickly & efficiently
True
32
connection between Eustachian tube & velopharynx & differences in kids vs adults
connects ME w/ pharynx
at horizontal angle in children under 6 -- kids more prone to ME infections
45 degree angle in adults
33
eustachian tube
pharyngeal opening is lateral & slightly above velum
craniofacial anomaly can affect ET function
34
levator veli palatini
elevates velum up & back
35
superior pharyngeal constrictor
move PPW anteriorly
LPWs medially
36
palatopharyngeus
constrict LPWs medially
don't know exactly what it does still
37
palatoglossus
depresses velum
38
tensor veli palatini
opens ET
39
musculus uvulae
bulks uvula
40
what structures does a cleft lip affect
nasal ala rim - spreadng
columella - short
teeth - missing
alveolar ridge
lip
41
what functions affected w/ cleft lip
facial aesthetics / identity - stigma
specific articulation errors
resonance
42
structures affected w/ cleft palate
hard palate
uvula
soft palate - absent velar aponeurosis, LVP muscles insert into hard palate
43
functions affected w/ cleft palate
speech - resonance, hypernasality
articulation - impaired vowels & high pressure non nasal sounds
hearing - conductive HL, ET malfunction
early feeding - affects sucking, nasal regurgitation
44
velopharyngeal dysfunction (VPD)
generic term used to describe abnormal VP function regardless of the cause
profound speech & swallowing effects
cause of nasal resonance disorders
45
order of embryological development
1. lip (primary palate)
6-8 weeks gestation
2. palate (secondary palate)
9-12 weeks gestation
development of each is independent
46
where does embryological closure begin
incisive foramen
zips forward to form alveolar ridge then lip
zips backward to form hard palate & velum
47
what is a cleft of the secondary palate
an opening in the palate behind the front teeth
48
complete cleft
didn't start forming
49
incomplete cleft
started forming but didn't finish
50
unilateral incomplete cleft lip
partial opening on one side of upper lip
51
unilateral complete cleft lip
full split from the lip to the nose on one side
52
bilateral incomplete cleft lip
partial splits on both sides of the lip
53
bilateral complete cleft lip
full splits on both sides of the lip
54
microform cleft lip
very small cleft
sometimes just a notch or line
55
simonart's band
band of skin that crosses over a cleft lip
56
cleft palate
opening in the roof of the mouth
57
Pierre Robin sequence
condition w/ a small jaw, tongue falls back, & cleft palate
58
what does a repaired cleft lip & palate look like
scarring or reshaped lip/palate but closure is present
59
palatal fistula
hole between mouth & nose
often after surgery
60
submucous cleft palate
hidden cleft under the skin of the mouth's rood
61
signs of submucous cleft
bfid uvula
bluish midline
notch in hard palate
62
can submucous clefts affect speech
yes if muscles are affected --> may cause resonance & speech issues
63
cul-de-sac resonance
sound gets "stuck" somewhere & sounds muffled
64
what is velopharyngeal dysfunction (VPD)
soft palate doesn't close properly during speech
65
incompetence VPD
muscles don't move well
neurological
66
insufficiency VPD
palate is too short
structural
67
mislearning VPD
speaker learned the wrong sounds placement
68
nasal emissions
air leaks through the nose on sounds like /p/, /t/, /s/
69
nasal turbulence
noisy airflow through a small nasal gap
sounds "rustly"
70
are nasal emissions always a problem
yes especially during pressure sounds
might need therapy or surgery
71
how can cleft palate affect speech & language
late babbling
fewer words
problems hearing & speaking clearly
speech can sound nasal or unclear
72
common surgeries for cleft
lip repair (2-6 mos)
palate repair (10-12 mos)
bone graft (8-9 yrs)
optional revisions or surgeries later
73
what are obligatory errors
mistakes caused by structure itself
therapy won't help - surgery needed
74
compensatory (maladaptive) errors
child makes up new ways to produce sounds incorrectly
therapy can help after surgery
75
mislearning
incorrect speech patterns even after repair
therapy helps
76
how can we test for speech errors
surgery history
oral exam
trial therapy
plug nose & listen for changes
77
submucous cleft palate
type of cleft where the tissue (mucosa) looks intact --> but muscles underneath did not form correctly
78
2 types of submucous cleft palate
overt - visible from the mouth
occult - hidden , only visible from nasal side
79
function of levator veli palatini
pulls velum up & back to close off the nose during swallowing & speech
80
fuction of musculus uvulae
shortens & lifts uvula to help seal nose during speech & swallowing
81
function of tensor veli palatini
opens ET to help drain middle ear & equalize pressure
not important for VP closure
82
classic triad of submucous cleft
bifid (split) or tiny uvula
zona Pellucidar - bluish midline on soft palate
notch in hard palate
83
muscles of veau
misplaced levator muscles inserting in the wrong spot (hard palate)
creating a tent-like shape during speech
84
effects of submucous cleft
may cause no issues & resemble full cleft
VP insufficiency
nasal regurgitation
ET issues
85
when might a submucous cleft become symptomatic
after an adenoidectomy
removal of adenoids
86
how do we change resonance
opening or closing VP port
87
resonance disorder
when sound energy flows abnormally through the mouth, nose, or throat
88
types of resonance disorders
hyper/hyponasality
cul-de-sac
assimilative
mixed
89
what causes hypernasality
incomplete VP closure
too much nasal resonance
90
what causes hyponasaltiy
blocked nasal passages / inability to open VP during nasal sounds
91
mixed resonance
combo of hyper/hyponasality &/or cul-de-sac resonance
92
what is VPD
any issue where the soft palate doesn't close the nose properly
93
nasal rustle
rustling sound due to small gap in VP closure
94
impact of cleft palate on speech
delayed speech
compensatory errors
nasal sounding voice
95
who's on the multidisciplinary cleft team
plastic surgeon
ENT
SLP
AuD
dentist
social worker
nutritionist
genetic counselor
96
SLP's role on cleft team
early feeding / speech support
evaluations
therapy
education
nasendoscopy guidance
97
what is AuD's role
hearing screenings
managing ear infections
providing hearing aids if needed
supporting school services
98
at what gestational age can suckle & swallow sustain nutritional needs
by 34 weeks gestatioin
99
why is feeding important beyond nutrition
provides oral sensorimotor stimulation
supports state regulation
offers comfort & bonding
contributes to caregiver confidence
100
what factors support successful feeding
stable state regulation
hunger cues
vital signs
intact anatomy
suck-swallow-breathe coordination
airway protection
adequate intake
101
what are consequences of poor suck-swallow-breathe coordination
fatigue
poor intake
airway compromise
oxygen desaturation
distoress
negative feeding experiences
102
how does infant anatomy support feeding differently from adults
smaller mandible
high larynx
sucking pads
epiglottis touches velum
103
what happens during the oral phase of infant feeding
rooting reflex triggers latch
tongue movement & jaw drop create suction to extract milk from nipple
104
what protects airway during the pharyngeal phase
VF adduction & epiglottis retroflexion over the larynx
105
what happens during the esophageal phase
UES opens
bolus travels through the esophagus
LES opens to allow passage into the stomach
106
can infants w/ only cleft lip breastfeed
yes
w/ little difficulty
upright positioning & broad based nipples help
107
why can't infants w/ cleft palate breastfeed effectively
cannot generate negative pressure needed for suction
108
SLP role in feeding therapy w/ cleft
prenatal counseling
feeding eval
therapy & modifications
pre/post operative support
109
how does prenatal counseling help
reduces NICU admissions for feeding issues
supports caregiver confidence & emotional health
110
caregiver challenges w/ cleft feeding
lack of professional support
overwhelming emotional responses to diagnosis & feeding difficulties
111
4 specialty bottles for cleft
pigeon
mead johnson
Dr browns specialty -- one way valve to prevent backflow
medela
112
important bottle characteristics for cleft
no suction required
manageable
safe
supports skill development
delivers adequate milk volume
113
key feeding recommendations for cleft
specialized bottles
upright or side laying position
frequent burping
pacing
monitor for distress
114
what does SLP look for during feeding eval
positioning
pulsing
pacing
flow rate
distress cues
aspiration signs
115
distress cues during feeding
raised eyebrows
splayed hands
turning away
rigidity
arching
rapid sucking
no breathing
116
common feeding modifications
swaddling
changing nipples / positions
pacing
further eval (SLP or medical)
117
interventions that support better feeding
correct bottle use
altering flow rate
external pacing
swaddling
medical/SLP follow up
118
how can infants w/ cleft palate benefit from breastfeeding
through skin to skin contact
expressed milk
non-nutritive sucking
alternating deeding sides
119
normal feeding & weight gain expectations
return to birth weight in 2 weeks
<30 min feedings
1-2oz every 2-3 hours
90-120 cal/kg/day
120
signs infant is ready to feed
alertness
rooting
sucking on hands / objects
121
how to help infant show feeding readiness
pacifier
swaddle
bounce gently
change diaper to rouse if sleepy
122
when should feeding strategies be modified
if energy is wasted
reflux occurs
hunger cues/weight gain are lacking
123
when are feeding tubes considered
when oral feeding isn't sufficient
124
what should be expected of infants w/ cleft but no other issues
efficient feeding & weight gain w/ special bottles
otherwise --> further eval needed
125
when to start open cup drinking
6-9 months
126
when should solids be introduced
6 months
if baby sits unsupported, shows interest, & doesn't gag
nasal regurgitation is okay
127
which speech sounds require full VP closure & are impacted by cleft palate
plosives, fricatives, affricates
128
what is phoneme specific nasal emission (PSNE) & what causes it
PSNE is nasal emission occurring only on certain phonemes
caused by mislearning
129
obligatory productions
happen when the structure is the problem, but placement is correct
130
will speech therapy help obligatory productions
no
131
compensatory production
learned adaptations due to structural deficits
pharyngeal stops/fricatives, glottal stops
132
when should speech/resonance be evaluated in children w/ clefting
between ages 3-5
when the child can:
produce connected speech
cooperate for testing
have an airway big enough for surgery
133
purpose of orofacial exam
identify structural anomalies
determine whether the issue is obligatory, compensatory, or mislearning
is further evaluation needed
134
structures examined during an orofacial exam
tongue
palatine tonsils
oral surface of velum/uvula
alveolar ridge
hard palate
teeth
135
visual tasks in resonance assessment
observe airflow
dental mirror
136
auditory tasks in resonance assessment
plug nostrils
listen for changes w/ straw to nose test
137
tactile tasks used in resonance assessment
feel for vibration
138
goal of cleft repair surgery is to optimize: (5)
feeding
speech
dentition
aesthetics
facial profile
139
recommended timeline for cleft speech/language evaluation
0-3: counseling, feeding eval, hearing screening
3-4: full speech / resonance / VP eval
4-12: annual screening
12-18: every 2 years
140
components of a cleft & craniofacial assessment
history
orofacial exam
speech & resonance assessment
instrumental evaluation
stimulatbility / trial therapy
141
purpose of a speech & language screening for a child w/ a cleft
monitor development
ensure appropriate growth
guide parents in stimulating language
track milestones
142
why don't we reevaluate speech/resonance until 3-5 years
the child must:
produce connected speech
cooperate w/ testing
have a large enough airway for surgery
143
what language development issues may arise in children w/ cleft palate
less consonant babbling
hearing loss (middle ear fluid)
late onset of words
atypical lexicon
144
causes of speech sound development issues in children w/ clefts
structural issues
neurologic issues
hearing loss
compensatory errors that become mislearned
145
what sensory areas important to monitor in children w/ craniofacial differences
hearing - common due to ET misfunction
vision - impacts speech learnin
146
psychosocial factors that might affect communication development
attention difficulties - often co-occur w/ language disorders
motivation - less pressure form families to communicate if speech is unintelligible
147
first step in speech/resonance assessment
perceptual assessment
148
what does a perceptual assessment determine
if a disorder exists
type & severity
likely cause
whether to treat or refer
149
tasks used to assess speech samples
single sounds & syllables - hypernasality & nasal emission
sentences - articulation & resonance
connected speech & conversation - real world impact
150
sounds & their purpose in single sound assessment tasks
vowels - hypernasality
/s/ - nasal emission
/m/ - hyponasality or cul-de-sac resonance
151
how do syllable repetition tasks help in assessment
oral voiced consonants & vowels - hypernasality
voiceless consonants - nasal emission
nasal consonants - hyponasality, cul-de-sac resonance
specific phonemes - sound specific errors
152
connected speech task to test hypernasality / nasal emission & hyponasality
hyper - counting 60-70
hypo - counting 90-99
153
how is conversational speech used in assessment
engage child in natural conversation / ask them to explain something
listen for resonance errors & intelligibility
154
what early evaluations are recommended for infants w clefts
feeding eval
language development monitoring
to ensure growth & development
155
how is early developmental progress monitored in children w clefts
parent reports
observation of speech milestones
156
what factors can limit language development in children w clefts
less consonant babbling
hearing loss
adult feedback issues
structural contraints
157
common causes of speech sound development issues in children w clefts
structural anomalies
neurological issues
hearing loss
158
what additional areas should be monitored in children w clefts
hearing
vision
attention
motivation
159
assessment timeline for children w clefts
0-3: counsel family, feeding/language eval
3-4: comprehensive speech/resonance eval
4-12: annual screening
12-18: every 2 years until dental/orthognathic treatment ends
160
goals of perceptual assessment
determine if disorder exists
type
severity
possible cause
treatment or referral
161
indirect instrumental procedures
acoustic or airflow measures
nasometry, aerodynamics
162
direct instrumental procedures
visualization
nasopharyngoscopy, videofluoroscopy
163
what does nasometry measure
nasalance score = nasal acoustic energy / total acoustic energy
164
what does speech aerodynamics assess
nasal airflow & pressure to estimate VP opening size or obstruction
165
why is team management essential in cleft/craniofacial care
treatments affect one another & require coordination across a long term multi-phase process
166
multidisciplinary team
independent work
little coordination
167
interdisciplinary team
collaborative care plan
168
transdisciplinary team
deep understanding across disciplines
169
who are the core ACPA members for a cleft team
surgeon
orthodontist
SLP
170
key roles of SLP in cleft ccare
counseling
feeding/swallowing
therapy
coordination w families & providers
speech / resonance
171
AuD role in cleft care
hearing screening
OAE / ABR testing
managing hearing loss
amplification
coordination w/ school services
172
standard of care for cleft conditions
inter/transdisciplinary team approach
173
main treatment categories for cleft care
surgery
speech/swallow therapy
dentistry
orthognathics
prosthetics
counseling
174
ultimate goal of cleft related speech therapy
normal speech & resonance
175
when is speech therapy effective vs not effective
effective for mislearning or phoneme-specific errors
not effective for obligatory errors due to structure (surgery needed)
176
what principles support successful speech therapy carryover
motor learning & memory
frequent short focused home practice
high reps per session
meaningful feedback
177
strategies for treating glottal stops
contrast glottal stops w correct sounds
use mirrors, tactile feedback, & coarticulation
178
how do you treat nasalized vowels or ng/l confusion
exaggerated yawning
stretch awareness
nasal occlusion
coarticulation for feedback
179
how do you treat phoneme specific nasal emission (PSNE)
start w loud /t/
close teeth
prolong shape into /s/
"tsssss"
