Medical SLP - Exam 2

Question 1

Endoscopic Results (5)

Answer 1

• normal speech
• consistent VPD
• task-specific VPD
• Irregular VPD
• Abnormal resonance without VPD

Question 2

What are endoscopic evaluations looking for?

Answer 2

Whether surgery is an option or not, what kind of surgery, and prognosis for success.

Question 3

Management options for VPI/VPD

Answer 3

• Pharyngoplasty (augmentation, sphincter and flap)
• Speech appliance (retainers, obturators and lifts)
• Behavioral Management (surgery)

Question 4

Pharyngeal Flaps

Answer 4

Inferior and Superior: can cause sleep apnea. not a great method.

Midline and Lateral (circular - cuts palatopharyngeus)

Question 5

Sphincter Pharyngoplasty

Answer 5

cuts palatopharyngeus

• doesn’t always get complete closure.
• may not be effective as a flap

Question 6

Pharyngoplasty

Answer 6

surgery on the velopharynx

might complicate a class III malocclusion

Question 7

Pharyngoplasty Augmentation

Answer 7

think boobjob

-take some material (saline/silicon wrapped in dacron ike a pillow), suture it to the posterior pharyngeal wall which makes the posterior wall closer to the velum. good for platybasia.

Question 8

Speech appliances are made by a..

Answer 8

Prosthodontist

Question 9

Speech appliances

Answer 9

Advantages: no risk, can be easily changed and used their whole life.
Earlier management is possible, revisions can be done when necessary, may stimulate growth

Question 10

Types of Appliances

Answer 10

Palate Obturator - anchor with teeth.
Palatal Lift - regular retainer with tail to lift velum closer to pharyngeal wall.
Obturator with a Speech Bulb - tail with bulb plugs hole

Question 11

Circumstances for Favoring a Speech Appliance

Answer 11

• younger children (3-5 years)
• unknown etiology
• severe paralysis
• severe articulation disorder/delay
• mild resonance imbalance

Question 12

VPI/D hearing issues and effect on language

Answer 12

• language delay
• conductive hearing loss
• middle ear disease (MED)
• hearing acuity

Question 13

Obligatory Errors

Answer 13

physically unable to make the sound; consistent with errors; surgical fix only.

• correct place but not voice or manner
• nasal air emission (NAE)
• hypernasality (voice error)
• air escaping in odd places because of dentition

Question 14

Compensatory Errors

Answer 14

most common; trying to make themselves intelligible; mostly substitutions; mostly place rather than manner changes.

• incorrect place, voice or manner
• nasal & pharyngeal fricative
• glottal stopping

Question 15

Nasometer

Answer 15

objective computer assistive instrument that measures how much air is coming out of the nose and mouth

Question 16

Surgical Lip Repair: first thing needed

Answer 16

connect the orbicularis oris

Question 17

Rule of 10’s for Lip Repair

Answer 17

baby needs to be 10lbs, have a minimum of 10 grams of hemoglobin (O2) in the blood for anesthesia, and 10 weeks of age.

otherwise surgery have the potential to suffocate the child.

Question 18

Straight Line Lip Repair

Answer 18

cut and sew the edges together. tight repair and tension of the epidermis can stop jaw from growing forward. can cause notching of upper lip.

Question 19

Triangular Flap Repair (Tennison-Randall)

Answer 19

triangle shaped tissue block is removed from the lip. lengthens lip; nice vermillion repair. bilateral and unilateral.

if you cut tissue off the lip your repair potentially needs to be too tight to get it to close.

Question 20

Millard Rotation-advancement technique

Answer 20

cut triangle at the top, release it, pull it down, fit into lower notch on either side. lengthens lip and sews together without cutting out any tissue. bilateral and unilateral.

Question 21

Palate repairs are…

Answer 21

soft tissue repairs. the only bone used is for the alveolar ridge.

Question 22

Types of One-Stage Palate Repairs

Answer 22

• free-flap
• Furlow Z-Plasty for the soft palate
• Von Langenbeck
• V-Y Retroposition procedure (Wardill Pushback)
• Vomer Flap

Question 23

Free Flap Repair

Answer 23

take a flap of skin from somewhere else and put it in the palate (e.g., crook of the elbow or back of knee)

Question 24

Furlow Z-Plasty for the soft palate

Answer 24

superior epithelium is raised in a couple of flaps as well as the inferior. flaps are sewn in the shapeof a Z in opposite directions.

Lengthens the soft palate.

Question 25

Von Langenbeck

Answer 25

hard and soft palate, not including alveolus cuts flaps off of the palatal shelves and sews everything together at midline. gaps left fill in. when surgeon lifts flap, need to be careful not to denude the bone.

Question 26

V-Y Retroposition Procedure (Wardill Pushnack)

Answer 26

tissue is not cut off. slices are made and tissue is lifted off the bone. hard and soft palate.

Question 27

Vomer Flap

Answer 27

taking tissue off palatal shelves and off the septum

Question 28

Two-Stage Palate Repair

Answer 28

do not support! - done around 12 and then 24 months - fistulae tend to develop

Question 29

Fistulae

Answer 29

an opening that comes up before the surgical site has healed; almost impossible to repair. -functional if it has an effect on speech, eating or drinking.

Question 30

Orthognathic Surgery

Answer 30

bone graft to the alveolus. done when there's a cleft in the alveolus, timing is controversial. generally, attempts are made to close fistulae at this time.

Question 31

Maxillary Osteotomy

Answer 31

surgical repairs probably disrupt blood supply, nerve supply and growth. -Le Fort Procedures which potentially pull velum causing VPI

Question 32

Le Fort I & II both start by...

Answer 32

peeling skin away from bone without cutting. drill holes in the maxilla and then cut by connecting the dots. this moves the maxilla forward. prevents dental occlusion. dog bones (titanium) go across gap and are screwed in. t aesthetics and occurs when facial growth is finished in teenagers.

Question 33

Le Fort I

Answer 33

moving the dental arch. cuts maxilla at dental arch. orofacial maxillary surgeon. no zygomatic is cut. muscles change.

Question 34

Le Fort II

Answer 34

pulls off more skin (cut cartilage on nose). pulls more maxilla forward up to beidge of nose. more facial skeleton and orbit of the eye. orofacial maxillary surgeon. no zygomatic is cut.

Question 35

Le Fort III

Answer 35

cranial surgeon because brain is exposed. cut is made around hairline, skin peeled down to lay over chin. orbits of the eye and part of frontal and nasal bone is pulled forward. held by dog bones or potentially bone grafts. zygomatic arch IS cut.

Question 36

maxillary advancement can create....

Answer 36

velopharyngeal dysfunction

Question 37

Mandibular Osteomy

Answer 37

shortening of the mandible. cut jagged line in the mandible, then either take out chunk and slide pieces together to shorten mandible or do distraction osteogenesis (for Pierre Robin).

Question 38

Deciduous Teeth

Answer 38

Baby Teeth A-J are on the maxille R to L K-T are on the mandible L to R no bicuspids or 2nd and 3rd molars

Question 39

Permanent Teeth

Answer 39

adult teeth 1-16 on the maxilla R to L 17 is under 16, 17-32 on mandible L to R wisdom teeth = 3rd molars

Question 40

SLP evaluation of speech and language before physical management

Answer 40

Language assessment FNAE/Hypernasality developmental errors and Phonological processes Endoscopic evaluation work with family and inform them (praise place even if manner is incorrect)

Question 41

Role of the SLP after physical management

Answer 41

training the patient to make the best of the appliance or pharyngoplasty, reduce NAE/hypernasality, eliminate articulation errors, assume the surgery or obturator was a good fit.

Question 42

Speech Therapy Goals

Answer 42

1) Decrease VP patency 2) Decrease NAE/increase oral pressure - octopus, cul-de-sac technique 3) Decrease Hypernasality 4) Decrease Compensatory Errors

Question 43

The velum is ________, lacking _____________ which tell the velum it's position in space

Answer 43

asensory | proprioceptors

Question 44

Non-speech activities and the closure they produce _______ carry over into speech activities because they're ______________ _________.

Answer 44

don't | neurologically different

Question 45

the _____ culture considered clefting to be a sign of blessing from the Gods

Answer 45

Mayans

Question 46

The primary plates form between __ to __ weeks of gestation and the secondary plates form between __ to __ weeks of gestation

Answer 46

6 to 8 | 8 to 10

Question 47

contour of the face is generally complete around the __th week of gestation

Answer 47

14

Question 48

____________ ultrasound gives clearer picture

Answer 48

transvaginal