Structural Flashcards
(143 cards)
0
Q
Most common palate repair surgeries
A
V-Y veau Walder Kilner
Von Langenbeck
Furlow… Double opposing z plasty
Vomer flap
1
Q
What age do we repair cleft palate with surgery?
A
9-12 mos
2
Q
The V-Y helps VP closure by
A
Elongating palate
Elevation of soft palate
3
Q
Secondary surgery, only for severe VPI
A
Pharyngeal flap
4
Q
Pharyngeal flap requires
A
Lateral wall movement
5
Q
Pharyngeal flap risks
A
Stunted facial growth
Sleep apnea
Hyponasality
6
Q
Prosthesis devices
A
Speech bulb/obdurator
Palatal obdurator
Palatal lift
7
Q
What % cleft palate have conductive hearing loss?
A
96%
8
Q
Therapy for cleft patient is appropriate if… (5)
A
Compensatory artic problems Inconsistent or mild nasal rustle (small gap) Phoneme specific nasality Nasality is due to dysarthria or apraxia Improves with trial therapy
9
Q
Muscle for velum raising and vp closure
A
Levator veli palatini
10
Q
Muscle for auditory canal tube opening
A
Tensor veli palatini
11
Q
What does the uvulus muscle do?
A
Shortens velum
Lifts and pulls velum back
Helps with VP closure
12
Q
What does the palatoglossus do?
A
Aids in velar lowering
And/or
Tongue elevation
13
Q
What does the palatopharyngeus do?
A
Constricts and elevates pharynx. Helps with swallowing
14
Q
Babbling and clefts…
A
Less babbling
Delayed reduplicated babbling
15
Q
Cleft and consonant inventories
A
Avoid pressure consonants
Avoid anterior sounds
Fewer overall
16
Q
Compensatory artic patterns
A
Glottal stops and glottal fricatives
17
Q
Common phonological processes with cleft
A
Backing
Nasal assimilation
18
Q
Improve with artic faster if cleft is repaired prior to age
A
10
19
Q
Hypernasality most noticeable on …
A
Vowels
20
Q
Decreased utterance length due to…
A
Air leaks, poor pressure… Causes more respiratory effort, resulting in more frequent breaths
21
Q
Face is developing in what week?
A
4-10th
22
Q
Combo of genetic and environmental factors called…
A
Multifactorial inheritance
23
Q
Incidence cleft lip with or without palate
A
1 in 1000 live births
24
Delayed dentition leads to
Delayed chewing
25
Pharyngeal swallow develops at...
10th to 11th week gestation
26
Palate fuses at what week gestation?
10-11th
27
Suckling ability (anterior to posterior motion) at what week
18-24 weeks gestation
28
Most can suckle and swallow enough to maintain nutrition by age...
8-8.5 months gestation
29
Mix of suckle and suck can be seen in infants as young as...
6-9 months
30
Feeding concerns include...
```
Weak suck
Not enough nutrition taken
Nasal regurgitation
Long feeding over 20-30 mins
Fatigue
Poor weight gain
Parental anxiety affects bonding
```
31
SLP roles
Counsel parent, education
Swallowing
Artic and language
Cleft team coordinator
32
Best feeding position
Upright with chin tuck
33
Tips on feeding...
Weigh infant daily
In/out diary
Frequent burping
34
When to do cleft lip surgery?
Rule of 10s... 10 g Hgb?, 10 weeks, 10 lbs
As early as 6-8 weeks
2-3 months
35
Most common cleft lip surgery
Millard technique...
Cut as you go
Preserves philtral dimple and cupids bow
Scar is along philtral
36
Post cleft lip surgery feelings...
By syringe for 10 days
Velcro arm restraints
Avoid nipples which might damage sutures
Suture line care and cleaning
37
Speech problems persist after palate surgery in what percent of cases?
25%
38
If speech problems persist, secondary physical management (prosthesis) is usually needed by what age?
4 to 8 years
39
Post-op concerns for palate surgery
Swelling obstructs airway
Pain management and over sedation.. Meds given 7-10 days
Change in oral nasal airway dynamics
40
Feeding post palate surgery
Liquid diet
Soft foods 3 weeks post op
Bottles avoided
Arm restraints
41
We may help VP ------- but not VP ----------
Incompetence, but not insufficiency
42
Feedback used in therapy
Biofeedback
Nasometer
CPAP therapy
43
Compensations in glottis and strain may lead to
Voice disorders... Dysphonia, nodules
44
Hypo nasality may be seen on...
Vowels, nasal consonants
45
Soft voice syndrome, due to
Large nasal resonance absorbs acoustic energy - quiet vowels
Loss of pressure through VP port, hard to get loud
As a compensatory strategy for hyper nasality
46
In compensatory artic
Manner usually maintained
Placement is moved back
Create pharyngeal rather than oral pressure
47
Nasal sniff may be used for phoneme...
/s/
48
3 syndromes
Pierre robin sequence
Velocardiofacial syndrome
Stickler syndrome
Apert syndrome
49
Cleft classifications
Lip, palate
Unilateral, bilateral
Complete, incomplete
Primary, secondary palate
50
What is the ratio of left, right, bilateral cleft incidence
6 left - 3 right - 1 both
51
Where pink part of lip meets skin
Vermillion- cutaneous border
52
Hard and soft palates are part of the ---- palate
Secondary
53
Layers of flat broad tendons...
Aponeusosis
54
Nasal cavity roof
Ethmoid bone
55
Nasal floor
Maxilla
56
Nasal lateral walls
Nasal bone
Nasal Conchae
Maxilla
Palatine bone
57
Nasal septum boundaries
Vomer
Ethmoid ... Perpendicular plate
Cartilage
58
Name for nose hairs
Vibrissae
59
Fx of nasal conchae
Increase surface area
Increase turbulence
Reclaim heat from exhaled air
60
Hard palate
Anterior 2/3
Mucosa covered bone
Press food against in chewing
61
Soft palate
Posterior 1/3
Muscle covered by mucosa
Ends in uvula
Closes VP port in swallow
62
Name for bony hard palate growth
Torus palatinus/mandibulus
63
3 phases prenatal development, basic
1 and 2 are embryonic
| 3 is fetal
64
1st embryonic stage
Weeks 0-4
Cellular proliferation and migration
Some differentiation
65
2nd embryonic stage
Weeks 5-8
Differentiation of all organs... Morphogenesis
Very vulnerable stage
66
3rd, fetal stage
Growth and maturation
67
How many face primordia?
5
68
Face primordia develop in week --- and fuse in weeks ----
Develop in week 4
| Fuse in weeks 5-8
69
Ectodermal swellings filled with mesodermal and neural crest cells
Primordia
70
Name the facial primordia
1 Frontonasal prominence
2 mandibular prominences... From branchial arch 1
2 maxillary prominences... From branchial arch 1
71
Primitive mouth
Stomodeum
72
Ruptures to form oral opening
Oral plate lining
73
Thickened plate in ectoderm where sensory organ will develop, ie nose
Placode
Nasal placode
Lens placode
Start out laterally located
74
At 4 weeks in utero
Stomodeum, lining ruptures to be mouth
Nasal placodes laterally
Frontal prominence centrally above
75
At 5 weeks in utero
All major primordia can be distinguished
Mandible forms lower arch
Maxillary arch is lateral
At 5.5 wks, nasomedial and nasolateral processes that form nose
76
Paired arches like gills
Branchial arches and grooves
77
1st branchial arch
Mandibular arch below Stomodeum
Lower lip, mandible, muscles of chewing, front of tongue
Incus and malleus of middle ear (form meckels cartilage)
78
2nd branchial arch
```
Hyoid arch
Side and front of neck
Styloid process
Upper part ... Lesser Cornu... Of hyoid bone
Stapes of middle ear
```
79
3rd branchial arch
Greater Cornu of hyoid bone , bottom part
| Part combines w 2nd arch to make hyoid and posterior tongue
80
4th branchial arch
Thyroid cartilage
81
5th branchial arch
Cricoid and arytenoid cartilages
82
At 6 weeks in utero
Maxillary process more prominent
Growth of nasal processes
Formation of primary palate
Fusion of median, lateral nasal processes and paired maxillary prominences
83
7th week in utero
Inferior tips of medial nasal processes expand laterally to form inter maxillary process
Tips of maxillary swellings meet the inter maxillary process and fuse
84
Cleft lip is a failure of fusion between...
Maxillary swellings and inter maxillary process
85
8th and 9th week in utero
Medial walls of maxillary process produce palatine shelves
Shelves grow down, parallel to lateral surface of tongue
End of week 9... Rotate up to horizontal position
Fuse w each other and primary palate to form secondary palate
86
Earliest ultrasound ID of clefting at...
13 weeks
87
Nares developed by week
Anterior nasal choane, 6th week
88
Tongue moves down, allowing
Palatal shelves to move up and tilt
Back to front
Toward midline
89
Palatal shelves are free of tongue by week...
8
90
Palatal shelves contact anteriorly by end of week...
8
91
Fusion of Palatal shelves moves from
Contact of Palatal shelves moves from
Font to back
Back to front
92
Uvula merges to soft palate by week
12, 1st trimester
Also this is the end of Palatal fusion
93
3 components of VP mechanism
Lateral pharyngeal wall
Posterior pharyngeal wall
Velum
94
Muscle that medializes lateral pharyngeal walls
Superior constrictor
95
For nasals, velum is...
Lowered
96
Swallowing muscles
Tensor veli palatini
| Levator veli palatini
97
Respiration muscles
Palatoglossus
| Palatopharyngeus
98
Innervated by cranial nerve...
10, vagus
99
Front 1/4 of velum is...
Tensor veli palatini
100
Back 3/4 of velum is the
Levator veli palatini
101
Is the uvulus paired?
Yes
102
Antagonist to levator veli palatini, covers mid 50% of velum
Palatopharyngeus
103
3 pharyngeal constrictors
Superior ... Smallest
Middle
Inferior... Largest
104
Saingopharyngeus muscle
Not always present, little relevance, weak muscle
105
Motor nerves of velum
5, 7, 9, 10, 11
106
Sensory nerves of velum
10, 11
107
VP especially important for pressure sensitive sounds, like...
Stops, fricatives, africates
108
Not in all ppl, posterior wall movement during speech...
Passavant's ridge
109
Coronal closure
Movement of velum and posterior pharyngeal wall
Not lateral
110
Sagittal closure
Movement of lateral pharyngeal walls
Little front,back
111
Circular closure pattern
All sides
| Often Passavant's ridge
112
VP insufficiency caused by
Anatomical defects...
Cleft history, short velum, deep pharynx, irregular adenoids, big tonsils
After surgery...
Maxillary advancement, Adenoids tony, treatment of tumor there, spine surgery through mouth
113
VP incompetence caused by
```
Poor muscle fx after cleft repair
Hypotonia
Velar paresis due to cranial nerve injury
Dysarthria
Myasthenia gravis
Apraxia
```
114
Both VP incompetence and insufficiency are types of
VP inadequacy
115
PSNAE
Phoneme specific nasal air emissions
116
When Sound resonates in pharynx or nasal cavity and is not released due to obstruction
Cul de sac resonance
117
Nasal rustle is due to
Turbulence
| Accompanied by nasal grimace often
118
How does nasal air emission affect consonants
Weakens them
119
Striped Y
```
1, 5 floor of nose
2,6 lip
3,7 alveolar ridges
4,8 premaxilla to incisive foramen
9, 10 hard palate
11 soft palate
12 congenital incompetence wo clefts
13 protruding premaxilla
```
120
Very mild incomplete lip cleft, looks like a scar
Forme fruste
121
Incidence cleft palate only
1 in 2000 births
122
Race and clefts
| Gender
Asian, white, black
| Male, female ... Except isolated cp
123
% of cleft types
50 cl and cp...... More unilateral
30 cp alone
20 cl alone, most unilateral
124
Viral risk that causes cleft
Rubella
125
Risk increases with
Dad's age
126
Separates primary and secondary clefts
Incisive foramen
127
Lip abnormality, not really a cleft
Microform
128
Thin bridge of soft tissue across cleft lip
Simonart's band
129
Sub mucosal cleft signs
Bifid uvula
Bony notch into the hard palate
Zona pellucida... Velum mucosa looks thin
130
Fusion of bone sutures is called
Ossification
131
Inter frontal suture timeline
Starts closing after 1 year, usually done by age 7
132
Premature fusion of sutures
Craniosynostosis
133
Craniosynostosis syndromes
Apert syndrome.... Coronal
Crouzon syndrome... Coronal and saggital
Pfeiffer syndrome....all sutures
134
Speech concern outweighs
Maxillary growth constriction
135
Cheiloplasty
Cleft lip repair
136
Which palate surgery elongates the palate?
V-Y repair
137
Orthodontics to prep for surgery
Nasoalveolar molding
138
Bone grafting
From iliac crest of pelvic girdle
Primary... Infancy
Secondary... 8-11 years
Because it doesn't grow
139
Furlow z plasty
Length at expense of width
Thickens velum
May be secondary surgery
140
More likely to be syndromic if
Cleft palate only
141
Ratio of nasal sound energy to total sound energy
Nasalance
142
Red flags, post surgery
Lack of consonant inventory growth
No oral stops 3 months post
Compensatory errors continue
