Structural, Cleft Palate, Craniofacial

Front 1

Which LAYER does CP result from?

Back 1

CP results from a disturbance to the MESODERM (middle layer):

The middle layer gives rise to: muscle, connective tissue, bone & cartilage, blood vessels

Front 2

When does CL form?

Back 2

Results when there is a failure in union/merging of the MAXILLARY& NASOMEDIAL processes

Front 3

When does CP form?

Back 3

Results from the failure in midline union of PALATAL SHELVES

Front 4

Normal VPC mechanism

Back 4

Is a sphincteric valving operation esstial to normal speech, whistling, blowing, swallowing, and sucking

Front 5

Normal VPC mechanism for speech

Back 5

VPC requires upward & backward movement of soft palate, along with medial movement of lateral pharyngeal walls and posterior pharyngeal walls.

- It separates the nasal and oral cavities

Front 6

Uvulus Muscle

Back 6

- BIG Contributor in VP closure

- The only INTRINSIC Muscle of the soft palate

Attachments: Has A-P orientation; Anteriorly attaches from palatine aponeurosis (two separate bundles run parallel to each other and course posteriorly thru velum superficial to levator)

Inserts: Into the uvula near the tip

Action: Bulges the middle third of dorsal (upper) surface of the velum, making the major contribution to Levator Eminence

Front 7

What are the muscles that contribute to VPC for speech?

Back 7

1. Levator Veli Palatini
2. Uvulus
3. Superior constrictor
4. Palatopharyngeus

Front 8

Superior Constrictor

Attachments/actions

Back 8

- Has lesser contributions in VPC than the other muscles

Attachments: From behind- attaches to median ralphe of pharynx; runs forward/anteriorly in pharyngeal wall and most superior fibers enter velum; attaches anteriorly to hamulus of medial pterygoid plate, pterygomandibular raphe; has lesser attachments to lingual base & mandibular alveolus

Actions: Responsible for medial movements of lateral pharyngeal walls & forward movements of posterior pharyngeal wall which take place at level of palatal plane (or below palatal plane for swallowing)

Front 9

Levator Veli Palatini

Back 9

Attachments: From the ptrous portion of temporal bone, courses downward and medially passing below and lateral eustachian tube opening and torus tubarius to enter the middle third of velum where it meets its partner from the other side

Actions: Elevates & retracts the velum; makes some contribution to levator eminence

Front 10

Palatopharyngeus

Back 10

Attachments: Attaches from lateral pharyngeal walls at the level of thyroid cartilage and courses up

Inserts: Into posterior third of velum on each side

Actions: May contribute to narrowing VP port; May be responsible for medial movement of lateral pharyngeal walls; **Participates in lowering velum

Front 11

At what age do you have the CL repaired? CP repaired?

Back 11

CL- 10-12 weeks

CP- 9-12 weeks

Front 12

Children with CP universally suffer from what?

Back 12

Chronic Middle Ear Dysfunction - PE tubes are typically inserted at the time of lip repair and/or initial repair

Front 13

What are sources of early speech sound MISLEARNING in CP?

Back 13

1. Deficient Velopharyngeal Valve - therefore VPC is not possible

2. Absent/structurally aberrant bony partition (causes sensorimotor mislearning)

3. Hearing loss 2' to middle ear effusion

Front 14

Submucous Cleft Palate signs?

Back 14

1. Bifid uvula
2. Midline Diastema/pale zone of the palate
3. Palpable notch

Front 15

What are some possible causes of VP Inadequacy?

Back 15

- SMCP
- Occult SMCP
- Palatopharyngeal Disproportion
- Mechanical Interference/obstruction to adequate VP closure (tonsils, adenoids, faucial pillars)
- Inadequate movement of velum
- Velopharyngeal mislearning

Front 16

What are some types of Velopharyngeal Incompetency? (non-cleft)

Back 16

1. Primary Motor/Neuromotor Control (Dysarthria, Cerebral Palsy, TBI, CVA, progressive disease)

2. Motor Association/Motor Programming (Arpaxia)

Front 17

What are some types of Velopharyngeal Mislearning? (non-cleft)

Back 17

1. Phonemic-Specific Nasal Emission (selective HPCs)

2. Persisting Post-op Nasal

3.Compensatory Misarticulations

4. Deafness/Hearing Impaired

Front 18

What are some types of Velopharyngeal Insufficiency? (non-cleft)

Back 18

1. Mechanical Interference (tonsils, adenoids, posterior pillar web)

2. Palatopharungeal Disportion (cervical anomalies, flattened cranial base)

3. Ablative palatal lesions (cancer, traumatic injury)

Front 19

What some causes of VP inadequacy with clefts?

Back 19

1. Unrepaired palatal clefts (overt, submucous, Occult submucous)

2. Post-surgical Insufficiency (post-palatal closure, Post-adenoidectomy, Post-pharyngeal flap, Complicated fistula)

Front 20

What does intermittent Hypernasality suggest?

Back 20

- Marginal/sporadic closure ability
or
- Phonemic Specific Nasal Emission

Front 21

What does continuous/pervasive Hypernasality suggest?

Back 21

- Physically based VP problem

Front 22

What does hyponasality or cul-de-sac in connected speech on nasal consonants, vowels, and sonorants suggests?

Back 22

- Large Adenoids
or
- Obstructive Pharyngeal Flap
or
- Intranasal airway obstruction

Front 23

What does consistent Nasal Emission on all pressure consonants suggests?

Back 23

Structural:
- Unoperated cleft
- Inadequately Repaired Cleft
or
Non-structural:
- Neurogenic

Front 24

What does inconsistent Nasal Emission suggests?

Back 24

Fistula
or
PSNE

Front 25

What does weak oral pressure suggests?

Back 25

- Physically based VP closure pattern

Front 26

What is always seen with pt w/ NE and continuous HN?

Back 26

Weak Oral Pressures