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Chapter 11
Lecture 8
35
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03/17/2012

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Term
Craniofacial Abnormalities
Definition
Congenitive malformations involving the head or face
Term
Clefts
Definition
Abnormal openings in anatomical features, interferes with basic biological functioning (eating) and communication
Term
Velopharyngeal Inadequacies (VPI)
Definition
Velopharyngeal mechanism (velum) does not close adequately
Term
[image]
Definition

Alar base and rim - where nose connects to face

Columella - column between nostrils, gives the nose its tip

Philtral ridges - ridges near the upper lip

Philtrum - groove between philtral ridges

Cupid's brow

Term
Velopharyngeal Port
Definition
Opening behind the velum, where velum goes when elevated
Term
Complete vs. Incomplete Cleft
Definition
Complete Cleft - goes into the nasal cavity
Incomplete Cleft - doesn't reach the nasal cavity entirely
Term
Bilateral vs. Unilateral
Definition
Bilateral - two, along both sides
Unilateral - one, usually centered
Term
Classifications (2)
Definition
1. Primary Palate - lip and alveolar process (bilateral/unilateral, complete/incomplete)
2. Secondary Palate - hard and soft palate/velum; area posterior to incisive foramen (complete/incomplete)
Term
Incisive foramen
Definition
Funnel-shaped opening in hard palate, located directly behind incisors where blood vessels and nerves pass
Term
Submucous Cleft
Definition
Mucus membrane is intact, cleft is beneath the skin, usually diagnosed by hypernasality in speech
May exhibit: bifid uvula, furrow along midline, zona pellucida (blueish tint to pallate), bony notch where posterior nasal spine should be, anterior insertion of levator muscles
Term
Cleft
Definition
#1 birth defect in the US
1 in 595
Term
% of Cleft
Definition
25% lip only
25% pallate only
50% lip and pallate
Most common in Native Americans, then Asians, then Caucasians, then African Americans
Term
Gender
Definition
males>females with combination clefts
males>females with severe forms
females>males with pallatal clefts only and often associated with syndromes
Term
Causes of Cleft
Definition
Multifactoral Inheritance: predisposition is added onto by environmental factors (terratogens; valium, dilantin, smoking, insufficient folic acid)
20% inherited
3-5% chromosomal
65% environmental/unknown
No specific gene found/specified that causes cleft
Term
Dental Issues in Cleft Lip and Pallate Cases (III Classes)
Definition
Class I - occlusion or malocclusion (normal)
Class II - mandibular retrusion and/or maxillary protrusion
Class III - mandibular protrusion and/or maxillary retrusion
Term
Occlusion
Definition
Arrangement of molars, to fix irregular occlusion must realign jaw
Term
Class I
Definition
[image]
Jaws are correctly aligned
Term
Class II
Definition
[image]
Cusp of the mandibular 1st molar sits between the 1st and 2nd cusps of the maxillary molars
Mandible is too far back
Term
Class III
Definition
[image]
Opposite problem of Class II
Maxilla is too far back
Term
Other Dental Problems
Definition
Overbite - upper teeth cover bottom
Overjet - front teeth too forward
Crossbite - upper teeth inside lower jaw
Missing or Rotated teeth
Supernumerary - extra teeth
Term
Hearing Problems
Definition

Ossicular Abnormalities

  • Causes: genetic (Treacher Collins Syndrome) and terratogens (viral infections)

Eustachian tube malformation

  • Chronic Otitis Media - fluid in the ears doesn't leave/drain into throat and gets infected
    • 2 causes
      • obstruction (enflamed adenoids, sinusitis, allergies)
      • dysfunction of opening mechanism
    • Treatment
      • Medical (antibiotics, antihistamines, decongestants)
    • Surgical (sometimes adenoidectomy, myringotomy - insertion of PE tubes; these may create more problems though)
Term
Surgeries for Cleft
Definition
Multiple surgeries necessary
Lip can be done at 10 weeks
Palate can be done at 9 to 12 months
Term
Secondary Repair is necessary to:
Definition
1. Close palatal fistula (hole in palate)
2. Correct maxillary or mandibular problems
3. Correct Velopharyngeal dysfunction (10-35%)

30% of patients need some type of secondary repair, technically the 3rd surgery but is the 2nd done to the palate
Term
Feeding Issues
Definition
Cleft Lip - problems with bottle/breast feeding, may see difficulty latching on
Cleft Palate - mostly due to nasal reflux (SLP tries to get rid of/get around reflux), selection of most appropriate bottle/nipple, positioning of infant and nipple, follow feeding schedule, and frequent burping
Term
Psychosocial Issues with Cleft
Definition
Perception of Intelligence - existence of cleft does not cause difference in IQ and academic success
Teachers report knowing little about cleft, misconceptions about IQ may shape teachers expectations for students and therefore the student's performance
Term
Speech/Language and Cleft
Definition
Babbling - fewer consonants, less frequent, slower, articulatory problems (compensatory articulatory errors)
Development of language is delayed but catches up with age, impairment varies but is associated with receptive, expressive, reading, or learning disorders

Patients with cleft DO catch up!
Term
Velopharyngeal Dysfunction (VP Dys)
Definition
Velum does not close off pharyngeal cavity completely, results in hypernasality
Term
Hypernasality
Definition
Excessive nasal resonance caused by structural differences
Hear: "m" and "n"
Term
Hyponasality (denasality)
Definition
Lack of normal nasal resonance caused by structural differences
Particularly affects m, n, ng sounds
Hear: "b," "d," and "g"
Term
Nasal Air Emission (NAE)
Definition
More air release through nasal cavity than normal; results in hypernasality, especially on consonants
May exhibit nasal grimace
Term
Phone Specific NAE
Definition
Produce posterior nasal fricative in substitution for "s" or "z"
Faulty articulation, not anatomical or physiological problems and therefore only require therapy
Term
Clinical Evaluation Steps
Definition
1. Listener judgement/perceptual analysis of problem
2. Assumptions of physiology and anatomy
3. Instrumental analysis should confirm perceptual judgement, NEVER USED TO MAKE DECISIONS
Term
Orofacial Exams, what to look for (oro)
Definition
Hard Palate
Term
Orofacial Evaluations, what to look for (facial)
Definition

Lips - is there sufficient movement for speech sounds?

Eyes

Ears

  • microtia - deformed ear
  • anotia - no outer ear
  • atresia - no ear canal

Nose/airway - patency of each nostril

Maxilla - micro/macronathia, micro/macrostoma

Dentition

Tongue

  • ankyloglossia - tongue tied
Term
Therapy
Definition
CAN'T change abnormal structure-> must have surgery to correct these problems
CAN change behavior and techniques and correct mislearning, sometimes used for velopharyngeal incompetence