question

Direct measurements

answer

videofluoroscopy & nasopharyngoscopy

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Indirect measurements

answer

nasometry and aerodynamic instrumentation

question

Advantage and disadvantage of indirect measurements

answer

Advantage: provide OBJECTIVE data about the function of the VP mechanism that is comparable across professionals and centers Disadvantage: No visualization of structures

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The most important tool we have for decision making regarding VP function and the need for management.

answer

Experienced examiner's ear

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The best age for a first speech assessment

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First year, preferably by 6 mos

question

What % of children with cleft palate will require secondary palatal surgery?

answer

25%

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A nasometer measures......

answer

nasal acoustic energy

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Nasometer scores

answer

10%-20% normal 20%-30% borderline 30%-40% mild 40%-50% moderate 50% + severe

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Interpretation of nasalance scores

answer

CulDeSac=normal SMALL VP opening= HIGH nasalance score LARGE VP opening=MODERATE score Low volume, articulation errors, fistulae can affect scores

question

Nasogram

answer

A contour display of the individual data points in a sequence as they are collected in real time during the production of a passage.

question

videofluoroscopy

answer

Why do we do it? Provides real time visualization of the VP valve during speech along with simultaneous audio recording. Useful in the evaluation of VP dysfunction (X-Ray source). What view does it give us? Two-dimensional imaging. Lateral (sagittal) view, AP view, base view looking up under the chin.

question

Videonasendoscopy:

answer

Why do we do it? Minimally invasive endoscopic procedure. Allows direct visual observation and analysis of the velopharyngeal mechanism during speech. Used to ASSESS THE RESULTS OF SURGERY for VPI. What view does it give us? NASAL SURFACE OF VELUM Scope is inserted into the nose and then directed back to the pharynx where the tip "periscopes" down to see the nasopharyngeal structures from above.

question

Palatoplasty:

answer

Cleft palate repair (done between 9-12 mos.) Goal = SEPARATE ORAL AND NASAL CAVITIES for the benefit of feeding, middle ear function, but most of all for speech Surgical restoration of soft tissue help to approx. maxillary bony segments à bone remains discontinuous, but covered with mucosa Delayed if mandible is small or significant airway probs (Pierre Robin sequence)

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Pharyngoplasty

answer

Surgical procedure of pharynx for correction of VPI Goals = "normalize" VP closure for speech, and avoid airway compromise Must make sure they don't have significant airway obstruction or medialized carotid artery in pharyngeal wall (e.g., velocardiofacial) All surgeries can result in a possible under (lack of total closure=hypernasal) or over (small port = hypo) correction

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Le Fort I:

answer

Low maxillary Includes maxilla with the alveolar arch

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Le Fort II:

answer

Mid maxillary Includes maxilla, nasal pyramid, and base of orbit

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Le Fort III:

answer

High maxillary Includes maxillary, nasal pyramid, zygomats, orbits and forehead. Advancements can cause VPI Purpose: To bring the maxilla into proper alignment with the mandible, thus correcting the facial profile and Class III malocclusion, which improves aesthetics and speech production.

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What do we know about infants & toddlers with CP/L? Speech production

answer

--Vocalizations are produced in larynx or posterior oral cavity --bilabial m first; often just use /m/, sometimes /n, y/ --GLOTTAL articulation may persist and become phonemic in the absence of adequate phonemic repertoire --Little production of oral stop and alveolar consonants ==Because infants with clp have limited practice with sounds==less feedback available from practicing of sounds

question

What do we know about infants and toddlers with CP/L? Language production

answer

Low MLU Limited CV inventory with meaning attached Slower lexical growth Expressive language/reading difficulties may persist in school-age

question

Glottal Stops

answer

Make the child aware of the wrong sound and the target -Watch neck in mirror during production -Feel the neck during production -Hear the difference by contrasting the glottal stop with voice onset with single vowels and with nasal syllables (i.e., ma) -Hear the difference between the target sound and the glottal stop -Produce an isolated voiceless plosive (i.e., /p/) -Produce the /p/ and then the vowel preceded by an /h/ (i.e., /p...hɑ/ -Produce the /b/ with a whisper and add an /h/ before the vowel (i.e., /b...hɑ/

question

Why is the birth of a baby with a craniofacial anomaly more stressful than a birth of a healthy baby?

answer

More demands on parents due to medical appointments and feeding difficulties.

question

Teasing of children with craniofacial anomalies can be

answer

altered by the child's personality style.

question

What causes stigma for people with CF anomalies?

answer

Deviation from cultural standards of beauty

question

What is not true about adults with clefts, as compared to their peers?

answer

Tend to end education earlier

question

What is true about teens and children with cleft/lip palate? (about relationships)

answer

They have more difficulty with peer relationships

question

Which syndrome includes a risk of psychosis as child gets older?

answer

Velocardiofacial

question

Which occlusion may cause bilabials to be produced as reverse labiodentals?

answer

Class III

question

Which occlusion may include mandibular prognathism?

answer

Class III

question

A normal skeletal relationship?

answer

Class I

question

Most likely associated with micrognathia?

answer

Class II

question

Normal occlusion, but maxillary incisors are inside the mandibular incisors?

answer

Anterior crossbite

question

Causes tongue tip to be under hard palate instead of alveolar ridge

answer

Class II

question

Causes frontal lisp as an obligatory error

answer

Anterior crossbite

question

NOT a dental anomaly associated with clefts?

answer

Diastema

question

What stage of dental development should palatal orthopedics be done?

answer

INFANT 0-12 mos

question

The appliance that may be helpful with speech therapy for correction of palatal dorsal productions?

answer

Rapid palatal expander

question

Sounds most likely affected by protruding premaxilla?

answer

bilabials

question

Sounds most likely affected by anterior crossbite?

answer

siblants

question

Permanent teeth

answer

succedaneous teeth

question

How many teeth do children have? adults?

answer

20; 32

question

When does buccal crossbite occur?

answer

When one or more maxillary teeth are positioned buccally such that the maxillary lingual cusps reside buccal to the mandibular cusps

question

Most commonly seen occlusion in people with history of CL/P?

answer

Class III

question

When lower teeth overlap the upper teeth?

answer

Anterior crossbite

question

Vertical overlap of lower incisors over upper incisors?

answer

UNDERbite

question

When upper teeth are lingual to lower teeth?

answer

UnderJET

question

Horizontal relationship of upper to lower incisors

answer

OVERjet

question

When one or more of the maxillary teeth fail to occlude with the opposing mandibular teeth?

answer

Open bite

question

Part of the dental arch posterior to the canine teeth?

answer

Buccal

question

Teeth that erupt in an abnormal position?

answer

Ectopic

question

What age does an infants tooth first erupt?

answer

8 months

question

When is primary dentition complete?

answer

24 to 30 months

question

Sounds MOST affected by dental anomalies?

answer

siblants

question

A COMPENSATORY error due to class III malocclusion

answer

lateral lisp

question

OBLIGATORY distortion due to class III malocclusion

answer

frontal lisp

question

Used to repair a cleft LIP

answer

Tennison-Randall also Millard

question

Oldest and most successful means to repair a cleft palate

answer

Von Langenbeck procedure

question

Used to close a fistula

answer

tongue flap

question

General term for lip repair

answer

Cheiloplasty

question

General term for surgery to repair VPI

answer

Pharyngoplasty

question

Used for very small VP openings?

answer

VP augmentations; substance such as collagen is injected or surgically placed into posterior pharyngeal wall.

question

Often needs to be done before a pharyngeal flap?

answer

Tonsillectomy

question

Can be used as primary palate repair or as a secondary procedure, lengthens velum and includes reconstruction of levator sling.

answer

Flurlow-Z Plasty

question

Best procedure for large midline VP opening

answer

pharyngeal flap A superiorly-based flap is made by making an INCISION IN THE PHARYNGEAL WALL that begins at the top of the nasopharynx, then goes down to the area near the base of the tongue, across the width of the pharynx, and then up again. The flap from the posterior pharyngeal wall is then elevated and SUTURED INTO THE VELUM, forming a bridge between the posterior pharyngeal wall and the velum. A port is left on each side of the flap for nasal breathing.

question

Uses palatopharyngeal muscles

answer

Sphincter pharyngoplasty Bilateral superiorly-based flaps are RAISED from the POSTERIOR FAUCIAL PILLARS (which include the palatopharyngeus muscles). Flaps are rotated posteriorly and inset into the nasopharynx at the level of VP closure. This creates a sphincter (which may not be dynamic) that encircles the velopharyngeal port. It can also be done unilaterally for unilateral gaps.

question

After facial growth is completed, to correct skeletal malocclusion

answer

Le Fort surgery I maxillary advancement

question

Rarely has effect on speech but may correct nasality/cul de sac resonance

answer

Tonsillectomy

question

usually contraindicated when there is a history of cleft palate

answer

adenoidectomy

question

Rule of 10s for LIP REPAIR?

answer

10 WEEKS old, 10 pounds, 10 grams of hemoglobin, (white count no higher than 10,000)

question

What is location of intentional fistula?

answer

Alveolus under the lip

question

Why is alveolar arch left unrepaired until age 6 or 7?

answer

Allows anterior facial growth without restriction

question

patients with history of cleft palate and surgical repair have history of

answer

class III malocclusion and midface retrusion

question

Earliest pharyngoplasty is usually done at age

answer

2.5 to 3 years

question

When is cheiloplasty performed?

answer

10 to 12 weeks

question

Common surgical procedure for VP insufficiency

answer

pharyngeal flap

question

Preferred method of treatment for VP insufficiency?

answer

surgical intervention

question

Can compensatory productions secondary to VPI be corrected with speech therapy?

answer

Yes

question

Best way to treat phoneme specific nasal emission of s?

answer

Changing articulation placement

question

Obligatory distortions commonly occur with structural abnormalities in the vocal tract (T/F)

answer

True

question

Yawn technique is used for?

answer

substitution of ing/l

question

_____ ______ can be corrected with speech therapy when there is VPI

answer

placement errors

question

Often co-articulated with oral placement?

answer

palatal dorsal production

question

pushing under child's chin may be helpful to achieve the sounds...

answer

/r/ and velars

question

What is treated by starting with a /t/ sound?

answer

Pharyngeal fricatives for /s/ and /z/

question

_________ and _______ most affects success of motor learning and motor memory

answer

feedback and frequent practice

question

For correction of speech sound errors: begin with sound in final word position (T/F)

answer

FALSE

question

Compensatory errors are NOT caused by nasal emission (T/F)

answer

TRUE

question

Speech therapy is effective for what, secondary to VPI?

answer

Compensatory productions

question

The extent to which a score is able to correctly identify individuals with abnormal resonance

answer

Sensitivity

question

The percentage value of nasal acoustic energy of the total (oral and nasal) energy

answer

Nasalance score

question

The extent to which the score correctly excludes individuals with normal resonance

answer

Specificity

question

Range between maximum and minimum nasalance

answer

Nasalance distance

question

Visual display of data on computer screen

answer

nasogram

question

Advantage of using a standardized passage to gather nasometric data?

answer

Can be compared to normative data

question

Nasalance score for prolonged /s/ in average person?

answer

0%

question

Primary determinant of nasalance score?

answer

Type of vowels in the passage

question

High vowels have more resonance than low vowels. Why?

answer

Tongue position in oral cavity

question

During production of an oral passage, typical nasal resonance should be

answer

Under 20 percentage points

question

When child orally reads a nasal passage and data points are consistently low, what does this mean?

answer

Hyponasality or upper airway obstruction

question

Accent, dialect, language with lots of high back tongue movements would give you a nasalance score that is......

answer

higher than normal

question

This can not be assessed through nasometry

answer

Intra-oral air pressure

question

Most important statistic obtained through nasometry?

answer

Mean nasalance score

question

First instrument to measure nasal and acoustic energy?

answer

TONAR

question

Not addressed routinely by palatoplasty or cheiloplasty

answer

alveolus

question

Procedure to correct an alveolar cleft?

answer

bone graft

question

Genioplasty?

answer

Advancement of the chin

question

What is a cant?

answer

Slant in occlusion

question

At what age (for girls and boys) is secondary orthognathic surgery performed?

answer

Girls: 15 Boys: 17

question

Timing of bone graft depends on

answer

Child's dental development

question

What can be fixed with maxillary advancement surgery alone?

answer

obligatory distortions and hyponasality

question

Children with what have a cant to the maxilla?

answer

Hemifacial microsomia

question

Orgnognathic surgery of maxilla cannot be performed until the ________________ is well developed

answer

maxillary sinus

question

Potential postoperative complication of maxillary advancement surgery?

answer

Loss of teeth

question

Common problem associated with a retrodisplaced or small maxilla?

answer

Sleep apnea and hyponasality

question

If alveolar cleft is left untreated, which teeth could a child lose?

answer

permanent lateral incisor and canine

question

A partial cut is made into the middle of the bone and then segments are slowly pulled apart to allow new bone to regenerate in the space

answer

distraction osteogenesis

question

Transducers convert detected air pressure or flow into ELECTRICAL SIGNALS for further processing (T/F)

answer

True

question

What procedure measures airway resistance in the nasal cavity?

answer

Rhinomanometry

question

Approximate surgery timeline

answer

Lip repair: 10-12 weeks (3 months optimal) Palate repair: 9-12 months (10 months optimal) VPI: 2.3-3 (3-5 years optimal) Bone graft: 6-7 years Oronasal fistula: typically with bone graft Orthognathic: girls: 14-15; boys: 18-19 (book says girls 15 and boys 17 for secondary)

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