CSD 2230 HUMAN COMMUNICATION DISORDERSMajor Landmarks of the Vocal TractThe PalateVelopharyngeal MechanismThe Purpose of the VelumSome Terms and DefinitionsEmbryologic Development of the Face and PalateSlide 8Classification of Clefts and Clinical FeaturesCleft LipUnilateral and Bilateral Cleft Lip and PalateSubmucous Cleft and Bifid UvulaEtiologiesIncidenceManagement of CleftsSurgical ManagementDental ManagementAudiological ManagementPsychosocial ManagementCommunication Problems Inherent with CleftsResonanceArticulationSome Audio ExamplesVoiceLanguageAudio Case Study of a Mild DisorderAudio Case Study of a Moderate DisorderAudio Case Study of a Severe DisorderPowerPoint PresentationCSD 2230HUMAN COMMUNICATION DISORDERSTopic 7Speech DisordersCleft Lip and PalateMajor Landmarksof the Vocal TractDisorders involving cleft lip and palate involve the lips, hard palate, and the velumThe PalateAnterior 2/3 is the hard palateStationaryPurpose is to separate the oral and nasal cavitiesPosterior 1/3 is the soft palateMucosal tissue and musclesVelopharyngeal MechanismComponents1. Velum2. Muscles in the back of the throatThe Purpose of the VelumThe velum needs to be closed and the oral and nasal cavities separated when we swallow and during the production of most English speech soundsSome Terms and DefinitionsVelopharyngeal CompetenceThe velopharygeal mechanism adequately closes the portal during swallowing and speechVelopharyngeal Incompetence (VPI)The velopharyngeal mechanism is incapable of separating the oral and nasal cavities during swallowing and speechEmbryologic Development of the Face and PalateDevelopment of the faceFormed between the 5th and 8th weeks of gestationResults from the fusion ofTwo mandibular processesOne frontonasal processTwo maxillary processesCleft lip occurs when the fusion process between the frontnasal masses and the maxillary processes is interruptedCD-ROM Ch.11.08 morphing sequence depicting embryologic development of the human faceEmbryologic Development of the Face and PalateDevelopment of the secondary palateBony hard palate and the velumProcess and fusion occurs between the 8th and 12th week of gestationProblems or factors that prevent fusion of the palatal shelves result in an isolated cleft of the hard and/or soft palateClassification of Clefts and Clinical FeaturesClefts are classified as1. unilateral or bilateral cleft of the lip2. unilateral cleft of the lip and palate3. bilateral cleft of the lip and palate4. submucous cleft5. bifid uvulaCleft LipInvolves the vermilion border of the upper lip and may extend through the lip toward the nostrilAffects the shape of the noseCan be either unilateral or bilateralUnilateral clefts usually occur on the left sideBilateral clefts usually involve the palateCleft lip by itself is rareUnilateral and Bilateral Cleft Lip and PalateUnilateralExtends from the external portion of the upper lip, through the alveolar ridge, and through the hard and soft palatesBilateralThe lip and the alveolar ridge is cleft under both nostrils and the central portion of the lip, alveolar ridge, and the premaxilla are positioned abnormallyThe tip of the nose is attached directly to the lipMost severe form of cleftSubmucous Cleft and Bifid UvulaSubmucous cleftMuscular cleft of the soft palateA bifid uvula sometimes accompanies thisEtiologies1. Genetic disordersnFactor in over 400 different genetic syndromes2. Chromosomal aberrations3. Teratogenically induced disordersnEnvironmental teratogens are agents that interfere with or interrupt normal fetal development4. Mechanically induced abnormalitiesAmniotic rupture, intrauterine crowding, uterine tumors, irregularly-shaped uterusIncidence1/750 live birthsClefts of the lip (with or w/out involving the palate) occur more frequently than cleft palate aloneSubmucous clefts are more rare (1/1200 births) The incidence of clefts are thought to be increasingClefts occur more often in males and tend to be more severeNative north Americans have the highest incidence rates followed by Asians, Caucasians, and AfricansManagement of CleftsTeam approachSurgical ManagementPrimary correctionLip surgery by 3 monthsPalatal cleft surgery by 6-18 monthsSecondary correctionPharyngeal flap25% of casesImproves velopharyngeal competenceDone between 6-12 years of ageDental ManagementIssues related to chewing and speechOrthodontistsProstodontistsobturatorsAudiological ManagementMiddle ear diseaseChronic otitis mediaPersistent conductive hearing lossPsychosocial ManagementFacial differencesSpeech differencesSelf-esteemCommunication Problems Inherent with Clefts80% of individuals born with clefts not associated with a syndrome who receive palatal repair by 18 months can expect reasonably good speech without interventionResonanceHypernasality because of VPIContinuum from hyponasility, which is due to the lack of nasal resonance to hypernasility, which is due to too much nasal resonance and not enough oral resonanceAudio example of samples of speech representing a continuum ranging from hyponasality through very severe hypernasalityArticulationArticulation disorders are the result of VPI, structural deviations in the oral cavity, dental anomolies, and faulty learningPhonemes commonly affected include /s/, /z/, /th/, /ch/, and /ts/Problems with oral pressureNasal emissionCompensatory articulation errorsGlottal stopSome Audio ExamplesSamples 1 and 2 illustrate reduced oral pressuresSamples 3 and 4 illustrate problems related to nasal emissionsSamples 10 and 11 illustrate common articulation errors (substitutions and omissionsSample 12 illustrates substitution of glottal stops for oral stopsSamples 13-16 illustrate some unusual substitutions and distortionsVoiceVocal nodulesHoarse and breath vocal qualityCaused by vocal hyperfunctionAudio examplesSamples 17 and 18 illustrate mild and severe degrees of hoarsenessSample 19 illustrates extreme vocal tension and the use of inhalation tensionLanguageMild language delaysAudio examplesSamples 22 and 23 illustrate problems with morphophonemic markersSample 24 illustrates a change of syntactic form when morphophonemic marking is too demandingAudio Case Study of a Mild Disorder10 year old maleSpeech problemsMild, inconsistent, bilateral nasal emissionMild hypernasalityModerate hoarsenessDevelopmental articulation