CSD 2230 HUMAN COMMUNICATION DISORDERS

1. CSD 2230HUMAN COMMUNICATION DISORDERS Topic 7 Speech Disorders Cleft Lip and Palate

2. Major Landmarksof the Vocal Tract Disorders involving cleft lip and palate involve the lips, hard palate, and the velum

3. The Palate Anterior 2/3 is the hard palate • Stationary • Purpose is to separate the oral and nasal cavities Posterior 1/3 is the soft palate • Mucosal tissue and muscles

4. Velopharyngeal Mechanism Components • Velum • Muscles in the back of the throat

5. The Purpose of the Velum The velum needs to be closed and the oral and nasal cavities separated when we swallow and during the production of most English speech sounds

6. Some Terms and Definitions Velopharyngeal Competence The velopharygeal mechanism adequately closes the portal during swallowing and speech Velopharyngeal Incompetence (VPI) The velopharyngeal mechanism is incapable of separating the oral and nasal cavities during swallowing and speech

7. Embryologic Development of the Face and Palate Development 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 interrupted CD-ROM Ch.11.08 morphing sequence depicting embryologic development of the human face

8. Embryologic Development of the Face and Palate Development of the secondary palate • Bony hard palate and the velum • Process and fusion occurs between the 8th and 12th week of gestation Problems or factors that prevent fusion of the palatal shelves result in an isolated cleft of the hard and/or soft palate

9. Classification of Clefts and Clinical Features Clefts are classified as • unilateral or bilateral cleft of the lip • unilateral cleft of the lip and palate • bilateral cleft of the lip and palate • submucous cleft • bifid uvula

10. Cleft Lip Involves the vermilion border of the upper lip and may extend through the lip toward the nostril Affects the shape of the nose Can be either unilateral or bilateral • Unilateral clefts usually occur on the left side • Bilateral clefts usually involve the palate Cleft lip by itself is rare

11. Unilateral and Bilateral Cleft Lip and Palate Unilateral • Extends from the external portion of the upper lip, through the alveolar ridge, and through the hard and soft palates Bilateral • 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 cleft

12. Submucous Cleft and Bifid Uvula Submucous cleft • Muscular cleft of the soft palate • A bifid uvula sometimes accompanies this

13. Etiologies • Genetic disorders • Factor in over 400 different genetic syndromes • Chromosomal aberrations • Teratogenically induced disorders • Environmental teratogens are agents that interfere with or interrupt normal fetal development • Mechanically induced abnormalities Amniotic rupture, intrauterine crowding, uterine tumors, irregularly-shaped uterus

14. Incidence • 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 Africans

15. Management of Clefts • Team approach

16. Surgical Management Primary correction • Lip surgery by 3 months • Palatal cleft surgery by 6-18 months Secondary correction • Pharyngeal flap • 25% of cases • Improves velopharyngeal competence • Done between 6-12 years of age

17. Dental Management Issues related to chewing and speech Orthodontists Prostodontists • obturators

18. Audiological Management Middle ear disease • Chronic otitis media • Persistent conductive hearing loss

19. Psychosocial Management Facial differences Speech differences Self-esteem

20. Communication Problems Inherent with Clefts 80% of individuals born with clefts not associated with a syndrome who receive palatal repair by 18 months can expect reasonably good speech without intervention

21. Resonance Hypernasality because of VPI Continuum 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 resonance Audio example of samples of speech representing a continuum ranging from hyponasality through very severe hypernasality

22. Articulation Articulation 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 emission Compensatory articulation errors • Glottal stop

23. Some 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 distortions

24. Voice Vocal nodules • Hoarse and breath vocal quality • Caused by vocal hyperfunction Audio examples • Samples 17 and 18 illustrate mild and severe degrees of hoarseness • Sample 19 illustrates extreme vocal tension and the use of inhalation tension

25. Language Mild language delays Audio examples • Samples 22 and 23 illustrate problems with morphophonemic markers • Sample 24 illustrates a change of syntactic form when morphophonemic marking is too demanding

26. Audio Case Study of a Mild Disorder 10 year old male Speech problems • Mild, inconsistent, bilateral nasal emission • Mild hypernasality • Moderate hoarseness • Developmental articulation errors • Omission of sibilants in consonant clusters

27. Audio Case Study of a Moderate Disorder 6 year old male Speech problems • Consistent, bilateral nasal emission • Audible nasal air turbulence • Moderate hypernasality • Mild hoarseness • Reduction of intraoral pressure on sibilants and lateralized sibilants • Other articulation errors

28. Audio Case Study of a Severe Disorder 8 year old male Speech problems • Severe, consistent, bilateral nasal emission • Severe hypernasality • Moderate hoarseness • Reduced intraoral air pressure • Glottal and pharyngeal substitution for plosives and fricatives