1. Obvious signs of SMCP
    • bifid uvula
    • zona pellucida of the soft palate (extending into the hard palate)
    • a notch in the posterior border of the hard palate (digitally palpable but not always easily visible)
  2. VP inadequacy in a single patient in the absence of observable clefting can have more than one etiology such as?
    Undiagnosed occult SMCP

    Palatopharyngeal disproportion

    Mechanical obstruction to VP closure

    VP mobility problems; VP incompetency

    VP mislearning
  3. Palatopharyngeal disproportion?
    length of velum-depth of nasopharynx mismatch
  4. Palatopharyngeal disproportion can be due to?
    Short hard palate (brings soft palate forward)

    Short soft palate

    Excessive pharyngeal depth (2 degree of cervical spine/vertebrae, flattened cranial base)
  5. Velopharyngeal Mislearning:

    PSNE-Phoneme specific nasal emission
    selected high pressure consonants

    physical problem
  6. Velopharyngeal Mislearning:

    ___ impairment

    The impact of ?
    post op nasal emission


    compensatory misarticulations (especially glottal stops) on VP closure.
  7. OSMCP is caused by?
    the absence of hypoplasia/underdevelopment of the uvulus muscle

    there is a muscular deficiency on nasal/dorsal surface of the velum
  8. The uvulus muscle runs? on the ?

    It is the most ? of the soft palate

    anterior/posterior direction on the dorsal surface of the velum

    superficial muscle

    from the palatine and runs back to insert into the uvula.
  9. Uvulus muscle is believed to be responsible for?
    • adding thickness to the dorsal surface of the velum
    • for bunching the velum and contributing to the levator eminence
  10. The diagnosis of OSMCP relies on ?
    instrumental (endoscopic) confirmation
  11. OSMCP instrumental (endoscopic) confirmation view?
    a midline deficiency/a central gap in closure, where uvulus muscle activity is missing
  12. OSMCP is a problem we cannot see?
    it is a problem we must suspect when there is? and ?

    hypernasal speech and no visible structural impairment
  13. Palatopharyngeal disproportion can occur ?
    with or without stigmata of SMCP
  14. Palatopharyngeal disproportion abnormal/excessive pharyngeal depth cause:

    fusion of spinous processes of 2 or more cervical vertebrae
    anomalies of the cervical vertebrae
  15. Palatopharyngeal disproportion abnormal/excessive pharyngeal depth cause:?
    Posterior displacement of cervical vertebrae can pull the posterior pharyngeal wall back creating an abnormally deep nasopharynx
  16. cervical spine anomalies can ?
    restrict ROM in the neck
  17. There can be displacement of the atlas up into the foramen magnum this can be?
    life-threatening with head extension- requires surgery
  18. the disproportion can be introgenic secondary to aggressive? that creates?
    adenoidectomy or tonsillectomy that creates an excessively deep pharynx.
  19. A flattened crainial base angle can also contribute to ?
    an abnormally deep pharynx as it has the effect of moving the PPW backward
  20. Mechanical interference or obstruction to VP closure mainly concerns?
    palatine tonsils and adenoid and how they interact with the velum and LPWs in VP closure.
  21. diagnosising tonsils requires?
    direct imaging instrumental assessment via videonasendoscopy or videofluoroscopy
  22. The upper poles of the tonsils can?
    grow up and behind the velum and obstruct velar elevation and retraction, preventing closure against the PPW.
  23. When there is hypernasal speech and no cleft always check for?
    large tonsils as a source of mechanical interference to closure.

    Large tonsils do not always cause hypernasal speech.
  24. Large tonsils tend to mandate movement of the ? in order to provide an ?
    tongue anteriorly

    adequate nasopharyngeal airway.
  25. When the tongue moves anteriorly in large tonsils they tend to ? and cause?
    break the labial seal

    the jaw to open/drop downward.
  26. Adenoid tissue (aka ?) can be either __ or __ to VP closure?
    • (pharyngeal tonsil)
    • assistive
    • inhibitory
  27. In the young and school age child VP closure is actually called?
    Veloadenoidal VA closure
  28. ___ is negligible or absent at birth, increases in size with maturation and then diminishes/involutes; the exact timing of this growth curve is variable?
  29. Snoring in a child usually indicates?
    enlarged, obstructive adenoid
  30. ___ unlike tonsils can be assistive to closure in that the velum has a shorter distance to travel to accomplish closure?
    Adenoid tissue
  31. Irregular adenoid contour or large double-lobed adenoid can be?
    obstructive or inhibitory to closure.
  32. In most instances of large adenoid (wiht or without large tonsils) in youngsters with normal VP closure mechanisms, the speech consequence is?
    denasal speech and possible upper airway restriction.
  33. Be watchful of adenoid growth and developement in both Cleft and non-cleft children, with respect to ?
    determining the stability of VP closure and the need for (more) surgery.
  34. Inadequate movement of velum (PPWs and LPWs) due to ?
    neuromotor dysfunction or primary muscle disease (can be congenital or acquired)
  35. There can be isolated involvement of ? (which is rare)
    VP closure mechanism
  36. Inadequate movement of the velum:
    This problem can be part of a more ? (which is most often the case)
    pervasive dysarthria
  37. Inadequate movement of velum:
    Dysarthria secondary to ?
    congenital problems of cerebral palsy or dystrophies

    or acquired pathologies of adulthood (TBI, stroke, progressive CNS disorders)
  38. In rare cases, VPI/C can be part of an?
    apraxia speech disorder
  39. Some individuals have structurally and phsiologically adequate or normal VP closure mechanisms, but for some reason misuse the closure mechanism in the production specific sounds?
    Velopharyngeal mislearning
  40. Phoneme specific nasal emission affects only selected ___ not all?
    High pressure consonants
  41. Stress ___ has been observed in some wind instrument players?
    • VPI/A
    • VP inadequacy
  42. The onset of VP inadequacy (VPI/A) occurs ?
    after a period of play on the instrument
  43. In reported cases in VPI/A the function for ___ is usually normal?
Card Set
Mod 13 non cleft VP problems