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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)
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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
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Palatopharyngeal disproportion?
length of velum-depth of nasopharynx mismatch
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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)
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Velopharyngeal Mislearning:
PSNE-Phoneme specific nasal emission
affects?
No?
selected high pressure consonants
physical problem
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Velopharyngeal Mislearning:
Persisting?
___ impairment
The impact of ?
post op nasal emission
deafness/hearing
compensatory misarticulations (especially glottal stops) on VP closure.
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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
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The uvulus muscle runs? on the ?
It is the most ? of the soft palate
Attaches?
anterior/posterior direction on the dorsal surface of the velum
superficial muscle
from the palatine and runs back to insert into the uvula.
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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
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The diagnosis of OSMCP relies on ?
instrumental (endoscopic) confirmation
-
OSMCP instrumental (endoscopic) confirmation view?
a midline deficiency/a central gap in closure, where uvulus muscle activity is missing
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OSMCP is a problem we cannot see?
it is a problem we must suspect when there is? and ?
intraorally
hypernasal speech and no visible structural impairment
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Palatopharyngeal disproportion can occur ?
with or without stigmata of SMCP
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Palatopharyngeal disproportion abnormal/excessive pharyngeal depth cause:
fusion of spinous processes of 2 or more cervical vertebrae
anomalies of the cervical vertebrae
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Palatopharyngeal disproportion abnormal/excessive pharyngeal depth cause:?
Posterior displacement of cervical vertebrae can pull the posterior pharyngeal wall back creating an abnormally deep nasopharynx
-
cervical spine anomalies can ?
restrict ROM in the neck
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There can be displacement of the atlas up into the foramen magnum this can be?
life-threatening with head extension- requires surgery
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the disproportion can be introgenic secondary to aggressive? that creates?
adenoidectomy or tonsillectomy that creates an excessively deep pharynx.
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A flattened crainial base angle can also contribute to ?
an abnormally deep pharynx as it has the effect of moving the PPW backward
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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.
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diagnosising tonsils requires?
direct imaging instrumental assessment via videonasendoscopy or videofluoroscopy
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The upper poles of the tonsils can?
grow up and behind the velum and obstruct velar elevation and retraction, preventing closure against the PPW.
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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.
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Large tonsils tend to mandate movement of the ? in order to provide an ?
tongue anteriorly
adequate nasopharyngeal airway.
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When the tongue moves anteriorly in large tonsils they tend to ? and cause?
break the labial seal
the jaw to open/drop downward.
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Adenoid tissue (aka ?) can be either __ or __ to VP closure?
- (pharyngeal tonsil)
- assistive
- inhibitory
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In the young and school age child VP closure is actually called?
Veloadenoidal VA closure
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___ is negligible or absent at birth, increases in size with maturation and then diminishes/involutes; the exact timing of this growth curve is variable?
Adenoid
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Snoring in a child usually indicates?
enlarged, obstructive adenoid
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___ unlike tonsils can be assistive to closure in that the velum has a shorter distance to travel to accomplish closure?
Adenoid tissue
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Irregular adenoid contour or large double-lobed adenoid can be?
obstructive or inhibitory to closure.
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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.
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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.
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Inadequate movement of velum (PPWs and LPWs) due to ?
neuromotor dysfunction or primary muscle disease (can be congenital or acquired)
-
There can be isolated involvement of ? (which is rare)
VP closure mechanism
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Inadequate movement of the velum:
This problem can be part of a more ? (which is most often the case)
pervasive dysarthria
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Inadequate movement of velum:
Dysarthria secondary to ?
congenital problems of cerebral palsy or dystrophies
or acquired pathologies of adulthood (TBI, stroke, progressive CNS disorders)
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In rare cases, VPI/C can be part of an?
apraxia speech disorder
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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
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Phoneme specific nasal emission affects only selected ___ not all?
High pressure consonants
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Stress ___ has been observed in some wind instrument players?
-
The onset of VP inadequacy (VPI/A) occurs ?
after a period of play on the instrument
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In reported cases in VPI/A the function for ___ is usually normal?
speech
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