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Levator Veli Palatini
major muscle for velum elevation
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palatopharyngeus
closes off part of the oral cavity and pull velum down
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bilamiderm disk
2 layers of tissue, how the embryo begins
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what happens when the facial parts do not meet correctly.
creates cranial fissures, clefts, immorality
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what week does face formation take place?
within 4 weeks
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what weeks does that palate form?
8-9 weeks
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direction of face formation
all comes down from midbrain or together from sides
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mechanically induced malformation
factors that directly influence the development of the embryo
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craniofacial
malformation of the cranium and face that effects or has the potential to effect communication
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cleft
elongated opening, resulting from failure of parts to fuse. Includes: lip, hard palate, and soft palate
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microforms
minimal changes is oralfacial structures
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examples of microforms
cleft uvula, submucous cleft, hairline indention of the lip, minimal palatal defects
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a patient with a cleft uvula is life to have
submucous cleft (palatal cleft hiding)
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submucous cleft
some tissue is covering the hard palate so looks normal, but the bone and muscles have not fused
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indications of submucous cleft
cleft/bifid uvula and/or high palatal vault
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cleft palate is related to what factor
sex: more frequent in males
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cleft palate is linked to ages in males or females (dads or moms)
males younger than 20 and older than 40
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international classification of clefts is based on:
where the lack of fusion took place
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muscles that make up the soft palate
levator and tensor palatine
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language disorder related to cleft palate and cleft lip and palate
mild language disorder
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language disorder related to cleft lip
no language disorder
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when to children with clefts begin to babble and speak?
later age than non-clefted children
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what speech sounds are the most frequent in error?
ones the require build up of oral pressure--intra-oral pressure
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what speech sounds of least affected with cleft palate?
nasal consonants and semi-vowels
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what common substitution patterns (2) for cleft palate?
- glottal stops for oral stops
- nasal fricatives for oral fricatives
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percent of cleft population that has phonatory problems
25-50%
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vocal problems are related to what happening with the vocal folds?
- hyperfunction of vocal folds overdrivien to compensate for inadequate velopharyngeal function
- push from the throat instead of the diaphragm to get louder voice
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soft voice syndrome
loss of air pressure through the nasal cavity
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resonance
quality of sound damped/enhanced by the cavities above the vocal folds
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resonance deal with...
vowels
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nasal emission deals with...
consonats
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how does articulation affect resonance?
- the position of the tongue in the oral cavity
- the tongue is held high or retracted--air gets sent through the nose and not mouth.
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how does the position of the mouth/lips influence resonance?
- limited opening of the mouth/lips results in limited jaw movement
- air mostly moves through the nasal cavity
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hypernasal
- nasal cavity is open
- occurs with abnormal coupling of the oral and nasal cavities
- sound: "too nasal"
- can be heard well on vowels
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hyponasal
- nasal cavity is closed
- occurs when VP port or nasal airway is partially or totally closed.
- noticeable on consonants
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hypernasality occurs with what factors:
- high vowels
- oral opening is small
- when valving closes too late or too early
- high tension in head and neck
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nasal air emission
- inappropriate release of air though the nasal cavity during speech
- only occurs on consonants
- most observable on high pressure consonants
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hypernasality is as ____disorder
resonance
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nasal air emission is a ____ disorder
articulation
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correlation phenomena
the greater the nasal air emission, the greater the likelihood of weak or omitted consonants
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primary surgery
closing the cleft
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secondary surgery
refining anatomic structures for speech normalcy and cosmetic concerns
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after prepalatal surgery what is used to keep lines from tearing
metal bow
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bilateral clefts needs pre-surgical management of what
the maxillary, to keep from collapsing by use of an arch expander
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what is also done prior to bilateral ceft surgery
premaxilla taping so tissues get used to being in place and wont tear after surgery
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issue with early secondary cleft repair
potentially interfere with mid facial growth
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