1
Q
Cleft
A
An abnormal opening or a fissure in an anatomical structure that is normally closed.
2
Q
Cleft Lip
A
It is the result of failure of parts of lip to come together early in the life of fetus. (fuse at 6-7 wks)
3
Q
Cleft Palate:
A
It occurs when the parts of the roof of the mouth do not fuse normally during fetal development, leaving a large opening between the oral cavity and the nasal cavity (9-10 wks)
4
Q
-
A
- Pinna – funnels sound
- External auditory canal (lined with cilia and has cerumen)
5
Q
-
A
- Tympanic membrane (air pressure converts to acoustic energy)
- Eustachian tube (connects middle ear to pharynx - equalizes pressure
6
Q
Inner Ear
A
Cochlea - 2 3/4 turns
Organ of Corti - outer hair cells
Semicircular canals - balance/equilibrium
7
Q
Nose and nasal cavity landmarks - be able to identify
A
Nasal root - where nose begins
Nasal bridge/nasion - hard part
Columella - fleshy structure that separates the two nostrils
Nasal tip - protruding part
Naris (pl. nares) or nostril - cavities of nose
Ala nasi -
-Alar rims - c-shaped curved structures/rim
-Alar base - where nose communicates with lip
Nasal sill -
Pyriform aperture - opening of nose
8
Q
Nasal septum - middle part of nose. 3 structures?
A
- Quadrangle septal cartilage
- Vomer—fits in median palatine suture groove
- Perpendicular plate of the ethmoid
9
Q
-
-
A
- Superior, middle, inferior turbinates (choanae)
- Superior, middle, inferior nasal meatuses
- Paranasal sinuses (frontal, maxillary, ethmoid, and sphenoid) (sinus=cavity)
10
Q
upper Lip
A
Philtrum - tip of nose to upper lip
Philtral ridges/columns
Cupid’s bow - (look at this after surgery - shows expertise of surgeon)
White roll
Vermilion - main part of lips - “where you apply lipstick”
Tubercle - where top lip dips down
11
Q
oral cavity (cleft can occur anywhere in these structures)
A
Hard palate - bony structure, part of maxillary bone Alveolar ridge Velum (soft palate) - muscular based, soft structure Uvula -"punching bag" Tongue Dorsal and ventral surface Faucial pillars Anterior and posterior Tonsils (palatine tonsils) Posterior pharyngeal wall
12
Q
Palate and Pharynx structures
A
Hard palate (maxilla) Velum (soft palate) Eustachian tube Tonsils Adenoid (pharyngeal tonsil) Tonsils (palatine tonsils) Lingual tonsil (at base of the tongue) Epiglottis
13
Q
Hard Palate (if you feed a baby with complete clef- nasal regurgitation) - - - -
A
- Separates nasal cavity and oral cavity
- Serves as roof of mouth and floor of nasal cavity
- Palatal vault—dome on upper part of oral cavity
- Alveolar ridge (alveolus)—provides bony support for teeth
14
Q
Hard palate -mucous periosteum -rugae incisive papilla palatine raphe foramen incisive foramen premaxilla
A
-Mucoperiosteum—tissue that covers the hard palate
—Mucous membrane—lining of stratified squamous epithelium
and lamina propria
—Periosteum—thick, fibrous tissue that covers bone
- Rugae—ridges that run horizontally
- Incisive papilla—projection of mucosa at area of incisive foramen (just behind central incisors)
- Palatine (median) raphe—line from incisive foramen to uvula
-Foramen—hole or opening in a bony structure to allow blood vessels and nerves to pass through to the mucosa
-Incisive Foramen
In the area of alveolar ridge behind the central incisors
Starting point of embryological development
-Premaxilla
Triangular-shaped bone
Bordered by incisive foramen and incisive sutures
Contains four maxillary incisors
15
Q
Hard Palate - 2 parts (Palatine processes of maxilla (ant) and horizontal plates of palatine bone (post)?)
A
- Palatine processes of maxilla
- -Forms anterior 3/4th of maxilla
- -Two plates separated by median (intermaxillary) palatine suture
- -Nasal aspect of palatine suture forms groove for lower portion of vomer (nasal septum)
16
Q
-
-
A
- Incisive suture lines
- Median (intermaxillary) palatine suture
- Transverse palatine (palatomaxillary) suture lines
17
Q
Hard palate - Horizontal plates of the palatine bones - - - -
A
- Posterior portion of the hard palate
- Bordered by the transverse palatine suture lines
- Meet in midline at the median palatine suture
- Ends with the posterior nasal spine
18
Q
-
-
A
- Seen in some Caucasians of Northern European descent
- Prominent longitudinal ridge on oral surface along intermaxillary suture line
- Normal variation and usually not the cause of a problem
19
Q
-
-
A
- Medial and lateral pterygoid plates—part of pterygoid process of sphenoid bone
- Pterygoid hamulus—inferior end of pterygoid plate
- Both provide bony attachment for velopharyngeal musculature
20
Q
Velum - - - -
A
- Consists of muscles and mucosa (no bone)
- Attaches to hard palate
- Median palatine raphe continues to uvula
- Uvula attaches to the posterior border
21
Q
Velum - Palatine (Velar) Aponeurosis
A
Consists of fibrous, connective tissue
Anchoring point for velar muscles
Provides stiffness
22
Q
Uvula - - - -
A
-Teardrop-shaped pendulum
-Consists of mucosa, glandular, and adipose tissue
-Very vascular
-Has no known function
(submucous cleft - bifid uvula?)
23
Q
Pharynx - - - - -
A
- Nasopharynx—above velum
- Oropharynx—below velum
- Hypopharynx - around larynx
- Posterior pharyngeal wall
- –Adenoid tissue located just behind the velum
24
Q
Adenoid Pad
A
- Mass of lymphoid tissue
- Located on posterior pharyngeal wall, just behind the velum
- More prominent in children than in adults
25
Eustachian Tube
- Connects middle ear with pharynx
- At horizontal angle in children under age 6
- At a 45º - angle in adults
children who get otitis media - cannot drain middle ear
26
Eustachian Tube
-
-
-
- Pharyngeal opening is lateral and slightly above velum
- Torus tubarius—ridge located posterior to Eustachian tube
- Salpingopharyngeal folds—originate from torus tubarius and course down to the lateral pharyngeal wall
27
```
Velopharyngeal (VP) Closure
-
-
-
*velopharyngeal port is open at rest and closed when eating (nasal regurgitation)
```
- Coordinated three-dimensional closure of structures
- Closes valve like a sphincter
- Closes off nasal cavity from oral cavity
28
Velopharyngeal (VP) Function
-
-
- Regulates and directs transmission of sound energy and airflow in the oral and nasal cavities
- Important for production of “pressure-sensitive” consonant sounds and all vowels
29
```
Velopharyngeal (VP) Function
-
-
-
-
```
- VP function requires coordinated movement of the following structures:
- Velum (soft palate)
- Lateral pharyngeal walls (LPWs)
- Posterior pharyngeal wall (PPW)
30
```
Velar Movement
-
-
-
-
```
- Moves in a superior and posterior direction
- Has a type of “knee” action
- Moves toward the posterior pharyngeal wall
- Velar dimple—point of bend in the velum during contraction
31
Lateral Pharyngeal Wall (LPW) Movement
-
-
-
- Moves medially
- Usually close against the velum
- Sometimes close in midline behind the velum
32
Posterior Pharyngeal Wall (PPW) Movement
-
-
-
- Moves anteriorly toward the velum
- Has very little role, however
- Passavant’s ridge—bulge of muscle on the posterior pharyngeal wall during speech; occurs in some normal and abnormal speakers
33
Muscles of VP Closure
- Levator veli palatini (velar “sling”)
- Superior constrictor (pharyngeal ring)
- Palatopharyngeus (posterior faucial pillar)
- Palatoglossus (anterior faucial pillar)
- Musculus uvulae (bulge on nasal surface)
- Tensor veli palatini
34
Motor and Sensory Innervation
| - pharyngeal plexus
-Pharyngeal plexus—a network of nerves that lies along the posterior wall of the pharynx and consists of the pharyngeal branches of the glossopharyngeal nerve (CN IX) and the vagus nerve (CN X)
35
Motor and Sensory Innervation - Cranial Nerves
```
Trigeminal (V)
Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)
```
36
Patterns of VP Closure
-
-
-
```
-Coronal pattern—velum and PPW
Most common
-Sagittal pattern—LPWs
Least common
-Circular pattern—all structures
Sometimes includes Passavant’s ridge
```
37
Pneumatic vs. Nonpneumatic Activities
- Nonpneumatic
- --Swallowing, gagging, vomiting
- Pneumatic
- --Positive pressure—whistling, blowing, speech
- --Negative pressure—sucking, kissing
38
Pneumatic vs. Nonpneumatic Activities
- During nonpneumatic activities:
- --Entire length of LPWs move together with exaggerated movement.
- --Closure is higher than with speech.
- During speech:
- --Greatest movement occurs with high-pressure consonants.
-Note: Closure for speech and other positive pressure activities are different. Do not work on blowing/sucking to improve speech!
39
Timing of Closure
- Valve closes before phonation begins or sound will be hypernasal.
- Closure is maintained until a nasal consonant or the utterance is ended.
40
Height of Closure
-
-
-
- Closure contact may vary with different sounds.
- Closure tends to be higher and tighter with high vowels and high-pressure consonants, especially voiceless consonants.
- Closure can be affected by rate and fatigue.
41
Firmness of Closure
-
-
-
- Contact firmness varies with consonant.
- **Gap of 5 mm (20 mm2) is the threshold for hypernasality.
- Even very small gaps cause audible nasal air emission.
42
Rate and Fatigue
-
-
- Velar movement and closure can decrease with rapid rate and muscular fatigue.
- Rate and fatigue affects the height and firmness of closure.
43
Changes with Growth and Age
-
-
- Velum increases in thickness and length—”velar stretch.”
| - Maturation results in an increase in oral-motor coordination.
44
Changes with Growth and Age
-
-
-
- Facial skeleton, including hard and soft palate, moves down and forward.
- Posterior pharyngeal wall changes in inclination and bends forward.
- Gradual involution of adenoid tissue occurs, particularly around puberty.
-age 13-14 velum has to get used to closing - has been using adenoids
45
Subsystems for Speech
```
Respiration
Phonation
Prosody (stress, rhythm, and intonation)
Resonance and velopharyngeal function
Articulation
```
46
Respiration
- Air pressure is required to initiate and sustain phonation:
- --Vocal folds close.
- --Subglottic air pressure builds.
- --Vocal folds break open and begin to vibrate.
- --Pressure is released.
47
Respiration: Science Experiment
-
-
- Take a deep breath and prolong an “ah.”
| - When does phonation stop?
48
Respiration
-
-
- Breathing for vegetative purposes is different than breathing for speech.
- There is a need to control breathing for phrasing.
49
Respiration: Science Experiment
-
-
- Note pattern of inspiration and expiration at rest vs. during speech.
- Inspiration is controlled based on phrasing and utterance length
50
Respiration
-
-
- Provides airflow, which converts to intraoral air pressure for articulation
- Is important for pressure-sensitive sounds
- 1:1 at rest
- during speech - 10% inhale, 90% exhale
51
Respiration: Science Experiment
-Put your hand in front of your mouth as you produce some of the following high pressure and low pressure phonemes. Feel the difference in pressure.
---High-pressure sounds
---Low-pressure sounds
---No-pressure sounds
-Put your hand in front of your mouth as you produce some of the following high pressure and low pressure phonemes. Feel the difference in pressure.
---High-pressure sounds
Plosives (p, b, t, d, k, g)
Fricatives (f, v, s, z, ʃ, Θ, ð)
Affricates (ʧ, ʤ)
---Low-pressure sounds
Liquids (l, r)
Glides (w, j)
---No-pressure sounds
Nasals (n, m, ŋ)
52
Phonation: Science Experiment
```
-Put your hand on your neck as you produce each of these sounds in isolation (without the vowel).
p, b
t, d
k, g
s, z
f, v
```
-Note the feeling of vibration with the voiced consonants.
```
-Put your hand on your neck as you produce each of these sounds in isolation (without the vowel).
p, b
t, d
k, g
s, z
f, v
```
-Note the feeling of vibration with the voiced consonants.
53
Phonation
- Must be able to start and stop phonation quickly throughout an utterance
- Example: “a cup” requires start-stop-start-stop of phonation in just two syllables
54
Prosody
-
-
-Stress
Desert vs. dessert
```
-Intonation
It’s raining outside.
It’s raining outside?
Well that’s just fine.
Well that’s just fine!
```
55
Velopharyngeal Function
| for oral sounds
For oral sounds:
- Velopharyngeal valve is closed.
- This allows acoustic energy to enter oral cavity.
- It is important for the production of most consonant sounds (particularly plosives, fricatives, affricates) and all vowels.
56
Velopharyngeal Function
| For nasal sounds
For nasal sounds:
Velopharyngeal valve is open.
This allows most of the sound energy to enter the nasal cavity
It is important for nasal sounds (m, n, ŋ).
57
Velopharyngeal Function
Velopharyngeal valve must open and close quickly and efficiently
Example: “It’s my map.” requires the valve to close-open-close-open-close in just three syllables.
58
Articulation
| vowels
- Produced by altering oral resonance
- Formant frequencies affected by:
- --Position of tongue, jaw, and lips
- --Size and shape of oral cavity
- Acoustics and vowel perception affected by formant frequencies
59
Articulation
| Consonants
- Produced with partial or complete obstruction of oral cavity and then release
- Usually produced with air pressure
60
Articulation
Manner of Production
- Plosives (p, b, t, d, k, g)
- --Completely close oral cavity.
- --Build up air pressure.
- --Release air pressure suddenly.
- Fricatives (f, v, s, z, ʃ, Θ, ð)
- --Partially close oral cavity.
- --Build up air pressure.
- --Release air pressure gradually.
- Affricates (ʧ, j)
- --Combine a plosive with a fricative.
- --ʧ = t + ʃ
- --ʤ = d + ʒ
61
Subsystems
- All subsystems need to be good “team players.”
| - If one subsystem is not working well, it affects the work of the other “team players.”
62
In the evaluation and treatment of speech and resonance disorders, it is important to have a thorough understanding of ...
In the evaluation and treatment of speech and resonance disorders, it is important to have a thorough understanding of the anatomy and physiology of the vocal tract.
- Anatomy of the face, oral cavity, and velopharyngeal valve is well documented.
- Physiology of the velopharyngeal mechanism, particularly as it relates to speech, is very complex.
Cleft Palate
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