developmental deficits

Question 1

what are the different type of anomalies associated with cleft

Answer 1

• dental
• ent
• language
• cognition
• psychosocial

Question 2

describe normal dentition

Answer 2

• Deciduous/primary: 20 teeth (10 maxillary arch, 10 mandibular arch), 29 months
• Permanent: 32 teeth (16 each arch), from about 7-20 years

Question 3

what is occlusion

Answer 3

teeth fit, bite

Question 4

what are the different occlusions

Answer 4

• class I occlusion: normal upper overlap
• class I malocclusion: incorrect line (teeth don’t match or are rotated)
• class II malocclusion: overbite more than 3 mm
• class III malocclusion: underbite

Question 5

what are the dental anomalies with clefts

Answer 5

• missing teeth
• supernumerary teeth
• ectopic teeth
• rotated teeth
• crowding
• crossbite
• class III malocclusion
• open bite
• protruding premaxilla

Question 6

describe how missing teeth causes issues

Answer 6

-primary cleft palate>lisp

Question 7

describe how supernumerary teeth causes issues

Answer 7

extra teeth>alveolars, interdentals, lateral lisp

Question 8

describe how ectopic teeth causes issues

Answer 8

erupt in abnormal position>abnormals, interdentals, lateral lisp

Question 9

describe how rotated teeth causes issues

Answer 9

primary cleft palate>lateral lisp

Question 10

describe how crowding causes issues

Answer 10

lateral lisp, frontal lisp

Question 11

describe how crossbite causes issues

Answer 11

cleft lip and palate> sound distortions, frontal lisp, lateral lisp

Question 12

describe how open bite causes issues

Answer 12

from missing teeth, finger/pacifier sucking, skeletal deformities> frontal lisp of fricatives, affricates; lateral lisp of sibilants

Question 13

describe how protruding premaxilla causes issues

Answer 13

bilateral cleft lip and palate> distortion of sibilants, sub labiodentals for bilabials

Question 14

what are speech problems associated with malocclusions

Answer 14

• misarticulation/distortion of sounds
• labioversion
• linguoversion
• teeth crowding/narrow maxillary arch/macroglossia

Question 15

what are examples of misarticulated or distorted sounds associated with malocclusions

Answer 15

• sibilants /s,z,sh,ch,j/
• labiodentals /f,v/
• alveolars /t,d,l,n/
• bilabials /p,b,m/

Question 16

what are examples of issues caused by labioversion associated with malocclusions

Answer 16

• overjet=horizontal overlap of incisors (norm 2mm)
• lip closure problems
• bilabial sound distortion

Question 17

what are examples of issues caused by linguoversion associated with malocclusions

Answer 17

• underjet= upper incisors lingual to lowers

- distorts sibilants and alveolars

Question 18

what are examples of issues caused by teeth crowding/narrow maxillary arch/macroglossia

Answer 18

• lateral lisp: if opening is in line with cleft (air flows around)
• frontal lisp: if maxillary central incisors missing

Question 19

What are ear anomalies

Answer 19

• microtia
• aural atresia
• abnormal ossicle formation/fusion
• otitis media
• otic capsule abnormal development/ossification

Question 20

what is microtia

Answer 20

small, deformed pinna which can cause conductive hearing loss

Question 21

what is aural atresia

Answer 21

abnormal EAM and tympanic membrane which can cause conductive hearing loss

Question 22

what can abnormal ossicle formation/fusion cause

Answer 22

conductive hearing loss

Question 23

what is otitis media

Answer 23

malfunction of e-tube which can cause the tympanic membrane to rupture or can cause a conductive hearing loss
*cleft kids have a reoccurrence of this

Question 24

what can otic capsule abnormal development/ossification cause

Answer 24

-sensorineural hearing loss

Question 25

What are the nose anomalies

Answer 25

- external deformities - abnormalities of nasal base - internal derangement

Question 26

what is an example of a external nose deformity

Answer 26

-facial cleft

Question 27

what are examples of abnormalities of nasal base

Answer 27

- cleft lip | - cleft palate

Question 28

what are examples of internal derangement

Answer 28

- deviated septum (cleft palate) which can cause hypo nasality or cup-de-sac resonance (septum deflects into cleft side of nose) - pyriform aperture stenosis= narrowed nares from overgrown maxilla (nostrils are narrow b/c of overgrown maxilla) - choanal stenosis/atresia= narrowed/blocked choanae which can cause death b/c of breathing issues *mouth breathers might be dealing with stenosis

Question 29

What are face anomalies

Answer 29

- maxilla | - facial nerve

Question 30

what are oral cavity anomalies

Answer 30

- lips - mouth - tongue - palate - tonsils and adenoids

Question 31

what are throat/upper airway anomalies

Answer 31

-adenotonsillar/adenoid/tonsillar hypertrophy

Question 32

what are the psychosocial aspects of cleft

Answer 32

- family issues - school issues - society issues

Question 33

what are examples of family issues in cleft kids

Answer 33

- initial shock and adjustment | - cleft as chronic medical condition

Question 34

what are examples of school issues in cleft kids

Answer 34

- knowledge and expectation of teachers - learning ability and performance - social interaction (early teens) - teasing - self-perception

Question 35

what are examples of society issues in cleft kids

Answer 35

- physical attractiveness - speech quality - hearing impairment - stigma - behavioral issues

Question 36

What are the development factors in language deficits for cleft kids

Answer 36

- IQ and brain structure - environmental stimulation - hearing - motivation - attention - A&P

Question 37

How is IQ and brain structure different for cleft kids

Answer 37

- there is no difference in cleft versus normal for the rate of acquisition of all developmental milestones - cleft palate plus syndrome are at risk

Question 38

How is environmental stimulation different for cleft kids

Answer 38

-no difference between cleft and normal kids in development of language skills in language rich environment under age of 5

Question 39

How is hearing different for cleft kids

Answer 39

-cleft palate has a high risk of chronic otitis media which can cause conductive hearing loss

Question 40

How is motivation different for cleft kids

Answer 40

- need and desire to learn skill - "motivation to talk" - cleft tend to revert to gestures (more than normal) b/c difficulty with speech production

Question 41

how is attention different for cleft kids

Answer 41

- ADHD is 3-5% in children with clefts - no increase or more risk than normal - most craniofacial syndromes and neuro at risk

Question 42

how is A&P different for cleft kids

Answer 42

- vocal tract - processes (resonation, respiration, phonation, arctic) - neuro function

Question 43

Describe the language development and learning in cleft kids

Answer 43

- early deficits in cognitive development - prelanguage skills - lower expressive language - common in syndromes

Question 44

describe the phonological/articulation development

Answer 44

- disrupted tactile-kinesthetic-auditory feedback loop (doesn't develop good artic) - less vocalization - predominant nasals for orals; glottals for plosives - habitual compensatory productions - age of palate repair is factor - apraxia co-occurence is factor