What are the three stages of antenatal development?
Conception - 2 weeks = zygote
2 - 8 weeks = embryonic period
9 - 38 weeks = foetal period
What is a teratogen?
Something that causes atypically development
What is a known teratogen that can cause cleft palate?
alcohol
True or false: teratogens do not cause any damage in the first 2 weeks of development
True, because the zygote is not attached to the uterine wall.
How does typical development of facial structure occur?
- Structures move toward the midline and fuse together starting at the lip.
- Starts at around 6 weeks and progresses to the soft palate
- Soft palate will be sealed around 16 weeks
What are the different types of clefts?
Cleft Lip
- range from notch to complete separation in one (unilateral) or both (biliateral) sides of the lip
Cleft palate
- roof of the mouth not joined completely
Submucous Cleft
- Cleft of the soft palate that is covered by a layer of skin
Bifid Uvula
- Cleft of the uvula only
Can clefts be identified before birth?
Generally, a cleft lip can be detected.
Cleft palate and submucous clefts are more difficult to identify before birth.
How common are clefts?
- Third most common congenital birth defect in NZ
- 1/550 live births in NZ
- Māori population have the highest incidence of cleft palate in the world 1/500
What is the cause of cleft?
In most cases, it is a combination of genes and environment (multifactorial)
Why might a psychologist need to be involved in the cleft process?
- Decisions about surgery
- Worries
- Mood
- Self esteem
- Appearance related concerns
Around what age might surgery be preformed?
Cleft lip: 3 - 6 months
Cleft Palate: 9 - 13 months
Alveolar Bonegraft: 9 - 10 years old
What are some secondary surgeries that may be preformed?
- Pharyngeal flap
- Pharyngoplasty
- Grommets
- Orthognathic surgery
- Rhinoplasty
- Lip revisions
What type of malocclusions are there?
Type II: upper teeth too far in front of lower teeth
Type III: Upper teeth behind lower teeth
What is a position that may help to breast feed?
The football hold
True or False: There are special bottle teets for children with cleft
True
How is hearing impacted with individuals with cleft palate?
- Otitis media is more common in children with cleft palate due to more exposure of the eustachian tube
- Often grommets are used
- Hearing issues may persist into adulthood
What are the speech implications for those with cleft?
Cleft Lip
- Normal articulation
Cleft Palate
- Cleft palate speech
- the “cleft accent”
What are some syndromes associated with cleft?
- Stickler syndrome
- 22q11 deletion
What is velopharyngeal insufficiency?
Incomplete velopharyngeal closure as a result of anatomical defects
- short velum
- cleft palate
- enlarged tonsils
What is velopharyngeal incompetence?
Incomplete veloharyngeal closure as a result of physiological defects
- poor muscle function
- neuromuscular disorders
What is cul de sac/potato in the mouth resonance?
Occurs when the sound resonated in the pharynx or nasal cavity, but is not released due to an obstruction
What can occur with abnormal nasal airflow?
- nasal grimace
What are some passive speech errors?
Weak or ommited consonants
- Nasal air emission reduces oral pressure which means pressure consonants become weak or left out
Short utterance length
- Losing air through the nose means ore respiratory effort
Why might someone with cleft have a voice disorder?
Use of glottal stops as a compensatory articulation production or the development of nodules as a result of strain in the vocal tract to achieve closure
Breathiness may be a compensatory strategy to reduce nasal air emission
