CSD 2230HUMAN COMMUNICATION

DISORDERS

Topic 7Speech Disorders

Cleft Lip and Palate

Major Landmarksof the Vocal Tract

Disorders involving cleft lip and palate involve the lips, hard palate, and the velum

The PalateAnterior 2/3 is the

hard palate Stationary Purpose is to

separate the oral and nasal cavities

Posterior 1/3 is the soft palate Mucosal tissue

and muscles

Velopharyngeal Mechanism

Components1. Velum2. Muscles in the

back of the throat

The Purpose of the Velum

The velum needs to be closed and the oral and nasal cavities separated when we swallow and during the production of most English speech sounds

Some Terms and Definitions

Velopharyngeal CompetenceThe velopharygeal mechanism

adequately closes the portal during swallowing and speech

Velopharyngeal Incompetence (VPI)The velopharyngeal mechanism is

incapable of separating the oral and nasal cavities during swallowing and speech

Embryologic Development of the Face and Palate

Development of the face Formed between the 5th and 8th weeks of gestation Results from the fusion of

Two mandibular processes One frontonasal process Two maxillary processes

Cleft lip occurs when the fusion process between the frontnasal masses and the maxillary processes is interrupted

CD-ROM Ch.11.08 morphing sequence depicting embryologic development of the human face

Embryologic Development of the Face and Palate

Development of the secondary palate Bony hard palate and the velum Process and fusion occurs between the 8th

and 12th week of gestationProblems or factors that prevent fusion of

the palatal shelves result in an isolated cleft of the hard and/or soft palate

Classification of Clefts and Clinical Features

Clefts are classified as1. unilateral or bilateral cleft of the lip2. unilateral cleft of the lip and palate3. bilateral cleft of the lip and palate4. submucous cleft5. bifid uvula

Cleft LipInvolves the vermilion border of the upper

lip and may extend through the lip toward the nostril

Affects the shape of the noseCan be either unilateral or bilateral

Unilateral clefts usually occur on the left side Bilateral clefts usually involve the palate

Cleft lip by itself is rare

Unilateral and Bilateral Cleft Lip and Palate

Unilateral Extends from the external portion of the upper

lip, through the alveolar ridge, and through the hard and soft palates

Bilateral The lip and the alveolar ridge is cleft under both

nostrils and the central portion of the lip, alveolar ridge, and the premaxilla are positioned abnormally

The tip of the nose is attached directly to the lip Most severe form of cleft

Submucous Cleft and Bifid Uvula

Submucous cleft Muscular cleft of the soft palate A bifid uvula sometimes accompanies

this

Etiologies1. Genetic disorders

n Factor in over 400 different genetic syndromes2. Chromosomal aberrations3. Teratogenically induced disorders

n Environmental teratogens are agents that interfere with or interrupt normal fetal development

4. Mechanically induced abnormalitiesAmniotic rupture, intrauterine crowding, uterine

tumors, irregularly-shaped uterus

Incidence 1/750 live births Clefts of the lip (with or w/out involving the palate)

occur more frequently than cleft palate alone Submucous clefts are more rare (1/1200 births) The incidence of clefts are thought to be increasing Clefts occur more often in males and tend to be

more severe Native north Americans have the highest incidence

rates followed by Asians, Caucasians, and Africans

Management of Clefts Team approach

Surgical ManagementPrimary correction

Lip surgery by 3 months Palatal cleft surgery by 6-18 months

Secondary correction Pharyngeal flap

25% of cases Improves velopharyngeal competence Done between 6-12 years of age

Dental ManagementIssues related to chewing and

speechOrthodontistsProstodontists

obturators

Audiological ManagementMiddle ear disease

Chronic otitis media Persistent conductive hearing loss

Psychosocial ManagementFacial differencesSpeech differencesSelf-esteem

Communication Problems Inherent with Clefts

80% of individuals born with clefts not associated with a syndrome who receive palatal repair by 18 months can expect reasonably good speech without intervention

ResonanceHypernasality because of VPIContinuum from hyponasility, which is due to

the lack of nasal resonance to hypernasility, which is due to too much nasal resonance and not enough oral resonance

Audio example of samples of speech representing a continuum ranging from hyponasality through very severe hypernasality

ArticulationArticulation disorders are the result of VPI,

structural deviations in the oral cavity, dental anomolies, and faulty learning Phonemes commonly affected include /s/,

/z/, /th/, /ch/, and /ts/Problems with oral pressure

Nasal emissionCompensatory articulation errors

Glottal stop

Some Audio Examples Samples 1 and 2 illustrate reduced oral

pressures Samples 3 and 4 illustrate problems related to

nasal emissions Samples 10 and 11 illustrate common

articulation errors (substitutions and omissions Sample 12 illustrates substitution of glottal

stops for oral stops Samples 13-16 illustrate some unusual

substitutions and distortions

VoiceVocal nodules

Hoarse and breath vocal quality Caused by vocal hyperfunction

Audio examples Samples 17 and 18 illustrate mild and

severe degrees of hoarseness Sample 19 illustrates extreme vocal tension

and the use of inhalation tension

LanguageMild language delaysAudio examples

Samples 22 and 23 illustrate problems with morphophonemic markers

Sample 24 illustrates a change of syntactic form when morphophonemic marking is too demanding

Audio Case Study of a Mild Disorder

10 year old maleSpeech problems

Mild, inconsistent, bilateral nasal emission Mild hypernasality Moderate hoarseness Developmental articulation errors Omission of sibilants in consonant clusters

Audio Case Study of a Moderate Disorder

6 year old maleSpeech problems

Consistent, bilateral nasal emission Audible nasal air turbulence Moderate hypernasality Mild hoarseness Reduction of intraoral pressure on sibilants

and lateralized sibilants Other articulation errors

Audio Case Study of a Severe Disorder

8 year old maleSpeech problems

Severe, consistent, bilateral nasal emission Severe hypernasality Moderate hoarseness Reduced intraoral air pressure Glottal and pharyngeal substitution for

plosives and fricatives