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Chapter 8 Facial, Oral, and Pharyngeal Anomalies

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1

Cleft palate and craniofacial anomalies can have an impact on the various functions.
Abnormalities of the ____, ____, and ____ particularly affect the ____ and ____ of ____

Cleft palate and craniofacial anomalies can have an impact on the various functions.
Abnormalities of the ear, nose, and throat particularly affect the quality and intelligibility of speech.

2

External Ear

____—_____ of a normal _____
____ (____) _____—closure of the _____ _____
_____—small _____
Treatment can include _____ and/or _____ _____ hearing aids.

Atresia—closure of a normal opening
Aural (auditory) atresia—closure of the auditory canal
Microtia—small auricle
Treatment can include surgery and/or bone conduction hearing aids.

3

Middle Ear

_____ may be ____, _____, or _____.
_____ _____ may be absent or hypoplastic.
_____ _____ malformations cause ______ hearing loss.
Treatment can include surgery and/or bone conduction hearing aids.

Ossicles may be absent, hypoplastic, or ankylosed.
Tympanic membrane may be absent or hypoplastic.
Middle ear malformations cause conductive hearing loss.
Treatment can include surgery and/or bone conduction hearing aids.

4

Eustachian Tube Function

At ____, Eustachian tube is ____.
During _____ (and ____), _____ _____ _____ muscle contracts to _____ Eustachian tube.
Opening of Eustachian tube:
Provides _____ for ____ ear
_____ middle ear _____ with environment
Allows ____ to drain

At rest, Eustachian tube is closed.
During swallowing (and yawning), tensor veli palatini muscle contracts to open Eustachian tube.
Opening of Eustachian tube:
Provides ventilation for middle ear
Equalizes middle ear pressure with environment
Allows fluids to drain

5

Eustachian Tube Malfunction

Children under age ____ are predisposed to Eustachian tube malfunction, causing ____ ear ____ and ____ ____ ____.
Eustachian tubes lie in a ____ plane, which ____ drainage.
____ ____ ____ muscles are directed at an unfavorable angle for function.
Children with cleft palate or submucous cleft are at greater ____ due to abnormality of tensor muscles.

Children under age 6 are predisposed to Eustachian tube malfunction, causing middle ear effusion and acute otitis media.
Eustachian tubes lie in a horizontal plane, which impairs drainage.
Tensor veli palatini muscles are directed at an unfavorable angle for function.
Children with cleft palate or submucous cleft are at greater risk due to abnormality of tensor muscles.

6

Eustachian Tube Malfunction CONT.

____ collect within the ____ ear (middle ear ____) due to the ____ pressure and cannot ____.
_____ can ascend tube and grow in fluid, leading to an ____ _____ (____ _____ ____).

Fluids collect within the middle ear (middle ear effusion) due to the negative pressure and cannot drain.
Bacteria can ascend tube and grow in fluid, leading to an ear infection (acute otitis media).

7

Eustachian Tube Malfunction CONT.

Middle ear ____ can cause:
_____ hearing loss
____ and _____ delay
Otitis media can cause serious potential complications, including:
____
_____ hearing loss due to ____

Middle ear effusion can cause:
Conductive hearing loss
Speech and language delay
Otitis media can cause serious potential complications, including:
Mastoiditis
Sensorineural hearing loss due to toxins

8

Treatment for Chronic Otitis Media

_____
_____ (small _____) and placement of ____ (____ ____) tubes in tympanic membranes
Often done prophylactically for children with history of ____, usually with lip repair at _____ months
____

Antibiotics
Myringotomy (small incision) and placement of PE (pressure equalizing) tubes in tympanic membranes
Often done prophylactically for children with history of CLP, usually with lip repair at 3 months
Adenoidectomy

9

Inner Ear

____ can occur in the ____, _____ system, and _____ nerve, causing a _____ hearing loss.
Treatment includes:
_____ _____(s)
_____ _____(s)

Malformations can occur in the cochlea, vestibular system, and auditory nerve, causing a sensorineural hearing loss.
Treatment includes:
Hearing aid(s)
Cochlear implant(s)

10

Audiologic Care

The American Cleft Palate-Craniofacial Association (ACPA) has specific recommendations for audiologic management for children born with cleft lip/palate or other craniofacial anomalies.
Patients should see an _____ and _____ periodically through adolescence.

The American Cleft Palate-Craniofacial Association (ACPA) has specific recommendations for audiologic management for children born with cleft lip/palate or other craniofacial anomalies.
Patients should see an audiologist and otolaryngologist periodically through adolescence.

11

Facial Structures

_____
_____
_____ Nerve

Nose
Maxilla
Facial Nerve

12

Nose

____ cavity compromised by _____ cleft deformities
_____ septum
Common with _____ cleft lip/palate
Deflects to the _____ side of the _____
_____ _____ _____
_____ _____ secondary to _____ repair
____ _____ or enlarged _____ blocking the _____

Nasal cavity compromised by midline cleft deformities
Deviated septum
Common with unilateral cleft lip/palate
Deflects to the cleft side of the nose
Pyriform aperture stenosis
Stenotic nares secondary to lip repair
Choanal atresia or enlarged adenoids blocking the choana

13

Nose CONT.

_____ obstruction of the _____ cavity
Can be due to _____ _____, _____ _____ _____, or _____ _____
Causes nasal ____-____-_____ resonance

_____ obstruction of the ____ cavity
Can be due to _____ _____/_____ or enlarged _____
Causes _____

Anterior obstruction of the nasal cavity
Can be due to deviated septum, pyriform aperture stenosis, or stenotic nares
Causes nasal cul-de-sac resonance
Posterior obstruction of the nasal cavity
Can be due to choanal stenosis/atresia or enlarged adenoids
Causes hyponasality

14

Maxilla

Can cause:
____-_____ deficiency
Anterior ____ with Class _____ malocclusion
_____ and _____ airway restriction
_____

Can cause:
Mid-face deficiency
Anterior crossbite with Class III malocclusion
Pharyngeal and nasal airway restriction
Hyponasality

15

Facial Nerve (VII)

_____ syndrome with _____ paralysis
Causes a “_____-_____” facies

Moebius syndrome with facial paralysis
Causes a “mask-like” facies

16

Facial Nerve (VII) Paralysis

Facial nerve paralysis causes a lack of facial _____ and _____ movement.
It affects _____ and sometimes _____ sounds.
_____ movement is usually _____.
Individuals may learn to compensate by producing _____ sounds with the ____.

Facial nerve paralysis causes a lack of facial expression and lip movement.
It affects bilabial and sometimes labiodental sounds.
Tongue movement is usually unaffected.
Individuals may learn to compensate by producing labial sounds with the tongue.

17

The Oral Cavity

____
____
____
____

Lips
Mouth
Tongue
Palate

18

Upper Lip

____ lip may be ____ after cleft repair due to:
Basic ____ from the cleft lip
_____ effects of the ____ from the lip repair
Relative lip _____ due to protruding ____

Upper lip may be short after cleft repair due to:
Basic dysmorphology from the cleft lip
Contractile effects of the scar from the lip repair
Relative lip shortening due to protruding premaxilla

19

Upper Lip

Short upper lip can…
Cause difficulty with ____ competence at rest
Affect production of _____ sounds (____,____,____)
Result in _____ placement as a substitute

Short upper lip can…
Cause difficulty with bilabial competence at rest
Affect production of bilabial sounds (p, b, m)
Result in labiodental placement as a substitute

20

Mouth

____ (large)
____ (small)
____ (mouth)

Macro (large)
Micro (small)
Stomia (mouth)

21

Macrostomia

Associated with facial clefts and syndromes, especially _____ _____, due to extension of _____ into _____
Usually does ____ affect speech

Associated with facial clefts and syndromes, especially hemifacial microsomia, due to extension of mouth into cheek
Usually does not affect speech

22

Microstomia

Can have a slight affect on _____
May cause oral ____-_____-____ resonance, with _____, ____ volume sound

Can have a slight affect on articulation
May cause oral cul-de-sac resonance, with muffled, low volume sound

23

Tongue

____
_____
_____ tongue (thick chunks of tissue)
_____

Macroglossia
Microglossia
Lobulated tongue
Ankyloglossia

24

Macroglossia

Tongue is very _____ relative to the oral cavity size.
Macroglossia is associated with _____ _____ and _____-_____ syndrome.

Tongue is very large relative to the oral cavity size.
Macroglossia is associated with Down’s syndrome and Beckwith-Wiedeman syndrome.

25

Macroglossia CONT.

Large tongue causes:
_____ protrusion
______ obstruction
_____-______ posture
______ open bite
______

Large tongue causes:
Lingual protrusion
Airway obstruction
Open-mouth posture
Anterior open bite
Drooling

26

Macroglossia CONT.

Effects on speech
It interferes with _____ _____ sounds (_____-_____ and _____).
_____-______ production is common.
It causes _____ (and occasionally lateral) distortion.
Oral ____-_____-____ resonance is often noted.

Effects on speech
It interferes with tongue tip sounds (lingual-alveolars and sibilants).
Palatal-dorsal production is common.
It causes frontal (and occasionally lateral) distortion.
Oral cul-de-sac resonance is often noted.

27

Microglossia

Tongue is ____ in size, especially relative to oral cavity size.
Microglossia _____ causes speech problems.

Tongue is small in size, especially relative to oral cavity size.
Microglossia rarely causes speech problems.

28

Lobulated Tongue

Seen in some syndromes, such as _____ ______ (OFD)
Usually has _____ significant effect on speech

Seen in some syndromes, such as orofaciodigital syndrome (OFD)
Usually has no significant effect on speech

29

Ankyloglossia ("Tongue-Tie")

Ankyloglossia is a ____ anomaly.
_____ _____ under tongue is too _____ and/or attaches close to the _____ of the tongue (rather than a third of the way back).

Ankyloglossia is a congenital anomaly.
Lingual frenulum under tongue is too short and/or attaches close to the tip of the tongue (rather than a third of the way back).