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Organic & Neurogenic Comm Disorders > Cleft Lip & Palate > Flashcards

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an abnormal opening in an anatomic structure


Cleft Lip/Palate

Occurs in utero and is a disruption to embryological development

Clefts are due to delayed migration of neural crest cells

Cleft lip – opening in the lip
Cleft palate – opening in the palate

Individuals with cleft palate without cleft lip are more likely to have other malformations

Cleft lip and/or cleft palate is associated with hundreds of syndromes


Craniofacial anomaly

– structural abnormality of the cranium (skull) and/or face


Embryonic Development of the Lip and Alveolus

– development begins at 6-7 weeks gestation

Development begins at the incisive foramen and moves forward to the alveolus closing along the incisive suture lines

Next, the base of the nose and then the upper lip fuse

The upper lip consists of two segments which fuse together to form the philtrum and philtrum lines


Embryonic Development of the Hard and Soft Palate

Palate development begins at 8-9 weeks gestation

At 7-8 weeks gestation the tongue begins to move down from the nasal cavity
At this time, the palate starts to close

Palate closure begins at the incisive foramen and moves posteriorly (back) along the median palatine suture line

Uvula and velum close at 12 weeks gestation


Oral Anatomy

Hard palate – separates the nasal and oral cavities

Formed by – the palatine process of the maxillary bone & horizontal part of the palatine bone

Anatomical landmarks:
-Incisive foramen
-Posterior nasal spine
-Incisive suture lines


Soft Palate Anatomy

At rest sits against base of tongue

Has an oral surface and a nasal surface

Uvula has no known function



Area between the nasal cavity and esophagus

Pharyngeal wall – have a posterior and lateral portion
-Posterior pharyngeal wall (PPW)- posterior (back) portion of throat
-Lateral pharyngeal wall (LPW) – side of throat

Divided into:
-Nasopharynx– nasal cavity to velum
-Oropharynx– oral cavity to epiglottis
-Hypopharynx– epiglottis to esophagus


Eustachian Tube

Connects middle ear to pharynx

Closed at rest

Opens during yawning and swallowing

pressure regulation (air and fluid)


Levator veli palatini

pulls the velum up and back



pulls the lateral pharyngeal walls upward and medially


Superior constrictor

constricts the pharyngeal walls against the velum


Tensor veli palatini

opens the Eustachian tube



vibration of sound energy throughout cavities and tracts

Can be disrupted with cleft palate


Speech Valves

3 valves contribute to the acoustic properties of voice; These valves can change in shape and size

Glottis – space between vocal folds
Vocal tract – glottis through pharynx to oral cavity

Velopharyngeal closure – separates nasal cavity from vocal tract

Constriction of the lips and tongue - articulation


Velopharyngeal valve

directs and redirects sound energy

All vowels and oral consonants produced with velopharyngeal closure

4 types of closure patterns – all types include PPW, LPW, and velar movement


Coronal Velopharyngeal Valve Closure Pattern

most common pattern

Velum moves up and back (like a bending knee), touching the PPW

PPW may move forward

LPWs move medially to touch the velum (movement is minimal)


Circular Velopharyngeal Valve Closure Pattern

second most common pattern

All velopharyngeal structures move

Velum moves posterior, lateral walls move medially, and PPW moves anterior


Circular with Passavant’s Ridge Velopharyngeal Valve Closure Pattern

Passavant’s ridge occurs in typical and atypical speakers

Superior constrictor muscle constricts creating a ridge on the PPW


Sagittal Velopharyngeal Valve Closure Pattern

least common pattern

Lateral walls move medially to meet midline behind the velum

Minimal velar movement


Velar Movement Summary

Velum moves up and back to close velopharyngeal valve during speech
-Also when you sing, vomit, whistle, gag, and suck

Velum bends like a knee but also stretches to reach PPW

Lateral walls move medially to touch velum

PPW moves anterior to meet velum

All movements vary by person


Velopharyngeal insufficiency

velum is too short to close against the PPW

Results in hypernasal resonance because of a STRUCTURAL deficit


Velopharyngeal incompetence

poor movement of the velopharyngeal structures due to physiological deficits

Results in hypernasal resonance because structures cannot MOVE well


Incomplete Cleft Lip

cleft of the upper lip that doesn’t extend to the floor of the nose


Complete Cleft Lip

cleft extends to floor of the nose
May include a cleft of the alveolar ridge


Unilateral Cleft LIp

cleft on one-side


Bilateral Cleft LIp

cleft on both sides of the upper lip


Submucous Cleft lip

outer layers of skin are intact, but the orbicularis oris muscle is incomplete underneath

Looks like a repaired cleft lip


Complete Cleft Palate

cleft is through uvula, all of the soft and hard palate and alveolus


Unilateral Cleft Palate

one-side of alveolus