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 gestation
Problems 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 Lip
Involves 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
Etiologies
1. Genetic disordersn Factor in over 400 different genetic syndromes
2. 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 Management
Primary 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 Management
Issues related to chewing and speech
OrthodontistsProstodontists
obturators
Audiological Management
Middle ear disease Chronic otitis media Persistent conductive hearing loss
Psychosocial Management
Facial 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
Articulation
Articulation 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 emission
Compensatory 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
Voice
Vocal 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
Language
Mild 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