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Obvious signs of SMCP
- bifid uvula
- zona pellucida of the soft palate (extending into the hard palate)
- a notch in the posterior border of the hard palate (digitally palpable but not always easily visible)
VP inadequacy in a single patient in the absence of observable clefting can have more than one etiology such as?
Undiagnosed occult SMCP
Mechanical obstruction to VP closure
VP mobility problems; VP incompetency
length of velum-depth of nasopharynx mismatch
Palatopharyngeal disproportion can be due to?
Short hard palate (brings soft palate forward)
Short soft palate
Excessive pharyngeal depth (2 degree of cervical spine/vertebrae, flattened cranial base)
PSNE-Phoneme specific nasal emission
selected high pressure consonants
The impact of ?
post op nasal emission
compensatory misarticulations (especially glottal stops) on VP closure.
OSMCP is caused by?
the absence of hypoplasia/underdevelopment of the uvulus muscle
there is a muscular deficiency on nasal/dorsal surface of the velum
The uvulus muscle runs? on the ?
It is the most ? of the soft palate
anterior/posterior direction on the dorsal surface of the velum
from the palatine and runs back to insert into the uvula.
Uvulus muscle is believed to be responsible for?
- adding thickness to the dorsal surface of the velum
- for bunching the velum and contributing to the levator eminence
The diagnosis of OSMCP relies on ?
instrumental (endoscopic) confirmation
OSMCP instrumental (endoscopic) confirmation view?
a midline deficiency/a central gap in closure, where uvulus muscle activity is missing
OSMCP is a problem we cannot see?
it is a problem we must suspect when there is? and ?
hypernasal speech and no visible structural impairment
Palatopharyngeal disproportion can occur ?
with or without stigmata of SMCP
Palatopharyngeal disproportion abnormal/excessive pharyngeal depth cause:
fusion of spinous processes of 2 or more cervical vertebrae
anomalies of the cervical vertebrae
Palatopharyngeal disproportion abnormal/excessive pharyngeal depth cause:?
Posterior displacement of cervical vertebrae can pull the posterior pharyngeal wall back creating an abnormally deep nasopharynx
cervical spine anomalies can ?
restrict ROM in the neck
There can be displacement of the atlas up into the foramen magnum this can be?
life-threatening with head extension- requires surgery
the disproportion can be introgenic secondary to aggressive? that creates?
adenoidectomy or tonsillectomy that creates an excessively deep pharynx.
A flattened crainial base angle can also contribute to ?
an abnormally deep pharynx as it has the effect of moving the PPW backward
Mechanical interference or obstruction to VP closure mainly concerns?
palatine tonsils and adenoid and how they interact with the velum and LPWs in VP closure.
diagnosising tonsils requires?
direct imaging instrumental assessment via videonasendoscopy or videofluoroscopy
The upper poles of the tonsils can?
grow up and behind the velum and obstruct velar elevation and retraction, preventing closure against the PPW.
When there is hypernasal speech and no cleft always check for?
large tonsils as a source of mechanical interference to closure.
Large tonsils do not always cause hypernasal speech.
Large tonsils tend to mandate movement of the ? in order to provide an ?
adequate nasopharyngeal airway.
When the tongue moves anteriorly in large tonsils they tend to ? and cause?
break the labial seal
the jaw to open/drop downward.
Adenoid tissue (aka ?) can be either __ or __ to VP closure?
- (pharyngeal tonsil)
In the young and school age child VP closure is actually called?
Veloadenoidal VA closure
___ is negligible or absent at birth, increases in size with maturation and then diminishes/involutes; the exact timing of this growth curve is variable?
Snoring in a child usually indicates?
enlarged, obstructive adenoid
___ unlike tonsils can be assistive to closure in that the velum has a shorter distance to travel to accomplish closure?
Irregular adenoid contour or large double-lobed adenoid can be?
obstructive or inhibitory to closure.
In most instances of large adenoid (wiht or without large tonsils) in youngsters with normal VP closure mechanisms, the speech consequence is?
denasal speech and possible upper airway restriction.
Be watchful of adenoid growth and developement in both Cleft and non-cleft children, with respect to ?
determining the stability of VP closure and the need for (more) surgery.
Inadequate movement of velum (PPWs and LPWs) due to ?
neuromotor dysfunction or primary muscle disease (can be congenital or acquired)
There can be isolated involvement of ? (which is rare)
VP closure mechanism
Inadequate movement of the velum:
This problem can be part of a more ? (which is most often the case)
Inadequate movement of velum:
Dysarthria secondary to ?
congenital problems of cerebral palsy or dystrophies
or acquired pathologies of adulthood (TBI, stroke, progressive CNS disorders)
In rare cases, VPI/C can be part of an?
apraxia speech disorder
Some individuals have structurally and phsiologically adequate or normal VP closure mechanisms, but for some reason misuse the closure mechanism in the production specific sounds?
Phoneme specific nasal emission affects only selected ___ not all?
High pressure consonants
Stress ___ has been observed in some wind instrument players?
The onset of VP inadequacy (VPI/A) occurs ?
after a period of play on the instrument
In reported cases in VPI/A the function for ___ is usually normal?