Chapter 6 (Part II Oral Facial Clefts)
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Development in the womb:
- Ovum: conception > 2 weeks
- Embryo: 3-8 weeks. In the 6th week the structures of the mouth and the face begin to unite to form the lip and palate. Fusion is complete by the 9th week of gestation. Fusion proceeds from front to back. Union of the lip occurs after palate formation begins - so the child may have an intact palate but a cleft of the lip.
- Fetus: 9 weeks to full term
Causes of clefting:
- Embryo is very vulnerable to the effects of harmful agents called teratogens. Teratogens are chemical or environmental agents that produce congenital abnormalities - intrauterine environmental factors. Cigarrettes, alcohol, drugs, medications, illegal drugs, x-rays, some viruses, multiple syndromes.
- -No single cause
- -May be a single gene
- -Over 300 syndromes in which a cleft is a feature
- -Chromosomal disorder
- -Combination of genes and environmental factors that trigger
Prevention to avoid oral and/or facial clefts
- -Avoid teratogens
- -Take Folic Acid
Structure involved with clefting:
- Upper lip
- Hard palate
- Soft palate
Palatopharyngeal Inadequacy/velopharyngeal inadequecy or insufficiency
- -This is not a result of a cleft
- -This problem is a congenitally short soft palate, an enlarged pharynx, or shortening of the muscles at the sides of the pharynx that restrict the movement of the velum. This makes it impossible for the soft palate to elevate and reach the back wall of the throat (posterior pharyngeal wall).
- -Sometimes this is not noticeable until the adenoids shrink at the time of puberty. The result is hypernasal speech.
Refers to neurological or physiological disorder that results in poor movement of the velopharyngeal structures.
- Is a defect in the hard palate but there is NO actual opening into the nasal cavity. Mucosal tissue covers the defect.
- A bifid uvual may indicate the presence of a submucous cleft
What are the conditions that interfere with basic biological functions and inhibit a child's development of speech and language when there are clefts of the lip and palate?
- Clefts of the lip and palate create a condition that interferes with basic biological functions such as breathing and swallowing AND can inhibit a child's developmental of speech and language.
- -Problems with feeding
- -Ottis Media: middle ear infecctions
- -Eustachian tube problems
- -Dental anomalities
- -Resonance disorders (Hypernasality, nasal air emission, hyponasality-some individuals with cleft lip and palate exhbit both hypernasality and hyponasality.
- -Language delays and differences
Rule of 10s
- A guideline to determine an infant's readiness for lip repair - before 3 months of age.
- -10 weeks
- -weigh 10lbs.
- -Hemoglobin count of 10 grams
Surgical repair of a cleft palate
Surgical repair involving the pharynx - designed to correct velopharyngeal incompetence or insufficiency.
Prosthetic Device (Prosthesis)
Artificial device to replace or augment a missing or impaired part of the body (in this case the palate).
Artic Disorders with clefts
- -Velopharyngeal insufficiency
- -Velopharyngeal incompetence
- -Missing of misaligned teeth
- -Structural deviations in the oral cavity
- -Faulty learning
- -Combination of the above
- -Problems with pressure consonants such as stops and fricatives.
Designed to RAISE the velum for speech if the velum is long enough to achieve velopharyngeal closure but does not move secondary to central or peripheral neurological impairment.
Prosthetic appliance designed to cover an open palatal defect.
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