CSD 438 ex 1 ch 1

What part of ear can be effected from a cleft palate?

Tympanic membrane (syndrome increases 40-60%)

External ear parts

Pinna

External auditory canal

Middle ear parts

Tympanic membrane

Ossicles

Eustachian tube

Inner ear parts

Cochlea

Semicircular canals

Children with fetal alcohol syndrome sometimes have a flat…

Philitrum

Aperture means

Opening

Nasal septum

Quadrangle septal cartilage

Perpendicular plate of the ethmoid

Vomer

Perpendicular structure that fits in median palatine suture groove (tongue in groove)

Upper lip parts

Philitrum

Philtral ridges/columns

Cupid’s Bow

White roll

Vermilion

Tubercle

Vermilion

Colored parts of lips

White roll

Around the lips where you would put lip liner

Orbicularis

The muscle that surrounds the mouth

• during a cleft palate surgery, the upper fibers are affected and muscles need to go back there

Hard palate

Separates the nasal cavity and oral cavity

Serves as roof of mouth and floor of nose

Hard palate: Palatal vault

Dome on upper part of oral cavity

Hard palate: Alveolar ridge (alveolus)

Provides bony support for teeth and a place for articulation of lingual-alveolar sounds

Hard palate: mucoperiosteum

Part of mucus membrane

Thin tissue that covers the hard palate and consists of mucous membrane and periosteum

Mucous membrane

lining of stratified squamous epithelium and laminate propria

Periosteum

Thick, fibrous tissue that covers bone

Hard palate: rugae

Ridges that run horizontally in the front part of the palate

Hard palate: incisive papilla

Projection of mucosa at area of incisive foramen (just behind central incisors)

Hard palate: palatine (median) raphe:

Line from incisive foramen to uvula

Hard palate: Foramen

Hold or opening in a bony structure to allow blood vessels and nerves to pass through to the mucosa

Incisive foramen

In the area of alveolar ridge, just behind the central incisors

The starting point of embryological development

Hard palate: premaxilla

Triangular-shaped bone

Bordered by the two incisive sutures and the incisive foramen

Contain all four maxillary incisors (central and lateral)

Palatine process of maxilla

Forms anterior 3/4th of the maxilla

Two plates separated by median (intermaxillary palatine suture)

Nasal aspect of palatine suture forms groove for lower portion of vomer (nasal septum)

Hard palate: horizontal plates of the palatine bones

Posterior portion of the hard palate

Bordered by the transverse palatine suture lines

Meet in midline at the median palatine suture

Ends with the posterior nasal spine (bony projection)

Hard palate: torus palatinus (palatine torus)

Normal variation

Seen in some Caucasians of Northern European descent

Prominent longitudinal ridge on oral surface along intermaxillary suture line normal variation and usually not the cause of a problem

Hard palate: sphenoid and temporal bones

Medial and lateral pterygoid plates

Pterygoid hamulus

Both provide bony attachment for velopharyngeal musculature

Medial and lateral pterygoid plates

Part of pterygoid process of sphenoid bone

On far end of palate

Pterygoid hamulus

Inferior end of pterygoid plate

Soft palate: velum

Consists of muscles and mucosa (no bone)

Attaches to hard palate

Median palatine raphe continues to uvula

Uvula attaches to the posterior border

Surface cant be seen through nasopharyngoscopy

Soft palate: velum: palatine (velar) aponeurosis

Consists of fibrous, connective tissue

Is an anchoring point for velar muscles

Provides stiffness

Uvula

Teardrop-shaped pendulum

Consists of mucosa, glandular, and adipose tissue

Very vascular (it would bleed a lot)

Has no known function

Pharyngeal structures

Pharynx, adenoid pad, Eustachian tube

Pharynx (throat) parts

Posterior pharyngeal wall

Eustachian tube

Tonsils

Epiglottis

Different types of Tonsils

Adenoid (pharyngeal tonsil)

Tonsils (palatine tonsils)

Lingual tonsil (at the base of tongue)

Epiglottis

Prevents aspiration by covering trachea opening

Sections of pharynx

Nasopharynx: above the velum

Oropharynx: below the velum

Hypopharynx: below the base of the tongue

Posterior pharyngeal wall

Adenoid pad

Mass of lymphoid tissue

Located on posterior pharyngeal wall, just behind the velum

More prominent in children than adults (shrinks around age 8)

Children have velo-adenoidal closure

Eustachian tube

Connects the middle ear with the pharynx

At horizontal angle in children around age 6

At a 45 degree angle in adults

Pharyngeal opening is lateral and slightly above velum

Structures near eustachian tube

Torus tubarius: ridge located posterior to Eustachian tube

Salpingopharyngeal folds: originate from torus tubarius and course down to the lateral pharyngeal wall

Anatomical position

Face forward, palms out

Prone

Lying face downward

Supine

Lying face upward

Anterior

Front (toward)

Posterior

Back (toward)

Superior

Towards the head of the body

Inferior

Away from the head

Lateral

toward the side (or away from the axis of symmetry)

o   Divides into two parts

Medial

Towards middle of body

Proximal

Closer to torso

Distal

Farther from torso

Bilateral

Equal/effecting both sides of the body

Ipsilateral

on the same side as…(referent)

Contralateral

on the opposite side of the body as…(referent)

Ventral

Toward bottom of brain

Along/toward the belly surface of body

Dorsal

Toward top of brain

Along/toward the vertebral surface of body

Abduction

Away from midline

Adduction

Towards midline

Lingual

Branch of the mandibular nerve (line underneath tongue)

Labial

Junction of upper and lower lips lateral to mouth angle (V shaped thing on top and bottom of gums)

Superior means the same thing as

Dorsal

Inferior means the same thing as

Ventral

Dorsal means the same thing as ___ when referring to the brain

Superior

Structures of the velopharyngeal valve

Velum, lateral pharyngeal walls, posterior pharyngeal walls

Movement of the velopharyngeal valve

Open during nasal breathing for air to go in nasal cavity

Closes like a sphincter during speech

• regulates and directs the transmission of sound energy and airflow into the oral and nasal cavities

Velum during nasal breathing

Rests against the back of the tongue

Results in a patent (open) pharyngeal airway for unobstructed movement of air between nasal cavity and lungs

Velar movement

Moves in a superior and posterior direction

• up and back

Has a type of “knee” action

Moves toward posterior pharyngeal wall

Velar dimple

Velar dimple

Point on the oral surface where the levator veil palatini muscles interdigitate; is visible during phonation

Lateral pharyngeal wall movement

Moves medically (middle)

Usually close against the velum

Sometimes close in midline behind the velum

Both walls move during closure

• Often dont move the same

Lateral walls appear to bow outward during speech

Posterior pharyngeal wall movement

Moves anteriorly toward the velum

• toward the front a little

Has a very little role

Passavant’s ridge: bulge of muscle on PPW during speech; occurs in some normal and abnormal speakers

• helps with closure; disappears during nasal breathing

• Often on people with clefts

Velopharyngeal function

Requires coordinated movement of the following structures:

• velum

• LPW

• PPW

If ones not working, then wont properly close

Closes like a sphincter

Separates the nasal cavity from the oral cavity

Regulates and directs transmission of sound energy and airflow into the oral and nasal cavities

Particularly important for production of “pressure-sensitive” consonant sounds (plosives, fricatives, and affricates) and all vowels

Levator veli palatini muscle (velar “sling”)

Velum closes against PPW

Elevates velum during VP closure @ 45 degree angle

Superior constrictor muscle (pharyngeal ring)

Constriction of LPW around velum VP closure

Palatoglossus muscle (anterior faucial pillar)

Depressing velum causing VP opening for nasal sounds

Musculus uvulae muscle (bulge on nasal surface)

Provides bulk on nasal surface of velum during VP closure

Tensor veli palatini muscle (for Eustachian tube function)

Open Eustachian tube to enhance middle ear aeration and drainage during swallowing

Pharyngeal plexus

A network of nerves that lies along the posterior wall of the pharynx and consists of the pharyngeal branches of the glossopharyngeal nerve (CN IX) and vagus nerve (CN X)

VP closure: Coronal pattern

Velum and PPW

VP closure: Sagittal pattern

LPWs move medically

Least common

VP closure: circular pattern

All structures move

Sometimes includes Passavant’s ridge

Nonpneumatic activites

Activities done without airflow

Velum closed high in the pharynx and LPWs close tightly along their length

• necessary to allow substances to pass through oral cavity without nasal regurgitation

Swallowing, gagging, vomiting

Pneumatic activities

Activities that utilize airflow and air pressure as a result of VP closure

• positive pressure: whistling, blowing, speech

  • Air coming out

• Negative pressure: sucking, kissing

  • Air coming in

Timing of closure

Valve closes before phonation begins or sound will be hyper nasal

• can’t build up any pressure, air will come out nose

Closure is maintained until a nasal consonant or the utterance is ended

Height of closure

Closure tends to be higher and tighter with high vowels and high-pressure consonants, especially voiceless consonants

Closure can be effected by rate and fatigue (ALS, MS)

VL consonants have more pressure than voiced

• vocal folds have to vibrate and takes off pressure

Firmness of closure

Gap of 5 mm (20 mm2) is the threshold for hypernasality (5 pencil tips) (will hear it here)

Even very small gaps cause audible nasal air emission

Rate and fatigue

Velar movement, height, and firmness of closure can decrease with rapid rate and muscular fatigue

• can cause increase in the perception of hypernasality

  • Tired children are “whiny” which is just nasal, since their rate of closure is slower

Changes with growth and age

Velum increases in thickness and length: “Velar stretch”

Maturation results in an increase in oral-motor coordination

Facial skeleton, including hard and soft palate, moves down and forward as we grow

Posterior pharyngeal wall changes in inclination and bends forward. More efficient closure

Closure changes from just below the velar eminence to on top of the velar eminence.

Gradual involution of adenoid tissue occurs, particularly around puberty

Subsystems of speech

Respiration: pharyngeal dysfunction can cause an alteration of respiration during speech because the loss of airflow through the nose causes the individual to take more frequent breaths to replenish the air

Phonation: may be altered if the individual compensates for inadequate oral airflow for VL sounds by substituting pronated sounds

• prosody (stress and intonation)

VP function

• resonance

Articulation

When saying “ah” phonation stops

When you run out of air

Reparation procedure

Air pressure is required to initiate and sustain phonation

1. Vocal folds close

2. Subglottic air pressure builds

3. Vocal folds break open and begin to vibrate

   1. Pressure is released

Respiration

Breathing for vegetative purposes is different then for speech

Inspiration and expiration are controlled based on utterance length and phrasing (take in as much air is required for the utterance)

There is a need to control breathing and phrasing

Need to maintain breath support for phonation and sound production throughout the utterance

Provides airflow, which converts to intraoral air pressure for articulation

Is important for pressure-sensitive sounds

Most intraoral air pressure

Voiceless consonants

High-pressure sounds

Plosives (p, b, t, d, k, g)

Fricatives (f, v, s, z, ʃ, Θ, ð)

Affricates (ʧ, ʤ)

Low pressure sounds

Liquids (l, r)

Glides (w, j)

No pressure sounds

Nasals (n, m, ŋ)

Phonation

Vibration of the vocal folds produces sound for speech

Needed for all vowels and some consonants

Must be able to start and stop phonation quickly throughout an utterance

• “A cup” start-stop-start-stop

Oral sound VP function

Velopharyngeal valve is closed.

This allows acoustic energy and airflow to enter oral cavity.

It is important for the production of most consonant sounds (particularly plosives, fricatives, affricates) and all vowels.

Nasal sound VP function

Velopharyngeal valve is open.

This allows most of the sound energy to enter the nasal cavity

It is important for nasal sounds (m, n, ŋ).

Articulation: vowels

Produced by altering oral resonance

Formant frequencies affected by:

• Position of tongue, jaw, and lips

• Size and shape of oral cavity

Acoustics and vowel perception affected by formant frequencies