Voice Therapy of Cleft Palate,10言听 蔡静雯 李伟 杨丽洁,Topics,What is Cleft Palate? definition development Incidence Etiology Classification Symptoms Repair Acoustic Characteristics Speech Therapy,part 1 What is Cleft Palate? * definition * development,What is Cleft Palate?,a kind of facial cleft* * facial cleft: Tissier1973 numbers the clefts from 0 to 14. 4 of the most common ones: lateral cleft（面侧裂）, oblique cleft（面斜裂）, cleft lip(palate)（唇/腭裂）, median cleft（面正中裂）,What is Cleft Palate?,congenital malformation of embryonic origin （先天性胚胎畸形） occurs by itself or together with an alveolar or lip cleft（齿槽或唇裂）,What is Cleft Palate?,how is the cleft palate comes to be ? incomplete development in the early weeks of pregnancy the face is being formed - the top and the two sides develop at the same time and grow towards each other, finally fusing（融合） in the middle. The lip and primary palate develop at 4 to 6 weeks of gestation, while the secondary palate develops at approximately 9 weeks.,part 2 Incidence * racial difference * sex difference * differences in types,Incidence,1/750 (safe & conservative estimated) Cleft Palate alone: 1/2,500 according to reports from ADA. racial difference: by Vanderas(1987),these differences could be attributed to environmental and genetic factors ,Incidence,sex difference * CLP: twice as often in males than females / more severe deformities * CP: females are more than or equal to males differences in type * varies, but hovers around a 3:3:4 ratio,part 3 Etiology * some related causes,Etiology,parental age （孕龄） drug use （药物） infections during pregnancy （孕期感染） smoking or/and drinking during pregnancy heredity , Family History （遗传） X-ray,microwave （辐射） deficiency of vitamin C,D,B （维生素CDB缺乏） environmental Factors （环境） Animal models have demonstrated that vitamin A, corticosteroids, and phenytoin produce cleft palate when given in pregnancy. （维A多度使用）,Unknown,part 4 Classification * soft palate alone * incomplete * complete,Classification,1- Cleft of the soft palate only（软腭裂） 2- Incomplete cleft of palate(unilateral/bilateral): not extend into the nose 3,4- Complete cleft of palate(unilateral/bilateral): extend into and involves the nose,Classification,1- Cleft of the soft palate only,Classification,2-unilateral Incomplete cleft of palate,Classification,3-unilateral complete cleft of palate,cleft palate only,cleft palate together with an alveolar or lip cleft,Classification,4-bilateral complete cleft of palate,cleft palate only,cleft palate together with an alveolar or lip cleft,part 5 Symptom * 5 of the symptoms,Symptom,Separation of the palate,Speech and/or language problem: Nasal voice*,Recurrent ear infections,Nasal regurgitations during bottle feeding（喂奶时鼻腔返流）,Psychological problems: of the adolescent or adult patients and their families.,* Velopharyngeal closure During speech and swallowing the palate moves both superiorly and posteriorly against the posterior pharyngeal wall to separate the oral pharynx and nasal pharynx. When palate is cleft ,however, not only is there inadequate Velopharyngeal closure but, in addition , the opening in the palate permits the air stream to pass partly through the nose. Thus ,the air stream ,passing through both nasal and oral cavities, can not be altered properly to produce the normal sounds.,Symptom,Nasal regurgitations during bottle feeding（喂奶时鼻腔返流）,A cleft feeding nipple must have: 1 a large enough opening to allow the formula to flow easily to prevent sucking fatigue, but it must not be so large as to cause choking. 2 Nipples should be soft and compressible（可压缩）, allowing liquid to flow easily. 3 the hole in the nipple designed for a premature neonate may need to be enlarged to increase the flow of milk ( performed by creating an X-shaped opening),Symptom,Nasal regurgitations during bottle feeding（喂奶时鼻腔返流）,squeeze the bottle in conjunction with the babys sucking/breathing rhythm to assist with swallowing,part 6 Repair * the goal * the age * the procedures,Repair,The goal: to create a velopharyngeal valving mechanism that is capable of seperating the oral from the nasal cavities during speech. primary goal added benefits: easier intake of food, reduction in the number of upperrespiratory infections, and improvment to the status of the middle ear. for parents: experience a psychological lift when the cleft is repaired,Repair,The age: The optimal timing for cleft palate repair is controversial.,a two-stage repair has been proposed. Involves: * closure of the soft palate between 6 to 12 m creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones * closure of the hard palate between 15 to 18 m,With this approach, the part of the palate necessary for normal speech development is intact, but without the growth restriction of closing the hard palate.,* In China: most commonly at 1.5 to 2 years old.【体重在12公斤以上，WBC（白细胞）在10,000以下，血红蛋白在10克以上，无发热咳嗽流鼻涕现象。】,