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29. Examples of Incomplete Clefts of Varying Degrees

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29 EXAMPLES OF INCOMPLETE CLEFTS OF VARYING DEGREES KEY TO CODE ON CASES NOSE NASAL FLOOR BD BIRTH DATE FAMILY HISTORY FT FIRST TRIMESTER LIP A1VEOLUS OCA OTHER CONGENITAL ANOMALIES OP OPERATION AD ADHESION ADV ADVANCEMENT ROT ROTATION RA ROTATIONADVANCEMENT HP HARD PALATE SOFT PALATE 13 BONE GRAFT BACKCUT WR WHITE ROLL FLAP FLAPC COLUMELLA CLEFT IS INDICATED BY STIPPLING UBMUCOUS CLEFT OR SUBMUCOUS DIS BY HORIZONTAL LINES VERMILION NOTCH CASE KR KR WEEKS POSTOPERATIVE BD OCTOBER 16 1961 OP POSTERIOR VY ROLL DOWN OF FR UNKNOWN VERMILION WITHOUT SKIN INCISIONS FT UNKNOWN OCA INTERNAL STRABISMUS MINIMAL CLEFT WITH CONGENITAL SCAR CASE MONTHS MONTHS BD MAY 15 1968 RA AT MONTHS COMMENT CONGENITAL SCAR WITH VET FR NO CLEFTS OP ROT WITH BC FOR COL NEAL SHORTNESS OF LIP AND WIDTH OF FT UNEVENTFUL ADV WITH WR ALAR BASE NASAL FLOOR REQUITED SCAR EXCISION OCA NONE DENUDED FOR INSERTION INTO AND MODERATE ROTATION AND AD COLUMELLA BASE VANCEMENT TO GIVE NATURAL BALANCE 336 MINIMAL CLEFT WITH CONGENITAL SCAR CASE BD MARCH21 1964 FH NO CLEFTS FT UNEVENTFUL OCA NONE RA AT 7½ MONTHS OP ROT WITH BC FOR COL 72 MONTHS ADV WITH WR CLEFT VERMILION EDGE INTERDIGITATION INTO NON CLEFT AT FREE BORDER YEATS COMMENT CONGENITAL SCAT WITH SHORTENING AND VERMILION NOTCH REQUITED SCAR EXCISION MODERATE ROTATION AND ADVANCEMENT NASAL FLOOR WEDGE EXCISION MUSCLE SU AND TURE VERMILION INTETDIGIRATION TO ACHIEVE BALANCE IT4 2Y T5 37 MINOR CLEFT WITH CONGENITAL GROOVE CASE SEPTEMBER 1964 FH NO CLEFTS FT UNEVENTFUL OCA NONE RA AR MONTHS OP ROT WITH FOR COL ADV WITH WR WEDGE FROM NASAL FLOOR III IN 141 MONTHS MONTHS II IN II II IN 31 SI II 11 COMMENT IMPORTANT TO PTESERVE I4 II PHILTRUM DIMPLE AND CLEFT SIDE COL UMN AS MUCH AS POSSIBLE 3YEARS PENICILLIN MINOR CLEFT WITH CONGENITAL GROOVE CASE 18 MONTHS MARCH 1964 AT 18 MONTHS COMMENT AIM TO PRESERVE COLUMN FH NO CLEFTS OP ROT WITH BC FOR COL ON CLEFT SIDE AS WELL AS NORMAL SIDE FT UNEVENTFUL ADV WITH WR ALAR RIM CXCI AND STILL ROTATE DIMPLE AND BOW OCA NONE SION INTO BALANCED POSITION HEALING SLIGHT CONTRACTURE MINOR CLEFT WITH CONGENITAL GROOVE CASE AR MONTHS COMMENT SCAR BALANCES BD APRIL 1969 OPPOSITE FH NO ANOMALIES OP ROT WITH FOR COL COLUMN MAINTAINING CENTRAL DIM K4I FT MOTHER HAD ADV WITH WR ALAR RIM CXCI PIE SION STREP THROAT TREATED WITH AND MYCIN DRUG OCA NONE MINOR CLEFT CASE NOVEMBER 1970 FH NO CLEFTS FT UNEVENTFUL OCA NONE RA AT 32 MONTHS ROT WITH HC ADV WITH MONTHS MONTHS DAYS POSTOPERATIVE WR POSTERIOR MUCOSAL INTERDIG ITATION IT II COMMENT MORE ROTATION NECESSARY THAN OBVIOUS AT FIRST GLANCE 10 MONTHS II 340 MILION MINOR CLEFT CASE JULY 29 1963 FT UNEVENTFUL RA AT MONTHS OP ROT WITH FAT CAL ADV WITH WR MONTHS MONTHS REVISIONS AT YEAT EXCESS VET TTIM SMALL SCAT TEVISIAN MONTHS FR COMMENT SCAR EXCISION WITH SLIGHT ROTATION AND ADVANCEMENT PLUS THE WHIRE ROLL ACHIEVED YEARS FLAP BALANCE MINOR CLEFT CASE 1960 ER ONLY ONE MALE SIBLING WITH CONGENITAL LIP SCAR AND CLEFT FT UNEVENTFUL OCA NONE RA AR MONTHS OP STANDARD RA WITHOUT RE FINEMENTS EXCEPT FOR COL LATERAL OVERLAP OF VERMILION MUCOSA II REVISIONS 14 MONTHS POSTOPERATIVE SLIGHT SCAR EXCISION VERMIL UPPER MONTHS ION TRIM ON CLEFT FREE BORDER II IJ ORIGINAL DEFORMITY AND EARLY RESULT PUBLISHED IN PLAST RECONSTR SURG 3336 1964 COMMENT LATERAL LIP ELEMENT THICKER AND LONGER VERTICALLY THAN NONCLEFT ELEMENT BY ELEVATION OF ADVANCE MENT INTO ROTATION GAP THIS DIS CREPANCY WAS BENEFITED LYEAR 342 MINOR CLEFT CASE 10 FEBRUARY 1962 FH NO CLEFTS FT ONE DAY OF NAUSEA CRAMPS DIARRHEA OCA NONE RA AR MONTHS OP ROT WITH HC FOR COL ADV WITH WR WEDGE FROM MONTHS NASAL FLOOR TRIMMING OF NORMAL VERMILION FREE BORDER REVISIONS YEARS LATER REVISION OF VERMILION VERTICAL AND HORIZONTAL FREE BORDER TRIMMING MONTH POSTOPERATIVE COMMENT THIS WAS ALMOST BILATERAL CLEFT BUT EFFECTIVELY CORRECTED WITH UNILATERAL ROTATIONADVANCEMENT AND WHITE ROLL FLAP IO YEARS HALFWAY CLEFT CASE 11 BD MAY 29 1957 FH NO CLEFTS FT UNEVENTFUL OCA NONE RA AT MONTHS OP EARLY STANDARD RA WITHOUT MONTHS MONTHS YEAT REFINEMENTS AND WITH INTETDIGITA NON OF VERMILION AT FREE BORDER HP SP VY PUSHBATK AT 11 MONTHS REVISION AT 11 MONTHS CLEFT SIDE VERMILION TRIMMED 11 41 COMMENT WELLBALANCED RESULT EVEN THOUGH WHITE ROLL FLAP NON BEING USED YET HERE MUSCLE TISSUE FROM THE CLEFT EDGE WOULD BE USED TO FILL OUT THE DEPRESSION IN THE UPPER PORTION OF THE LATERAL LIP ELE MENT PRIMARILY NOW 15 YEARS LH 344 II IT 11 HALFWAY CLEFT CASE 12 MONTHS 10 13 YEARS YEARS YEARS WHITE ROLL OCTOBER 1959 RA AR MONTHS COMMENT CONTINUITY REFINEMENTS ACHIEVED BY MM SKIN GRAFT FROM MOTHER HAS CLEFT OP RA WITHOUT NO THE ARM AS PRIMARY WHITE ROLL FLAP NOSE DEFORMITY WR FLAP WAS NOT USED IN 1959 PATIENT WITHOUT CLEFT BEING HE HAD CLEFT AR MUCOCUTANE DOES NOT KNOW LIP HALFBROTHER REVISION YEARS ON MATERNAL SIDE OUS WHITE ROLL CREATED BY TINY SKIN HAS CLEFT LIP GRAFT FROM ARM WITH NASAL DE AND RESULT FORMITY AND AL ORIGINAL DEFORMITY EARLY AND PALATE VEOLAR DEFECT PUBLISHED IN CLEFT LIP BY FT UNEVENTFUL GRABB ROSENSTEIN AND BZOCH OCA NONE 1971 HALFWAY CLEFT CASE 13 MONTHS 4S MONTHS WEEKS POSTOPERATIVE BD 1962 AT MONTHS MAY 22 RA COMMENT THE MUSDE DEFICIENCY IN FJ NO CLEFTS ROT WITH HC FOR COL THE OP UPPER PORTION OF THE LATERAL LIP FT UNEVENTFUL ADV WITH NOSTRIL WR FLOOR ELEMENT IS NOT EVIDENT IN EARLY OCA NONE EXCISION ALAR RIM EXCI WEDGE POSTOPERATIVE PHOTO MUSCLE FLAP SION FROM MEDIAL ELEMENT WOULD HE IN SERTED INTO THIS DEFICIENCY DURING THE PRIMARY PROCEDURE IF DONE TO DAY 23 WAY CLEFT CASE 14 CI IL 4MONRHS 4MONTHS LYEAR APRIL 30 1968 RA AT 4I MONTHS COMMENT UPPER PORTION OF LATERAL NO ROT WITH HC FH CLEFTS OP FOR COL LIP ELEMENT THIN AND DEFICIENT IN FT MEDICATION ADV WITH TO WR MUSCLE MUSCLE FLAP FROM EDGE OF 21 PREVENT MIS MEDIAL ELEMENT WOULD HAVE FILLED III CARRIAGE OUR THE CONTOUR OCA NONE II HALFWAY CLEFT CASE 15 NOVEMBER 20 1964 FH NO CLEFTS FT UNEVENTFUL OP ROT WITH FOR COL ADV WITH WR POSTETIOR MEDIAL MUCOSAL FLAP TO CLEFT SIDE REVISIONS YEAR LATER ELLIPTICAL EXCISION FROM FREE BORDER OF CLEFT VY ADVANCEMENT OF ALAR BASE COMMENT MUCOCURANEOUS RIDGE ON THE LATERAL LIP ELEMENT FLATTENED OUR TOO SOON IN THE ORIGINAL DEFORMITY SO THAT GETTING STRONG RIDGE IN CONTINUITY ACROSS THE CLEFT WAS DIFFI CULT OF AT THE STELIN TWINS AND CLEFTS TWINS TWINNING RATE 133 1921 FOGH ANDERSEN 1962 INTERNATIONAL CLEFT PALATE CONGRESS IN AND FRENKEL IN 1970 REPORTED SIAI IF ANY TRAIT IS SOLELY GENETICALLY DETER IN HE 100 TWINS WITH MIRROR UNILATERAL BE SIMI 1973 COPENHAGEN REPORTED IMAGE MINED THERE SHOULD 100 PERCENT OF TWINS IN CLEFTS INCLUD THERE HAVE BEEN NO CONCER THIS PAIRS OVER 5000 REPORTS LARIRY IN MONOZYGOTIC TWINS DEGREE OF IDENTICAL ING 17 PAIRS OF MONOZYGORIC TWINS TREATMENT CONCORDANT OF CNNCORDANCE HOWEVER IS NOR FOUND HAVE HAD AMONG THESE WERE TWO PAIRS OF IDENTICAL BUT AS PAIR AS PATIENTS AS POINTED OUR BY FOGH ANDERSEN IN CONCORDANT TWINS ONE THEY ARE FOR YOUR STUDY ACCORDIN DIFFERENCE IN MONOZYGORIC PAIR 1942 ANY PHYSICAL MONOZY HAD UNILATERAL LEFT COMPLETE CLP THE COHN CONDRON ONCE MEDICAL DIRECT TWINS MAY BE ATTRIBUTED TO EXOG GONE THE OF MIAMI MAILMAN OTHER PAIR HAD UNILATERAL LEFT INCOMPLETE UNIVERSITY CT ENOUS FACTORS INFLUENCING THE AFFECTED WITH FOR CHILD THERE IS CL THERE WAS ALSO PAIR SYMMET DEVELOPMENT TWIN OR TO AN ARREST OF MANIFESTATION IN RICAL OR MIRROR TYPE RIGHT AND LEFT COM WHELMING EVIDENCE THAT THESE BOYS THE APPARENTLY NORMAL TWIN TWINS WITH PLERE CL MONOZYGOTIC SINGLE PLA MENRAKOS METRAKOS AND BAXTER IN 1958 IN MONOCHORIONIC STATE AND COM REPORTED PAIR OF MONOZYGORIC TWINS ONE IN 1972 FOR ENGLAND AND WALES BLAKE AMNION SHARING MOST COMMON WITH CL AND THE OTHER NORMAL NOR REFUTE RECORDED FOR THE YEAR 1968 819272 LIVE GROUP ANTIGENS BIAS RAMSEY AND WYNNWILLIAMS IN 1960 RE MIXED CULTURES WAR BIRTHS 8697 TWIN PREGNANCIES TWINNING LYMPHOCYTE PORTED PAIR OF MONOZYGONIC TWINS ONE AND SIMILA DERN OF WITH CLEFTS HE EXTRA HAVING REMARKABLY WITH LEFT UNILATERAL AND THE OTHER RATE 194 1175 CLP AND COUNTS NUMBER OF MONO GLYPHICS RIDGE WITH BILATERAL CLP IN 1966 BOOCHAI POLARED EXPECTED OF TWINS REPORTED TWO PAIRS OF MONOZYGOTIC TWINS ZYGORIC TWINS 2609 30 PERCENT DIAMOND FLAPS FOR TWIN TUHERCIES NUMBEROF ONE PAIR HAD CLP AND NORMAL MATE BEING MONOZYGOTIC EXPECTED EACH IDENTICAL TWIN WITH HIS SYMMEL WHILE HAD THE OTHER PAIR RIGHT CLP 8697 CLEFTS IN TWINS 25 ONE CONCORDANT CLEFT NOT ONLY HAD ROTA AND THE OPPOSITE TWIN HAD LEFT MICRO 697 ADVANCEMENT BUT RECEIVED BLAKE AND WREAKES FORM CL IN 1972 THIRD OF THIS SHOULD BE MONOZYGOTIC DIAMONDSHAPED POSTERIOR MUCOSAL FIVE OF TWINS REPORTED PAIRS MONOZYGOTIC TWINS WITH CLEFTS IF 30 TO 40 PERCENT OF POSITION FLAP TO BOLSTER HIS ONE HAD CLEFTS OF PAIR UNEQUAL DEGREE MONOZYGOTIC TWINS WITH CLEFTS ARE CON RUBERELE WHILE THE OTHER FOUR PAIRS HAD ONE CLEFT CORDANT 1967 THERE FOGHANDERSEN NO MATTER HOW CAREFULLY NATURE AND ONE NORMAL EACH FOGHANDERSEN IN SHOULD HAVE BEEN THREE CONCORDANT MONO TO DUPLICATE OR HOW DILIGENTLY THE SUR OF OF 1971 PUBLISHED AN ACCOUNT PAIR TWINS IN ENGLAND AND WALES IN ZYGORIC ATTEMPTS TO ASSIST HER IDENTICAL MONOZYGOTIC TWINS ONE WITH UNILATERAL 1968 DUCNION DOES NOT OCCUR NOR ONLY HA AND THE OTHER WITH BILATERAL CLP CLP IN THE USA WITH 4000000 YEARLY TWIN DIFFERENCE IN VISUAL ACUITY REQU AND CITED IT AS ANOTHER TO EXAMPLE SUPPORT BIRTH RATE AND 47500 TWIN LIVE BIRTHS GLASSES BUT THE TWO LIPS SHOWSLIGHT HIS THAT CP IS DISTINCT THEORY GENETICALLY THE CLEFT RATE OF 1750 ONE 86 USING ARIONS IN THEIR HEALING GROWTH AND NOTED FROM CLP HE CAN THE NUMBER OF TWINS WITH EXTRAPOLATE OPMENR THEY ARE BOTH HOWEVER 47500 TWIN STUDIES IN DENMARK AND OTHER
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    PART Normal and Abnormal 1 Craniofacial Structures CHAPTER 1 Anatomy and Physiology CHAPTER 2 Genetics and Patterns of Inheritance CHAPTER 3 Clefts of the Lip and Palate CHAPTER 4 Dysmorphology and Craniofacial Syndromes CHAPTER 5 Facial, Oral, and Pharyngeal Anomalies CHAPTER 6 Dental Anomalies CHAPTER 7 Early Feeding Problems 1 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION 9781284149722_CH01_Pass03.indd 1 04/06/18 8:20 AM © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION 9781284149722_CH01_Pass03.indd 2 04/06/18 8:20 AM CHAPTER 1 Anatomy and Physiology CHAPTER OUTLINE INTRODUCTION Muscles of the Velopharyngeal Valve Velopharyngeal Motor and Sensory Innervation ANATOMY Variations in Velopharyngeal Closure Craniofacial Structures Patterns of Velopharyngeal Closure Craniofacial Bones and Sutures Pneumatic versus Nonpneumatic Activities Ear Timing of Closure Nose and Nasal Cavity Height of Closure Lips Firmness of Closure Intraoral Structures Effect of Rate and Fatigue Tongue Changes with Growth and Age Faucial Pillars, Tonsils, and Oropharyngeal Subsystems of Speech: Putting It All Isthmus Hard Palate Together Velum Respiration Uvula Phonation Prosody Pharyngeal Structures Resonance and Velopharyngeal Function Pharynx Articulation Eustachian Tube Subsystems as “Team Players” PHYSIOLOGY Summary Velopharyngeal Valve For Review and Discussion Velar Movement Lateral Pharyngeal Wall Movement References Posterior Pharyngeal Wall Movement 3 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION 9781284149722_CH01_Pass03.indd 3 04/06/18 8:20 AM 4 Chapter 1 Anatomy and Physiology INTRODUCTION The nasal, oral, and pharyngeal structures are all very important for normal speech and resonance. Unfortu- nately, these are the structures that are commonly affected by cleft lip and palate and other craniofacial anom- alies.

  • Cleft Lip and Palate: the Effects on Speech and Resonance

    Cleft Lip and Palate: The Effects on Speech and Resonance Ann W. Kummer, PhD, CCC-SLP Cincinnati Children’s Hospital Medical Center ___________________________________________________________________________ Cleft lip and/or palate can have a negative impact on both speech and resonance. The following is a summary of normal anatomy, the types and causes of clefts, and the effects on speech and resonance. ______________________________________________________________________________ Normal Anatomy Nose • Columella - the column that separates the nostrils and holds up the nasal tip • Ala base - the base of the nostrils • Ala rim - the rim of the nostrils • Philtrum - the depression on the upper lip under the columella • Philtral ridges – embryological suture lines above the lip that border the philtrum Lip • Cupid’s Bow - the shape of the upper lip • White Roll - border of the red part of the lips • Vermilion - the red part of the lip Hard Palate - consists of the premaxilla, the maxilla proper and the palatine bone. • Premaxilla - triangular structure in the middle anterior portion of the palate. It is bordered by the incisive foramen and bilateral incisive structures, which extend between the lateral incisors and canines. • Palatine Process of Maxilla - horizontal plates starting at the alveolar process, and bordered by the incisive sutures and the transverse palatine suture. • Palatine Bone - horizontal plate which is bordered by the transverse palatine suture and completes the hard palate posteriorly. Velum (Soft Palate) - muscular portion of palate which is attached to the posterior edge of the palatine bone. 1 Cleft Lip and Palate 0814 1 of 4 Cleft Lip and Palate: The Effects on Speech and Resonance Ann W.