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A Descriptive Analysis of Individuals with Congenital Palatal Insufficiency

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A Descriptive Analysis of Individuals with Congenital Palatal Insufficiency Western Michigan University ScholarWorks at WMU Master's Theses Graduate College 12-1977 A Descriptive Analysis of Individuals with Congenital Palatal Insufficiency Judith Dabkowski Follow this and additional works at: https://scholarworks.wmich.edu/masters_theses Part of the Speech and Hearing Science Commons, and the Speech Pathology and Audiology Commons Recommended Citation Dabkowski, Judith, "A Descriptive Analysis of Individuals with Congenital Palatal Insufficiency" (1977). Master's Theses. 2244. https://scholarworks.wmich.edu/masters_theses/2244 This Masters Thesis-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Master's Theses by an authorized administrator of ScholarWorks at WMU. For more information, please contact [email protected]. A DESCRIPTIVE ANALYSIS OF INDIVIDUALS WITH CONGENITAL PALATAL INSUFFICIENCY by Judith Dabkowski A Thesis Submitted to the Faculty of The Graduate College in partial fulfillment of the Degree of Master of Arts Western Michigan University Kalamazoo, Michigan December 1977 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENTS The author wishes to extend sincere thanks to the many individuals who have helped in the development and execution of the research presented here. Special thanks go to the thesis committee members, Dr. Robert L. Erickson and Dr. Ralph Blocksma for their helpful suggestions and encouragement. Sincerest appreciation is extended also to the records department of the Butterworth Hospital, Grand Rapids, Michigan and to the subjects, parents, and informants for their willing cooperation during the collection of data. Finally, the author wishes to especially thank Dr. Clyde R. Willis for his unlimited assistance, guidance, and encourage­ ment during the preparation of this thesis. He was an instru­ mental and supporting force throughout the research period. Judith Dabkowski ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. INFORMATION TO USERS This material was produced from a microfilm copy of the original document. While the most advanced technological means to photograph and reproduce this document have been used, the quality is heavily dependent upon the quality of the original submitted. The following explanation of techniques is provided to help you understand markings or patterns which may appear on this reproduction. 1.The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)". If it was possible to obtain the missing page(s) or section, they are spliced into the film along with adjacent pages. 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The majority of users indicate that the textual content is of greatest value, however, a somewhat higher quality reproduction could be made from "photographs" if essential to the understanding of the dissertation. Silver prints of "photographs" may be ordered at additional charge by writing the Order Department, giving the catalog number, title, author and specific pages you wish reproduced. 5. PLEASE NOTE: Some pages may have indistinct print. Filmed as received. Xerox University Microfilms 300 North Zeeb Road Ann Arbor, Michigan 48106 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. MASTERS THESIS 13-10,931 DABKOWSKI, Judith, 1954- A DESCRIPTIVE ANALYSIS OF INDIVIDUALS WITH CONGENITAL PALATAL INSUFFICIENCY. Western Michigan University, M.A., 1977 Health Science, speech pathology University Microfilms International,Ann Arbor, Michigan 48106 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS CHAPTER PAGE I THE REVIEW OF THE LITERATURE AND PURPOSE OF THE S T U D Y ........................................ 1 The Purpose of the Study....................... 8 II PROCEDURES AND METHODS............................ 10 Subject Selection ............................. 10 Variables...................................... 10 Questionnaire .................................. 11 Data Collection and Analysis................... 12 III R E S U L T S ........................................... 14 IV DISCUSSION........................................ 24 Implications for Further Research .............. 32 V SUMMARY AND CONCLUSIONS.......................... 34 Conclusions.................................... 35 APPENDIX A .................................................... 36 APPENDIX B .................................................... 38 APPENDIX C .................................................... 43 BIBLIOGRAPHY .................................................. 48 iii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES TABLE PAGE 1 Frequency distribution of reported time of onset of the p r o b l e m ....................................... 1 4 2 Frequency distribution of source of Oral Cleft Clinic referral......................................... 15 3 Frequency of occurrence of reported anatomical characteristics......................................... 16 4 Frequency of occurrence of reported physiological conditions..............................................17 5 Frequency distribution of reported occurrence of conditions possibly related to CPI ................... 19 6 A list of management procedures and their frequency of use on the subject population.......................20 7 Reported effect of management procedures on speech . 21 8 Frequency distribution of reported treatment sequence................................................ 23 iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER I THE REVIEW OF THE LITERATURE AND PURPOSE OF THE STUDY Congenital palatal insufficiency (CPI) refers to an anatomical/ physiological condition resulting in hypernasal speech in the absence of an overt cleft of the palate. Some authors (Lubit, 1967; Peterson- Falzone and Pruzansky, 1976) include submucous clefts of the palate (SMCP) under the general heading of CPI. A SMCP is a congenital defect characterized by an imperfect union of the velar musculature. A triad of visible stigmata typically used to determine the presence of a SMCP include the muscular disunion in the soft palate with accompanying zona pellucida, a bifid uvula, and notching of the posterior border of the hard palate. Velopharyngeal insufficiency resulting in hypernasal speech is usually evident (Calnan, 1954). Other authors (Calnan, 1954; Crikelair et al., 1970) deal with SMCP as a condition separate from CPI. While increased attention to CPI has been evident in recent years, the identification of the condition spans more than a century. Winters (1966) identifies Passavant as the first author to acknowledge velo­ pharyngeal insufficiency in the absence of a cleft. He contends that Passavant referred to an individual with velopharyngeal incompetency in 1862. Winters also cites Demarquay as the first individual to identify submucous cleft of the hard and soft palate in 1846. Other authors (Blackfield et al., 1962; Calnan, 1954; Dorrance, 1930; and Weatherley- White, 1972) have suggested that Roux first identified CPI in 1825, but Winters contends that Roux actually described a palatal fistula and a submucous cleft of the hard palate. 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 Stimson (1909) gave a lengthy description of an individual with congenital insufficiency of the palate. He describes a woman with a SMCP and hypernasality of speech. In 1892, Lermoyez (as cited in Blackfield et al., 1962) reported on twelve subjects with a condition he described as "velopalatine insufficiency." These were subjects exhibiting inadequate velopharyngeal closure in the absence of a palatal cleft. He attributed their velopharyngeal insufficiency to anatomical shortness of the hard palate. Gutzman (as cited in Blackfield et al., 1962), in 1899, suggested the possibility of deficiency of the length of the soft palate as well as the hard palate causing CPI. Kelly (1910) cited three possible causes for the condition including (1) a short palate and a deep pharyngeal vault (2) a palate of adequate length but defective in movement (3) a combination of the above. In doing so, Kelly was the first to report a physiological dimension in addition to the previously suggested anatomical causes. Dorrance (1930) cites all of the above conditions as variables affecting CPI and includes two others, SMCP and velopharyngeal insufficiency secondary to successful cleft palate surgery. Presently,
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