Evaluation and management of cleft lip and palate: a developmental perspective

433 Pages·2017·73.574 MB·English

by  David J. Zajac, Linda D. Vallino

Evaluation and Management
of Cleft Lip and Palate
A Developmental Perspective

Evaluation and Management
of Cleft Lip and Palate
A Developmental Perspective
David J. Zajac, PhD, CCC-SLP
Linda D. Vallino, PhD, CCC-SLP/A
5521 Ruffin Road
San Diego, CA 92123
e-mail: [email protected]
Website: http://www.pluralpublishing.com
Copyright © by Plural Publishing, Inc. 2017
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Names: Zajac, David J., author. | Vallino, Linda D., author.
Title: Evaluation and management of cleft lip and palate : a developmental
perspective / David J. Zajac, Linda D. Vallino.
Description: San Diego : Plural, [2017] | Includes bibliographical references
and index.
Identifiers: LCCN 2015042352| ISBN 9781597565516 (alk. paper) | ISBN
1597565512 (alk. paper)
Subjects: | MESH: Cleft Lip. | Cleft Palate. | Speech Disorders — prevention &
control. | Velopharyngeal Insufficiency.
Classification: LCC RD525 | NLM WV 440 | DDC 617.5/22 — dc23
LC record available at http://lccn.loc.gov/2015042352
Contents
Preface vii
Acknowledgments ix
Contributors xi
Part I. Fundamentals 1
1
Orofacial and Velopharyngeal Structure and Function 3
Jamie Perry and David J. Zajac
2
Clefts of the Lip and Palate 23
3
Syndromes and Associated Anomalies 49
Part II. Birth to Age Three 111
4
Feeding the Newborn 113
5
Presurgical and Surgical Management 129
6
Hearing and Otologic Management 151
7
Early Linguistic Development and Intervention 177
Nancy J. Scherer
Part III. Early to Middle School Age 191
8
Speech and Resonance Characteristics 193
9
Assessment of Speech and Velopharyngeal Function 227
10
School-Based Intervention 281
Dennis M. Ruscello
11
Secondary Management of Velopharyngeal Inadequacy 319
12
Alveolar Cleft Repair 339
Joseph A. Napoli
Part IV. Adolescents and Adults 355
13
Maxillary Advancement 357
Joseph A. Napoli and Linda D. Vallino
14
The Adult With Cleft Lip and Palate 379
Glossary of Terms 391
Index 401
v

Preface
This book is intended to be a concise, To help achieve these goals, the mate-
practical, and evidence-based text on cleft rial in the book is presented in a devel-
lip and palate and related craniofacial opmental framework that emphasizes the
disorders for advanced undergraduate most critical needs of the individual from
students, graduate students, and profes- birth to adulthood. This organizational
sionals in speech-language pathology. approach has both practical and concep-
Students and professionals in related dis- tual advantages. Practically, it allows the
ciplines such as dentistry, medicine, psy- reader to access information more read-
chology, and social work also may find ily according to the age and presenting
this book useful in providing information condition of the individual (i.e., birth, lip
on individuals with craniofacial condi- repair, palate repair, alveolar cleft repair
tions. Cleft palate with or without cleft or bone grafting, maxillary advancement).
lip is a congenital defect that varies both Conceptually, it chronicles the lifelong
in its severity and impact on facial and impact of craniofacial birth defects on the
oral structures and communication. Treat- individual and elucidates the timing and
ment of individuals is typically a long and rationale of surgical, dental, and behav-
often-complicated process, extending into ioral interventions.
early adulthood and beyond, that is best Part I provides necessary funda-
accomplished in a team setting. In addition mentals for the student and professional.
to the speech-language pathologist, other Chapter 1 reviews anatomy and physiol-
team members typically include a plastic ogy of the facial, oral, and velopharyn-
surgeon, dentist, orthodontist, oral and geal structures that are affected by clefts.
maxillofacial surgeon, otolaryngologist, Chapter 2 describes the types and causes
audiologist, geneticist, social worker, and of clefts with an emphasis on embryologi-
psychologist. Even though all members cal development and classification. The
of the team contribute to the habilitation controversy regarding timing of palate
of the individual througout his or her repair is discussed from the perspective
life span, certain team members assume of speech and language development.
critical roles at specific times of life. The Chapter 3 provides an overview of genet-
purpose of the book is to provide the stu- ics and the terminology used to catego-
dent and professional in speech-language rize and identify congenital anomalies.
pathology the information needed to (a) A select group of craniofacial anomalies
evaluate and treat communication disor- most likely to be encountered by the pro-
ders associated with cleft palate regard- fessional is reviewed.
less of their primary place of employment Part II focuses on evaluation and
(i.e., craniofacial team, hospital, school, or management of the individual from birth
private practice), and (b) understand the to 3 years of age. Chapter 4 describes nor-
complex — and sometimes controversial — mal feeding physiology, feeding prob-
surgical and dental management of indi- lems associated with cleft palate, and
viduals across the life span. approaches to facilitate feeding prior to
vii
viii Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective
palate repair. Chapter 5 describes presur- viduals affected in the United States is
gical and surgical management of cleft lip relatively low. It is not unusual, therefore,
and palate. Chapter 6 covers the almost for speech-language pathologists working
universal occurrence of otitis media with in the schools to infrequently see children
effusion and conductive hearing loss that with clefts. It is our hope that the materi-
occurs in infants with cleft palate and cur- als in this book will be a valuable resource
rent methods of management. Chapter 7 for school-based clinicians when they do
reviews early linguistic development in encounter children with clefts. Some mate-
infants with cleft palate and intervention rial traditionally covered in other texts is,
strategies before and after palate repair. unfortunately, omitted in the book. Due to
Part III focuses on evaluation and a goal to be concise and follow a develop-
management of the individual from age mental framework, separate chapters on
3 throughout the middle school years. craniofacial team function and psycho-
Chapter 8 describes the resonance, nasal social aspects of individuals with cranio-
emission, articulation, voice, fluency, and facial anomalies are not included. These
intelligibility characteristics of children are obviously important areas. We have,
with repaired cleft palate. Chapter 9 pro- however, interweaved these materials in
vides detailed coverage of perceptual various chapters throughout the book.
assessment and an overview of instru- Maternal reactions to an infant born with
mental assessment techniques. Chapter 10 a cleft are covered in Chapter 4, learning
describes practical approaches to treat- disabilities of children with cleft palate
ing children with articulation problems and treatment collaboration models with
in the school setting. Chapter 11 presents teams are reviewed in Chapter 10, and the
an overview of behavioral, surgical, and last chapter deals exclusively with quality
prosthetic options to manage velopharyn- of life issues facing the adult.
geal inadequacy that persists following Finally, the book has been written
initial palate surgery. Chapter 12 describes with a goal to be concise and cite evidence-
the orthodontic preparation and surgical based sources to support intervention
correction of clefts of the alveolus. approaches. In some areas, there is little
Part IV focuses on evaluation and man- objective evidence available to guide
agement of adolescents and adults with cleft clinical decision making. In those areas,
palate. Chapter 13 describes the rationale we note the lack of evidence and suggest
and timing of maxillary advancement in directions for future research. It is our
adolescents to improve facial aesthetics, hope that this book will not only inform
dental occlusion, and articulation. Chapter but also challenge clinicians in speech-
14 discusses issues facing adult patients. language pathology to provide the best
Although clefts of the lip and palate evidence-based evaluation and manage-
are among the most frequently occurring ment of individuals with craniofacial
birth defects, the actual number of indi- anomalies as possible.
Acknowledgments
I am indebted to many who have contrib- I strived to emulate relative to scholar-
uted either directly or indirectly to this ship and research productivity. Others at
book. While at the University of Pitts- the University of North Carolina at Cha-
burgh, I was fortunate to have Betty Jane pel Hill who have been influential include
McWilliams as an early mentor. Dr. McWil- Amelia Drake, Tim Turvey, Gerald Sloan,
liams, the first and longtime director of Wolf Losken (also at Pittsburgh), and
the Cleft Palate Center, was an inexhaust- John van Aalst. They were instrumental
ible clinician and researcher who first and in helping me understand surgical treat-
foremost put the welfare of the patient ment of patients.
above all else. I have been truly influ- I am most appreciative of Linda Val-
enced by her wisdom, knowledge, and lino, co-author of the book, and Jamie
caring. Campbell C. Yates and Raymond Perry, Nancy Scherer, Dennis Ruscello,
Linville also were mentors at Pittsburgh. and Joseph Napoli, contributors to the
Professor Yates, chair and emeritus pro- book. They are outstanding clinicians
fessor of mechanical engineering, volun- and researchers in their respective areas.
teered his time to establish aerodynamic This book would not be what it is without
assessment procedures at the center. Pro- their input. A special thanks is also due
fessor Yates helped me to understand and to Marziye Eshghi, Jacqueline Dorry, and
appreciate the nuances of fluid dynamics Ramona Hutton-Howe for their help with
when applied to the complex geometry of figures, tables, and photography.
the human upper airways. Raymond Lin- On a personal note, I am indebted to
ville, a mentor and friend, was influential my family for their support and encour-
in guiding my early research endeavors. agement. They graciously endured count-
Many colleagues have been influen- less dinnertime book conversations — and
tial during the past 20 years at the Uni- dinners without me — during the writing
versity of North Carolina at Chapel Hill. of the book. I am grateful to my loving
Donald W. Warren, the Craniofacial Cen- wife, Robin, children, Jared and Rachel,
ter’s first director, was a prolific researcher daughter-in-law Elizabeth, son-in-law,
who applied aerodynamic techniques Matt, and grandson, William, for their
to the evaluation of nasal and palatal encouragement. The thought of William’s
function. Don was a role model whom wonderful smile was the best inspiration.
— David J. Zajac
Chapel Hill, North Carolina
This book would not have been possible ing and doctoral degree at the University
without the encouragement, mentor- of Pittsburgh, under the direction of Dr.
ship, and friendship of some very special Betty Jane McWilliams. Dr. McWilliams
people. Like David, I received my train- was the quintessential teacher, researcher
ix