Speech Function Of

Children
With Cleft Palate

Presented by:

Choirunnisa Nur Humairo

PPDGS IKGA 2019

The lips and palate originate from three areas How Does Nose And Lip Formed?

normally grows to become the forehead,

nose, middle portion of the upper lip
Central or Frontal Nasal Prominence (philtrum or Cupid’s bow) and the primary
palate (part of the upper jaw that holds the
middle four teeth) grow towards the
center of the face
and fuse together
during the 6th -13th
Left Maxillary Prominences
weeks of pregnancy
Correct
child’s lips, mouth,
grow and become the lower face, lower lip
Right Maxillary Prominences and jaw, all but the middle portion of upper lip and palate develop
and jaw, and the secondary palate (behind the normally
four upper middle teeth to back of mouth.
Incorrect
Cleft
Definition

A cleft palate is an opening or split in the roof of the mouth that occurs when the
tissue doesn't fuse together during development in the womb.
 Cleft Palate Possible Causes

Most cleft palates seem to be caused by environmental factors that

increase a mother’s risk of giving birth to a child with a cleft palate.
Since the baby’s face develops so early in the pregnancy,
exposure to German measles (Rubella) or other even when these factors are minimized through proper prenatal care,
environmental
vitamin and folic acid deficiencies
alcohol infections
cigarette
certain
andmedications
smoking
drug usage the damage may have already occurred to the child
factors before the mother was even aware that she was pregnant.

The number of children born each year with cleft palates is growing.
Some doctors and scientists believe this rise is caused by the recent
increase in teenage pregnancies and the unavailability of proper
prenatal care to many pregnant women.
 Based On Anatomical Position,
Classification Of Cleft Palate By Veau

–
Cleft lip is classifed as being complete or incomplete based
on the extent of the cleft, as well as unilateral or bilateral
depending on whether it affects one or both sides.
– An incomplete cleft of the lip does not involve the
complete thickness of the lip, but has a band of tissue
intact across the cleft.
– A complete cleft of the palate involves both the primary
and secondary palates as well as the alveolus.
 Submucous Cleft

– A less severe form of cleft palate is a submucous cleft, which is

a deformity in which there is a defective muscle union across
the soft palate but the oral mucosa is intact. Classically, this
presents as a bifid uvula, an absent posterior nasal spine, and
a transparent band of mucosa at the midline of the palate
called the zona pellucida.
A submucous cleft often goes undiagnosed until the toddler
years, with one of the first signs being hypernasal speech.
Baby With Cleft Palate

early feeding difficulties, nutritional issues,

developmental delays, abnormal speech
and / or resonance, dentofacial and
orthodontic abnormalities
Medical Definition Of Logopedics
“the scientific study and treatment of speech defects”
(Merriam Webster Dictionary)

Its main concern includes young

children with speech impairment,
mostly in phonetic function in
order to speak in a language.
 Surgical Treatment of Cleft Palate

There are two ways to Staging could affect speech

“stage” primary palatal outcomes, because two-
repair: stage surgeries reduce the
Timing and type of surgical
amount of time that
repair may be additional one-stage (i.e., a single
children have with an intact
factors affecting speech and surgery)
palate during the crucial
language development. or two-stage (i.e., two speech and language
surgeries to close the learning development
palate) repair. period.
 Early Language Development In Children With
Cleft Lip And Palate

Children with CL/P show

children with CL/P
delayed
show delays in expressive language, Some reports suggest that
It was also believed
language development evidenced by slower these
that they catch up by early difficulties in the
that may encompass
acquisition of sounds and
both receptive
the age of acquisition
three, of language may
usually after palate
(comprehension) and words and restricted repair. persist into childhood in
expressive
inventory of sounds in early
(production) language some individuals.
infancy
 Cleft Palate Speech

• Atypical consonant productions, abnormal nasal resonance,

Characteristics abnormal nasal airflow, altered laryngeal voice quality, and nasal or
facial grimaces.
• The basic principle of speech therapy in cleft lip and palate is to
establish the correct placement of the articulators and appropriate
Speech Therapy
air flow. Appropriate feedback is important during therapy for
establishing the correct patterns of speech.

• Thus, there has been great interest in the measurement of surgical

the primary purpose of outcomes, candidacy for secondary surgeries for speech, and
palate repair is to speech therapy. Speech-language pathologists evaluate language,
facilitate speech speech, resonance, and velopharyngeal function in individuals with
production cleft lip and palate and make recommendations for appropriate
treatment
 Logopedic of The Cleft Palate

Young children with CL/P may

also demonstrate greater use Delayed expressive vocabulary
of atypical phonological acquisition may be attributed,
• smaller consonant inventories processes • such errors may develop in the
following palate repair and context of velopharyngeal
reduced speech accuracy • during the preschool years dysfunction and become • in part, to young children with
relative to their peers during compared to their peers which habituated speech error CL/P continuing to produce
early school–age years. may further delay their speech patterns. fewer words that contain high-
development. pressure phonemes (e.g., stop
phonemes) because they were
unable to produce these
In addition, children with CL/P sounds prior to palate repair.
often use compensatory
These concerns include
articulation errors more
frequently than their peers;
 Normal speech production
The production of This airflow is modulated at the laryngeal, articulatory,
speech involves a and resonatory systems, producing different sounds
series of coordinated
movements that
begins with airflow
from the respiratory
system.

Various sounds are The vowel sounds are produced without any significant
Low mid vowel (A); high front vowel
produced across the constriction made by the tongue / lip, and are
vocal tract, classified based on the position and height of the (I); rounded high back vowel (U)
tongue and rounding of the lips
depending on the
place and the manner The consonants are classified as glottal, pharyngeal,
of these modulations. velar, palatal, retroflex, alveolar / dental, labiodental,
and bilabial, based on the place of articulation, i.e., the
place where a constriction is made by the tongue / lip. 
 The classification of
consonants based on the
manner of articulation.
In individuals CL/P, errors in speech
production are noticed due to:
the abnormalities in oronasal structure /
function,
orofacial structure and growth,
learned neuromotor patterns during early
infancy,
disturbed psychosocial development
 Velopharyngeal dysfunction (VPD)

Very often, resonance and airflow disturbances in individuals with cleft lip and palate are due to VPD.
In VPD, the incompletely closed velopharyngeal valve causes an inability to effectively manage the air
stream for continuous speech. This could be manifested as one or more of the following:
 Hypernasality
 Audible / visible nasal air emission during production of oral consonants like /p/b/t/d/
 Facial / Nasal grimaces
 Weak or omitted consonants
 Reduced mean length of utterance
 Compensatory articulation errors
 Individuals with cleft lip and palate may also exhibit dysphonia. This is characterized by
breathiness, hoarseness, and low intensity of voice during speech tasks. This is usually due to
increased respiratory and muscular effort, and hyper-adduction of vocal folds while attempting to
close the velopharyngeal valve.
 Assessment
Nasoendoscopy and
videofluoroscopy to view the
anatomical and physiological
defects that cause VPD.

Speech tasks: spontaneous

speech, repetition of oral and
nasal consonants at syllable
level (/papi/, /kaki/, /sasi/,
/mami/), number-counting

sentence repetition
(sentences loaded with oral
and nasal consonants) are
used during both the
procedures.
 Management of VPD

(pharyngeal flap,
sphincter
surgical intervention pharyngoplasty, or speech therapy
posterior pharyngeal
wall augmentation)

Prosthetic devices can

also be used on a to correct the
temporary or articulation errors due
permanent basis in to VPD
some instances.
 Principles and Conclusion Of Speech Therapy For
Individuals with Cleft Lip/Palate

1. Speech intervention for individuals with cleft lip and palate can begin even before the palate is repaired.
2. In very young infants, the emphasis is on training the parent / caregiver to stimulate the child's ability to understand and use
language, focusing on the language skills and emerging sound production.
3. Older children (about age three) can be involved in direct therapy for the correction of errors in speech sound production
(misarticulation)
4. It should be kept in mind that errors due to structural defects cannot be corrected through speech therapy unless the
structural deformity is corrected.
5. Also, the structural correction should invariably be followed with speech therapy to correct the functioning / production of
speech sounds.
6. Appropriate feedback (using multiple modalities such as auditory, visual, tactile, etc.) is extremely important in the
management of articulation and resonance disorders.
7. Cleft care is most successful when services are not only comprehensive, but also interdisciplinary in nature.
Thank You
Soal OSCE
 Di suatu desa pedalaman, ada seorang pasien anak lelaki usia 12 bulan datang bersama ibunya ke
praktek dokter gigi di RSUD mengeluhkan anaknya tidak bisa mengoceh seperti bayi lain. Hal ini
disadari ibunya sejak 2 minggu lalu saat berkumpul dengan tetangga. Berdasarkan keterangan ibu
pasien, anak juga mengalami kesulitan makan dan minum serta bentuk bibir yang terlihat terlipat.
Keluhan tersebut pernah diperiksakan ke dokter gigi dan dibuatkan alat penutup celah saat bayi
berusia 2 hari. Pada saat hamil muda, ibu pasien pernah masuk rumah sakit karena hanya makan
nasi pakai garam setiap hari. Ibu pasien mengatakan bahwa kondisi ini juga dialami oleh kakak dari
ibu pasien saat [Link] pasien tidak bekerja, suaminya merupakan buruh kayu dengan
penghasilan minimal.
 Berdasarkan pemeriksaan klinis intraoral, ditemukan adanya deformasi bibir dan adanya celah
pada palatum di sisi kiri.
Skenario Kasus
Dx: Klasifikasi Veau III Unilateral Complete Cleft Lip/Palate
Treatment Planning:
1. DHE
2. Surgical Treatment for Cleft Closure
3. Speech Therapy
Soal CBT

1. Ada berapa prominensia yang membentuk bibir dan hidung pada saat janin?
A. 1
B. 2
C. 3
D. 4
Jawaban: C. 3 (prominensia frontal nasal, maskila kiri, dan maksila kanan)
Soal CBT

2. Manakah yang bukan termasuk akibat dari Cleft Lip palate pada bayi?
A. Susah menyusui dan makan
B. Gangguan berbicara dan mengeluarkan konsonan
C. Abnormalitas Ortodontik
D. Pernapasan terganggu
Jawaban: D. Pernapasan terganggu
Soal CBT

3. Pada Velopharingeal dysfunction, pasien anak dapat mengalami dysphonia.

Manakahd ari tanda tersebut yang merupakan ciri-ciri dysphonia?
A. Berat dalam bernapas dan mengorok
B. Intensitas suara tinggi
C. Mengeluarkan air liur terus menerus
Jawaban: A. Berat dalam bernapas dan mengorok(heavy breathing and hoarsiness)