Craniofacial anomalies represent a varied cluster of defects in the development of both the facial bones and the head. An anomaly means ‘not normal’ or ‘irregularity.’ These anomalies are usually present even at birth (congenital) and feature several variations while others are quite severe and may need surgery.
For a better understanding on how these anomalies affect speech development and feeding, it is essential to establish a proper understanding on specific details about the craniofacial anomalies to establish how they affect such aspects of human body functioning.
Causes of Craniofacial Anomalies
A majority of medical professionals unanimously agree that no single factor can be credited for causing these abnormalities. Alternatively, there are numerous factors which may contribute to them developing among them:
- Gene combination: A child may get a particular gene(s) combination from either or both parents, as well as a slight alteration in the genes may occur during conception that may result in craniofacial anomalies.
- Environmental: Exposure to environmental factors may play a vital role in the development of craniofacial anomalies particularly combined with genetic anomalies.
- Folic acid Deficiency: Folic Acid is a vitamin B component found in enriched grain products, leafy, green vegetables, orange juice, as well as breakfast cereals (fortified). Research outlines women who do not consume adequate or any folic acid amounts during pregnancy are more prone to their babies having particular craniofacial anomalies including cleft palate or cleft lip.
Types of Craniofacial Anomalies
- Cleft Palate
It is a condition where the mouth’s roof is unable to close completely, leaving an opening which can broaden into the nose cavity. This cleft can occur on both sides of a palate. Also, it can stretch from the hard (mouth front) to soft palate. It may also include the lip.
- Cleft lip
This is an abnormality where the lip is unable to form completely. The extent of this defect can greatly vary, from mild (lip notching) to relatively severe (big opening from a lip up to the nose).
This is a condition where the soft spots (sutures) in an infant’s skull close early on resulting in issues with ordinary skull and brain development. This (premature) sutures closure can also prompt increased pressure within the head resulting in a alteration from normal (symmetrical) appearance of skull or facial bones.
- Hemifacial microsomia:
This is a condition where tissues are underdeveloped on a given side of the face therefore primarily affecting the mouth, jaw, and ear (aural) regions. At times, both face sides can be affected and can usually include the skull together with the face.
- Vascular malformation:
This is congenital growth or birthmark which comprises blood vessels and can result in aesthetic or functional problems. This defect may involve numerous body systems. It features multiple malformations all labeled in accordance to the blood vessels type affected. This condition is also called vascular gigantism, arteriovenous malformations and lymphangiomas.
This is an unusually developing blood vessel which can either appear as a red (faint) mark, or show in the initial months after being born. It is also called strawberry hemangioma, among other names.
- Deformational plagiocephaly:
It is a condition where the head’s shape has a deformed shape because of repeated pressure to a particular region.
Craniofacial Anomalies and Their Effects of Feeding and Speech Development
Children having craniofacial anomalies have some difficulties with their swallowing, feeding, oral motor movements, and speech development. This is a result of the lack of physical structure (since they have a hole between their mouth and nose). The infants have delays when it comes to phonation, articulation, resonance, and respiration primarily because their soft palates are not fully functional.
- Craniofacial Anomalies and Feeding:
Infants with incomplete or minimal clefts of the lip can usually show some difficulty with achieving full lip seal on a nipple. An infant with complete or incomplete clefts of the soft palate demonstrates variant challenges in feeding, typified by nasal regurgitation due to inadequate velopharyngeal closure while swallowing or inability to proper negative intraoral pressure during sucking.
This nasopharyngeal regurgitation can usually be reduced or eradicated with positional alterations (upright) as well as by using specialized feeding systems by placing the nipple away from the infant’s cleft while feeding.
Additionally, infants featuring broader clefts of the soft and hard palate show difficulty with extracting liquids since their open palate offer a little surface area to compress the nipple. The ability of the infant to produce adequate compression (positive pressure) and suction (negative pressure) for proper sucking is impaired.
Infants with a cleft lip will perhaps breastfeed or feed using a standard bottle. However, infants having a cleft palate may exhibit difficulties in breastfeeding. As such, they may need special nipples or feeding bottles for feeding.
- Craniofacial Anomalies and Speech Problems
Children with a medical history of having cleft palate are prone to delays in acquiring speech skills and might even be at risk of delayed early language development – not just because of orofacial incongruity but also because of neurological disorders as well as cognitive problems commonly associated with the craniofacial syndrome. This is usually because their open palate renders them slower in developing phonemes.
This particular delay endures until the open palate has been repaired and in most cases for periods, postoperatively. The articulation problems are usually due to velopharyngeal incompetence/insufficiency (VPI). The abnormal function or structure of the human velopharyngeal valve may result in impaired speech often resulting in compensatory and obligatory errors.
Children with VPI (velopharyngeal insufficiency) cannot touch their soft palates at the back of their throat. This can be either due to the soft palate being unable to move correctly or is too short. This allows sound and air to escape through the nose during communication. Our soft palate needs to move to touch the throat’s back. This subsequently shuts the space between our nose and mouth and is essential for sounds to be produced from the mouth. Some sounds such as ‘n’ and ‘m’ come off our noses. For such sounds to come out, it is essential for soft palates to stay closed.
These children may require surgery to correct the VPI problem or an exclusive device in their mouths to help keep their soft palate closed. Additionally, therapy may be necessary to help them cope with the condition and lead a healthy life.