Articulatory System PDF

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Articulatory System Introduction ● What is articulation? ○ Adjustment of the shape of the vocal tract by movement of articulators ○ When you change the shape of the vocal tract, you can change the quality of the sound that is produced ○ Multiple moving at the same time, moving at all times ○ Brian is programming this all to happen ○ Speech tract alters the sound, with shape and size of oral cavity, etc. ○ Same frequency and same loudness can be different noise heard due to the anatomy Articulatory System Framework ● The human “speech tract” has defined spaces or cavities for the structures of the articulatory system: ○ Oral ○ Nasal ○ Pharyngeal ○ Laryngeal Muscles of Articulation & Swallowing ● To produce speech sounds (vowels and consonants), a speaker must be able to move: ○ Lips ○ Tongue ○ Velum ○ Vocal folds ● To swallow, we use the lips, tongue, cheeks, epiglottis, and the pharyngeal muscles Embryology of the Oral Cavity ● Normally, there is a complete fusion of the bony processes in the anterior head by the 12th week of conception: ○ By Week 3, a primitive oral cavity is formed ○ By Week 8, the primary palate (lips and premaxilla) is formed ○ By Week 10, the hard palate is formed ○ By Week 12, the soft palate is formed ● Fusion takes place at midline, anteriorly to posteriorly (front to back) ○ If there is an interruption in this fusion can cause a cleft in the front or the back Oral Cavity Boundaries ● Inferior to the nasal cavity ● Continuous anteriorly with the external environment, and posteriorly with the oropharynx ● Can be thought of as having 2 regions: ○ Oral vestibule (opening) ○ Oral cavity ‘proper’ ● Oral Vestibule = the shallow, curved space in between the lips and the teeth ● Oral Cavity = bordered by the teeth and structures of the roof and floor of the mouth Anatomy of the Lips

● Vermilion Border: red transitional area between the skin and inner mucosa ● Tubercle: small projection in the midline of the lips ● Philtrum: vertical groove below the nose ● Columella: vertical grooves on either side of philtrum Tongue ● Tip: part closest to the front teeth at rest ● Blade: part just posterior to the tip and inferior to the alveolar ridge ● Dorsum: part posterior to the blade and below the back part of the hard palate ● Root: part that faces the back of the pharynx and front of the epiglottis ● Body: central mass of the tongue that underlines the surface features ● Anterior ⅔ cranial nerve 7 taste, cranial nerve 5 is general sensation ● Posterior ⅓ cranial nerve 9, taste and sensation ● Nerves to the tongue? Sensation ● Tongue down the middle is from equal force of both sides of the tongue ○ One side: goes towards the side of the weakness Muscles of the Tongue Intrinsic Tongue Muscles ● The 4 intrinsic muscles originate from bone and extend to the tongue. They are the: ○ Superior longitudinal ○ Inferior longitudinal ○ Vertical ○ Transverse ● These muscles alter the tongue’s s  hape ● Any kind of paralysis or alteration from surgery, will affect articulation and swallowing Super longitudinal ● Originates from the hyoid bone within the root of the tongue and inserts into the front edges of tongue and upper surface of the tongue tip ● Contraction can shorten the tongue, pull the tip upward Inferior Longitudinal ● Originates from they hyoid bone at the root of the tongue and inserts near the lower surface of the tongue tip ● Contraction shortens the tongue and pulls the tip downward Vertical ● Originates from just beneath the dorsum of the tongue and inserts near the side of the lower surface of the tongue ● Contraction flattens the tongue Transverse ● Originates from the median fibrous skeleton of the tongue and inserts in the fibrous tissue long the side of the tongue ● Contraction narrows and elongates the tongue Extrinsic Tongue Muscles ● The 4 extrinsic muscles originate from bone and extend to the tongue. They are the:

○ Genioglossus ○ Hypoglossus ○ Styloglossus ○ Palatoglossus ● Their main functions are altering the tongue’s position ● Attach from outside and move the tongue around Genioglossus Muscle ● Origin: mandible ● Insertion: tongue undersurface; hyoid bone ● Action: moves tongue down protrudes it out of the mouth ● It is also known as the tongue’s “safety muscle” since it is the only muscle that propels the tongue forward ● Depressing and moving out Hyoglossus Muscle ● Origin: hyoid bone ● Insertion: sides of the tongue ● Action: lowers the tongue body and draws it backward Styloglossus Muscle ● Origin: styloid process of the temporal bone ● Insertion: tongue undersurface and sides ● Action: elevates and retracts the tongue Palatoglossus Muscle ● The paired create ridges of mucous membrane in the lateral pharyngeal wall called the palatoglossal arches (also known as the anterior faucial pillars). These form the lateral boundary between the oral cavity anteriorly and the oropharynx posteriorly. ● This muscle, as you’ll see in later slides, is also considered one of the palatal muscles ● Origin: inferior surface of the palatine aponeurosis ● Inserition: posterolateral tongue ● Innervation: pharyngeal branch of the vagus nerve (CN X) ● Action: elevates the posterior tongue and draws the soft palate onto tongue. Thereby narrowing the diameter of the oropharyngeal isthmus. Important during oral stage  of swallowing ● Palatoglossal is front arch ● Palatopharyngeal is back arch Tonsils ● Three kids of tonsils: ○ Lingual - on dorsal surface of the base of the tongue ○ Palatine - in between the faucial pillars on each side ○ Pharyngeal (aka Adenoids) - in the region of the nasopharynx, on the pharyngeal wall ● Can interfere with articulation ● Part of the lymphatic system

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Tonsils act like a net to trap germs and debris that enter the mouth and prevent them from going down the throat ● Why would large tonsils interfere with voice? ○ Change the sound get absorbed by the tonsil/tissue ○ Dampened by this ○ Patient will put extra strain on their vocal folds, we do not want them doing this ■ Compensatory dysphonia Tonsillitis ● Inflammation of the tonsils; due to virus or bacteria

32 Teeth ● 8 teeth in each quadrant ● Central incisors ● Lateral incisors ● Canine ● 1st premolar ● 2nd premolar ● 1st molar ● 2nd molar ● 3rd molar ● Alveolar ridge: gumline Dental Abnormalities ● Can take the form of: ○ Malocclusion ■ Class I, II, or III ○ Crossbite (maxillary teeth are inside or lingual to mandibular teeth): ■ Anterior crossbite ■ Canine crossbite ■ Lateral crossbite Malocclusion ● A malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close

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Classification of malocclusion is based on relative position of the permanent maxillary first molar Class I : Normal Occlusion

Class I: Malocclusion

Class II Malocclusion

Class III Malocclusion

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Open bite (open space between maxillary and mandibular teeth) ○ Anterior ○ Posterior Effect on Speech ● More likely to affect speech if the following conditions apply: ○ If dental occlusal anomalies occur together ○ If present during the speech-learning years ○ If the spatial relationship between the tip of the tongue and incisors is altered ○ If there's a restriction in the size of the palatal vault

Hard Palate ● Anterior ⅔ of the palate (aka hard palate) is hard because of its underlying bony structure: ○ Premaxilla ○ Paired palatine processes of the maxilla ○ Paired palatine bones ● The hard palate is comprised of multiple layers: ○ Oral mucosa; oral mucoperiosteum (fibrous membrane); bone; nasal mucoperiosteum; nasal mucosa Palatine Aponeurosis ● Aponeurosis: a sheet of pearly-white fibrous tissue that attaches sheet-like muscles needing a wide area of attachment/primary function is to join muscles and the body parts they act upon, whether it be bone or other muscles ○ Primarily joins muscles to the body parts that they act upon Palatine Aponeurosis ● Attached to the posterior border of the hard palate is a thin, firm, fibrous plate called the palatine aponeurosis, which supports the muscles and gives strength to the soft palate ● It serves as the insertion for the tensor veli palatini and levator veli palatini, and the origin for the musculus uvulae, palatopharyngeus, and palatoglossus. Formation of the Primary Palate ●

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Primary palate = middle 2/3 of upper lip + alveolar ridge + anterior maxilla (to the incisive foramen) • alveolar ridge + hard palate a.k.a. premaxilla • associated lip a.k.a. prolabium Primary palate is formed by fusion of the medial and lateral nasal processes and the the paired maxillary processes Occurs about two weeks after the formation of the lower lip, mandible and lower face Forms first couple weeks

Formation of the Secondary Palate ● Secondary palate = hard palate posterior to the incisive foramen + soft palate (and uvula)

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Secondary palate forms from fusion of various palatal processes, which emerge from the medial maxillary processes ○ Anterior-to-posterior fusion (from front and rolls in back, primary to secondary) ■ 6-8th week ○ Depending on when the process gets interrupted which causes the cleft, more primary or more secondary

Soft Palate Overview ● The soft palate (aka velum) is the posterior muscular extension of the hard palate which together, with the soft palate, make up the roof of the oral cavity and the floor of the nasal cavity Soft palate/velum ● Velum means “curtain” ● Consists of the soft palate and uvula ● Covered with connective tissue ● Muscle fibers are most numerous in middle portion; scarce at front and back Borders of the Soft Palate ● The soft palate is bordered: ○ Superiorly by the respiratory mucosa of the nasal cavity ○ Inferiorly by the mucosa of the oral cavity ○ Posteriorly it has no borders and hangs at an inferior angle towards the larynx, where it dangles the uvula in its midline ○ Posterolaterally, however, it forms part of the superior portion of the palatoglossal and palatopharyngeal folds/pillars ○ Anteriorly it is connected to the bony hard palate Development of VP Function ● Many structural changes (e.g. vleum and epiglottis separate as larynx moves down, hard and soft palates grow) ● Infants are preferential nasal breathers ● Velopharynx closes occasionally for vocalization as early as 2 months of age ● By about 19 months, the velopharynx closes for oral sound production nearly all the time Effect of Aging on VP Function ● No apparent change in velopharyngeal function for speech production with aging

● Anatomical changes (e.g., tissue and bone Anatomy of the Soft Palate ● Posterior ⅓ of the palate is soft because it is composed of oral mucosa, tissue, and nasal mucosa ● The velum + lateral and posterior pharyngeal walls comprise the “velopharyngeal mechanism” ● The space surrounding the above is the “velopharyngeal port” (or opening) Velum Muscles ● The 5 paired  muscles of the soft palate play important roles in swallowing and breathing: 1. Musculus uvulus 2. Tensor veli palatini 3. Levator veli palatini 4. Palatoglossus 5. Palatopharyngeus ● These muscles are innervated by the pharyngeal branch of the Vagus Nerve (CN X), with the exception of the tensor veli palatini a. The tensor veli palatini is innervated b the mandibular division of the trigeminal nerve (V3) Uvula ● Origin: posterior border of the hard palate ● Insertion: palatine aponeurosis and mucosa of the uvula ● Innervation: Pharyngeal branch of CN X ● Action: Shortens, lifting, and increases the bulk of the velum ● Uvula is Latin for “little grape” ● The only intrinsic muscle of the velum Bifid Uvula ● A failure of fusion during the last phase of development of the soft palate ● Gives the uvula the appearance of being ‘split’ into two Tensor Veli Palatini ● Origin: medial pterygoid plate, spine of sphenoid bone, lateral cartilage of eustachian tube ● Insertion: palatine aponeurosis ● Innervation: CN V3 ● Action: Tenses the palatine aponeurosis and opens the auditory tube during swallowing Levator Veli Palatini ● Origin: ○ Inferior surface of the temporal bone ○ Medial rim of the auditory tube ● Insertion: palatine aponeurosis ● Innervation: pharyngeal nerve ● Action: draws the velum upward and backward. It also aids the tensor veli palatini in opening the Eustachian tube on swallowing to allow pressure equalization between the middle ear and pharynx

● Forms V-shaped “sling Palatoglossus Muscle ● The paired muscles create ridges of mucous membrane in the lateral pharyngeal wall called the palatoglossal arches (also known as the anterior faucial pillars) ● This muscle is also considered one of the extrinsic tongue muscles ● Origin: inferior surface of the palatine aponeurosis ● Insertion: posterolateral tongue ● Innervation: pharyngeal branch of CN X ● Action: pulls downward and forward on the velum and raises the tongue bases Palatopharyngeus Muscle ● The paired muscles create ridges of mucous membrane in the lateral pharyngeal wall called the palatopharyngeal arches (also known as the posterior faucial pillars) ● Origin: palatine aponeurosis, hard palate ● Insertion: thyroid cartilage ● Innervation: CN XI ● Action: pulls downward and backward on the velum, which is important during the pharyngeal stage of swallowing

arrows give sense of direction that the soft palate is moving Movements of the Velum ● Mainly upward/backward and downward/forward ● Goal is to seal off the nasal cavity from the oral cavity ● Want this seal for sound, nothing else into the nose ○ Becomes “hooked” when moving upward/backward ○ Top of the hook is the velar eminence

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Undersurface of hook is the velar dimple

Velopharyngeal Port ● The space between the velum and posterior pharyngeal wall is commonly referred to as the ‘which of the following can lead to an increase in real output ‘velopharyngeal port’ ● When we are simply breathing (but not speaking or swallowing) the nasal and oral cavities are coupled-that is- the VP port is open ● VP port borders: ○ Anterior = velum ○ Posterior = posterior pharyngeal wall ○ Lateral = lateral pharyngeal walls ● Control of the VP port during speech is a voluntary a  ction (cortex) ● Control of the VP port during swallowing is an involuntary a  ction (brainstem) Velopharyngeal Closure ● When the VP port is open, air can flow from the nasal cavity into the pharynx, and vice versa; similarly, the vocal signal can enter the nasal cavity and “resonate: (i.e., become louder and fuller) ● When the VP port is closed, air does not flow in/out of the nasal cavity, nor does resonate, nor does food/liquid enter the nasal cavity Vocal Resonance ● Sound shaped by mucosa, size, shape, tongue blocking sound, where soft palate is, size of tonsils, adenoid pad, size of nasal cavity ● Depending if the sound stays in the oral cavity or goes to the nasal changes the sound ● What comes out at the end is different, even if same pitch same frequency ● Boone and McDarln (2000) define vocal resonance as: ○ “...the perceptual increase in loudness of the laryngeal tone due to the concentration and reflection of sound waves by the oral, pharyngeal, and nasal cavities during speech production” (p. 265) ○ Concentrated and reflected in the oral pharyngeal and nasal cavities ● Resonance is a physical as well as perceptual phenomenon ● Normal resonance involves a balance between oral and nasal resonance, and falls along a continuum of normalcy

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Nasal resonance disorders may take the form of: ○ Hypernasality, hyponasality (aka denasalty): mixed nasality ○ ALWAYS some nasal resonance ● Oral resonance disorders may take the form of: ○ Strident voice; thin voice; baby voice ● Are vowels nasal or not? Where does the vowel come into the syllable Hypernasality ● Too much nasal resonance on vowels and vocalic consonants, i.e., phonemes other than /m,n,ng/ ● Hearing resonance when you don't expect it ● Occurs secondary to abnormal coupling of the oral and nasal cavities ● May be accompanied by “visible” or audible nasal emission of air (an articulatory phenomenon), but this is not synonymous with hypernasal ● Velopharyngeal cavity is more open than it should be Hyponasality ● Not enough nasality ● Not enough When you expect it,n,m,ng - sound like /b,d,g/ ● B instead of an M is hyponasal ● stuffy nose ● Occurs usually due to occlusion of the nasal cavity or blockage of the VP port ● May be due to the VPI, but can’t tell this until the occlusion is eliminated ● Cul-de-sac resonance occurs when there is anterior blockage of the nasal cavity - the sound resonates, but has a different characteristic ○ Say “mi, mi, mi” then pinch nostrils and repeat Mixed Nasality ● Too much nasal resonance on vowels and vocalic consonants, and not enough nasal resonance on /m,n,ng/

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Need to be aware of this phenomenon after pharyngeal flaps, placement of palatal obturators, and in persons with neurogenic VPI

Closure patterns ● Coronal - closure is obtained primarily by velar elevation ● Sagittal - medial movement of the lateral pharyngeal walls to make contact with the elevated velum, with pharyngeal walls the primary facilitator of closure ● Circular - similar to sagittal, only the lateral pharyngeal walls and velum contribute equally

Listening notes: ● Open ● Position of the body and gravity

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Insufficient no structure Incompetence no control Hoarse voice ○ Hypernasal because of compensation to make less air come out

Terminology of VPI ● Velopharyngeal “inadequacy is more umbrella or general term which describes VP problems regardless of etiology ● Velopharyngeal “insufficiency” is a term that implies a structural basis ● Velopharyngeal “incompetence” is a term that implies a neurogenic basis ● Velopharyngeal “mislearning” is another term sometimes used to imply a learned behavior Speech problems in VP Disorders ● Reduced speech intelligibly ● Compensatory articulations (e.g., posterior shift in place of articulation) ● Reduced intraoral pressure of oral pressure consonants ● Audible emission of nasal air on oral pressure consonants ● Hypernasal resonance ● Hoarse voice ● Decreased vocal loudness CLEFT PALATE SLIDES MONDAY notes: ● Cleft - an incomplete fusion ○ Through mucosa ○ Or through all the way ●

Think about how the muscles are grouped together and oriented

Facial Muscles ● Mandible ○ Movement: two dimensions: up/down and side/side ■ Important for speech because of articulation ● Lips ○ Movement: elevate and depress, rounded forward (protrude) and retract, pull inward ■ MULTIPLE on lips ■ certain position to help air movement ○ Moving depending on particular speech sounds that are being made ● Muscles moving at the same time ○ Mandible, tongue, soft palate, lips, etc.

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Internal and external all moving in ways that make the 43 phonemes in english, 40 are not nasal cavity, majority is made in oral cavity controlled by the mandible, lips, oral, tongue In order for speech sounds to be produced, things need to be moving Origins of the muscles are on the surface of the skull ○ attach from the skull to the lips, maxillae, mandible, etc Insertion is with connective tissue and dermis of the skin ○ Since the muscles insert in the skin rather than the bone, when they contract, the skin moves to create facial expression Arbitrarily divided into two groups: ○ Medial muscles ○ Lateral muscles

Why in the design do we have so many muscles attached to the lips? To eat food, breathe, air in, redundancy, connections above, below, side Facial muscles are anchored in bone, most of them What every structure they are attached to will move towards the bone and depending on the orientation, (horizontal, circular, etc) will determine what shape the lips take Medial facial Muscles ● Single muscles along the midline of face: ○ Procerus muscle ○ Nasal muscle ○ Orbicularis oris ALL SLIDES OF MUSCLES THURSDAY NOTES

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