SAMENVATTING CRANIOFACIALE
AFWIJKINGEN
INHOUD
1. Inleiding ........................................................................................................................................................... 5
1. Craniosynostose .............................................................................................................................................. 5
A. Behandeling ............................................................................................................................................... 6
2. Schisis .............................................................................................................................................................. 6
A. Schisis: ontstaanswijze ............................................................................................................................... 7
I. Normale vorming van primaire gehemelte ........................................................................................... 8
II. Normale vorming van secundair gehemelte ......................................................................................... 8
B. Schisis: oorzaken ........................................................................................................................................ 9
C. Schisis: prevalentie..................................................................................................................................... 9
D. Schisis: classificatie .................................................................................................................................... 9
I. Kernahan & Stark ................................................................................................................................... 9
E. Schisis: submuceuze spleet ...................................................................................................................... 12
I. Uvula bifida .......................................................................................................................................... 13
II. Zona pellucida...................................................................................................................................... 13
III. Inkeping in achterste rand van harde verhemelte .............................................................................. 13
IV. Occulte submuceuze spleet ................................................................................................................. 13
F. Ernst v/d schisis........................................................................................................................................ 14
A. Opbouw van velopharyngaal afsluitingsmechanisme .............................................................................. 15
I. Palatum durum .................................................................................................................................... 15
II. Os temporale ....................................................................................................................................... 16
III. Os sphenoidale .................................................................................................................................... 16
B. Spieren en innervatie van VFAM.............................................................................................................. 17
I. Palatale aponeurose ............................................................................................................................ 18
I. M. levator veli palatini ......................................................................................................................... 19
II. M. uvulae ............................................................................................................................................. 19
III. M. tensor veli palatini .......................................................................................................................... 20
IV. M. constrictor pharyngeus superior .................................................................................................... 20
V. M. palatopharyngeus ........................................................................................................................... 21
VI. M. palatoglossus .................................................................................................................................. 21
VII. M. salpinogophangeus .................................................................................................................... 21
1. Afwijkende werking v/h VFAM: velopharyngeale dysfunctie ....................................................................... 22
Margot Vermeersch 1
,2. Normale werking van VFAM ......................................................................................................................... 22
A. 4 patronen bij VFAM ................................................................................................................................ 23
1. chirurgie ........................................................................................................................................................ 24
2. Oor- en gehoorproblemen ............................................................................................................................ 24
3. Tandheelkundige problemen ........................................................................................................................ 24
4. Psychosociale gevolgen ................................................................................................................................. 25
A. Ouders ...................................................................................................................................................... 25
B. Kind .......................................................................................................................................................... 25
5. Hechting en ouder-kind interacties............................................................................................................... 25
A. Tijdens sociale interacties tss moeder + kind met schisis ........................................................................ 25
B. Normaal hechtingsproces + ontwikkeling van spraak-, taal en communicatie ........................................ 26
6. Voeding ......................................................................................................................................................... 26
A. Is borstvoeding mogelijk bij kinderen met schisis? .................................................................................. 26
B. Ontwikkeling i/d perinatale periode – voedingsreflexen ......................................................................... 26
C. Zuigen....................................................................................................................................................... 26
D. Voeding bij schisis .................................................................................................................................... 26
E. Voedingsproblemen bij schisis ................................................................................................................. 26
F. Lepelvoeding/vaste voeding .................................................................................................................... 27
7. Spraak, taal en communicatie ....................................................................................................................... 27
1. Normale spraak- en taalontwikkeling ........................................................................................................... 28
2. Spraak- en taalontwikkeling bij kinderen met schisis ................................................................................... 28
3. Voornaamste moeilijkheden met de spraak ................................................................................................. 29
A. Foutieve resonantie op de klinkers .......................................................................................................... 30
B. Nasale luchtstroom in plaats van orale .................................................................................................... 30
C. Producties van glottale/faryngeale aard .................................................................................................. 31
D. Overige: labiale, alveolaire en palatale afwijkingen ................................................................................ 31
1. Schisisteams .................................................................................................................................................. 32
A. Organisatie van zorg voor patiënten met schisis ..................................................................................... 32
B. Taak v/h schisisteam ................................................................................................................................ 32
C. Functioneren v/h schisisteam .................................................................................................................. 32
D. Doel van het schisisteam ......................................................................................................................... 33
E. Voordelen van teamwerk......................................................................................................................... 33
F. Belangrijke vraag ...................................................................................................................................... 33
G. Specifieke doelstellingen qua behandeling .............................................................................................. 33
H. Samenstelling v/e team voor schisis + craniofaciale afwijkingen ............................................................ 33
I. Rol van de chirurgen ............................................................................................................................ 34
II. Rol orthodontist................................................................................................................................... 34
Margot Vermeersch 2
, III. Rol pediater ......................................................................................................................................... 34
IV. rol NKO-arts ......................................................................................................................................... 34
V. Rol audioloog ....................................................................................................................................... 35
VI. Rol geneticus ....................................................................................................................................... 35
VII. Rol maatschappelijk/sociaal werker ................................................................................................ 35
VIII. Rol psycholoog ................................................................................................................................ 35
IX. Rol logopedist ...................................................................................................................................... 35
1. Instrumenteel/objectief onderzoek .............................................................................................................. 36
A. Onderzoek nasaliteit ................................................................................................................................ 36
I. Spiegelproef (Glätzel) .......................................................................................................................... 36
II. Objectieve beoordeling via nasometrie............................................................................................... 36
III. Nasometrie .......................................................................................................................................... 36
2. Perceptueel/subjectief onderzoek ................................................................................................................ 37
A. Logopedisch onderzoek bij kinderen vanaf +/- 4 jaar .............................................................................. 37
I. AA-IE proof (Gutzmann) ...................................................................................................................... 37
II. Bzoch test: nazeggen van woorden ..................................................................................................... 37
III. Stembeoordeling (G, R, B, A, S, I)......................................................................................................... 38
B. Oro-nasale-faryngale inspectie ................................................................................................................ 38
I. Flexibiliteit week gehemelte bij productie van /aa/ ............................................................................ 38
C. Mondmotorische vaardigheden .............................................................................................................. 38
I. Bewust oraal sturen v/d lucht ............................................................................................................. 38
D. Perceptuele beoordeling van spraak ....................................................................................................... 39
3. Onderzoek naar taalontwikkeling bij jonge kinderen ................................................................................... 39
1. Mogelijke problemen .................................................................................................................................... 41
2. Opstart voeding na de geboorte ................................................................................................................... 41
A. Ontwikkeling in perinatale periode – voedingsreflexen .......................................................................... 41
B. Borstvoeding bij schisis ............................................................................................................................ 41
C. Flesvoeding bij kinderen met schisis ........................................................................................................ 42
D. Lepelvoeding bij kinderen met schisis ..................................................................................................... 43
E. Voeding na chirurgie ................................................................................................................................ 43
1. Belang van preventie, vroegtijdige detectie en begeleiding ......................................................................... 44
2. Diagnostiek: een permanent dynamisch diagnostisch proces ...................................................................... 44
A. Wat? ......................................................................................................................................................... 45
B. Voordelen ................................................................................................................................................ 45
C. Concrete toepassing in de praktijk........................................................................................................... 45
3. Spraak- en taalontwikkeling (herhaling) ....................................................................................................... 45
4. Theoretische kaders ...................................................................................................................................... 45
Margot Vermeersch 3
, A. Metamorfoseconcept van Xavier Tan ...................................................................................................... 45
5. Parent Focused approach (Mie Cocquyt) ...................................................................................................... 46
A. Stap 1: ouder-kind relatie ........................................................................................................................ 49
B. Stap 2: bouwen aan interacties ............................................................................................................... 49
C. Stap 3: correcte spraak- en taalpatronen ................................................................................................ 50
I. Versterkte stimulatie: concreet ........................................................................................................... 50
II. Incidental teaching: concreet .............................................................................................................. 50
1. Van indirecte therapie naar directe behandeling ......................................................................................... 53
2. Algemene behandelprincipes vanaf 3-4 jaar................................................................................................. 53
A. 4 foutencategorieën ................................................................................................................................ 53
3. Welke klank eerst? ........................................................................................................................................ 53
4. Behandelvolgorde ......................................................................................................................................... 54
A. Oefening: klanken uitlokken .................................................................................................................... 55
5. Voorbeelden .................................................................................................................................................. 55
A. Actief nasale fricatief i.p.v. /s/ ................................................................................................................. 55
B. Glottisslag i.p.v. /p/ .................................................................................................................................. 56
6. Strategieën om klanken uit te lokken ........................................................................................................... 56
7. Gebruik van lax vox ....................................................................................................................................... 57
8. Therapievormen voor fonologsiche problemen ........................................................................................... 57
A. Hodson & Paden ...................................................................................................................................... 57
C. Behandeling van hypernasaliteit (niet VPI) ................................................................................................... 57
D. Behandeling – casus ...................................................................................................................................... 58
Examen ......................................................................................................................................................... 58
Margot Vermeersch 4
AFWIJKINGEN
INHOUD
1. Inleiding ........................................................................................................................................................... 5
1. Craniosynostose .............................................................................................................................................. 5
A. Behandeling ............................................................................................................................................... 6
2. Schisis .............................................................................................................................................................. 6
A. Schisis: ontstaanswijze ............................................................................................................................... 7
I. Normale vorming van primaire gehemelte ........................................................................................... 8
II. Normale vorming van secundair gehemelte ......................................................................................... 8
B. Schisis: oorzaken ........................................................................................................................................ 9
C. Schisis: prevalentie..................................................................................................................................... 9
D. Schisis: classificatie .................................................................................................................................... 9
I. Kernahan & Stark ................................................................................................................................... 9
E. Schisis: submuceuze spleet ...................................................................................................................... 12
I. Uvula bifida .......................................................................................................................................... 13
II. Zona pellucida...................................................................................................................................... 13
III. Inkeping in achterste rand van harde verhemelte .............................................................................. 13
IV. Occulte submuceuze spleet ................................................................................................................. 13
F. Ernst v/d schisis........................................................................................................................................ 14
A. Opbouw van velopharyngaal afsluitingsmechanisme .............................................................................. 15
I. Palatum durum .................................................................................................................................... 15
II. Os temporale ....................................................................................................................................... 16
III. Os sphenoidale .................................................................................................................................... 16
B. Spieren en innervatie van VFAM.............................................................................................................. 17
I. Palatale aponeurose ............................................................................................................................ 18
I. M. levator veli palatini ......................................................................................................................... 19
II. M. uvulae ............................................................................................................................................. 19
III. M. tensor veli palatini .......................................................................................................................... 20
IV. M. constrictor pharyngeus superior .................................................................................................... 20
V. M. palatopharyngeus ........................................................................................................................... 21
VI. M. palatoglossus .................................................................................................................................. 21
VII. M. salpinogophangeus .................................................................................................................... 21
1. Afwijkende werking v/h VFAM: velopharyngeale dysfunctie ....................................................................... 22
Margot Vermeersch 1
,2. Normale werking van VFAM ......................................................................................................................... 22
A. 4 patronen bij VFAM ................................................................................................................................ 23
1. chirurgie ........................................................................................................................................................ 24
2. Oor- en gehoorproblemen ............................................................................................................................ 24
3. Tandheelkundige problemen ........................................................................................................................ 24
4. Psychosociale gevolgen ................................................................................................................................. 25
A. Ouders ...................................................................................................................................................... 25
B. Kind .......................................................................................................................................................... 25
5. Hechting en ouder-kind interacties............................................................................................................... 25
A. Tijdens sociale interacties tss moeder + kind met schisis ........................................................................ 25
B. Normaal hechtingsproces + ontwikkeling van spraak-, taal en communicatie ........................................ 26
6. Voeding ......................................................................................................................................................... 26
A. Is borstvoeding mogelijk bij kinderen met schisis? .................................................................................. 26
B. Ontwikkeling i/d perinatale periode – voedingsreflexen ......................................................................... 26
C. Zuigen....................................................................................................................................................... 26
D. Voeding bij schisis .................................................................................................................................... 26
E. Voedingsproblemen bij schisis ................................................................................................................. 26
F. Lepelvoeding/vaste voeding .................................................................................................................... 27
7. Spraak, taal en communicatie ....................................................................................................................... 27
1. Normale spraak- en taalontwikkeling ........................................................................................................... 28
2. Spraak- en taalontwikkeling bij kinderen met schisis ................................................................................... 28
3. Voornaamste moeilijkheden met de spraak ................................................................................................. 29
A. Foutieve resonantie op de klinkers .......................................................................................................... 30
B. Nasale luchtstroom in plaats van orale .................................................................................................... 30
C. Producties van glottale/faryngeale aard .................................................................................................. 31
D. Overige: labiale, alveolaire en palatale afwijkingen ................................................................................ 31
1. Schisisteams .................................................................................................................................................. 32
A. Organisatie van zorg voor patiënten met schisis ..................................................................................... 32
B. Taak v/h schisisteam ................................................................................................................................ 32
C. Functioneren v/h schisisteam .................................................................................................................. 32
D. Doel van het schisisteam ......................................................................................................................... 33
E. Voordelen van teamwerk......................................................................................................................... 33
F. Belangrijke vraag ...................................................................................................................................... 33
G. Specifieke doelstellingen qua behandeling .............................................................................................. 33
H. Samenstelling v/e team voor schisis + craniofaciale afwijkingen ............................................................ 33
I. Rol van de chirurgen ............................................................................................................................ 34
II. Rol orthodontist................................................................................................................................... 34
Margot Vermeersch 2
, III. Rol pediater ......................................................................................................................................... 34
IV. rol NKO-arts ......................................................................................................................................... 34
V. Rol audioloog ....................................................................................................................................... 35
VI. Rol geneticus ....................................................................................................................................... 35
VII. Rol maatschappelijk/sociaal werker ................................................................................................ 35
VIII. Rol psycholoog ................................................................................................................................ 35
IX. Rol logopedist ...................................................................................................................................... 35
1. Instrumenteel/objectief onderzoek .............................................................................................................. 36
A. Onderzoek nasaliteit ................................................................................................................................ 36
I. Spiegelproef (Glätzel) .......................................................................................................................... 36
II. Objectieve beoordeling via nasometrie............................................................................................... 36
III. Nasometrie .......................................................................................................................................... 36
2. Perceptueel/subjectief onderzoek ................................................................................................................ 37
A. Logopedisch onderzoek bij kinderen vanaf +/- 4 jaar .............................................................................. 37
I. AA-IE proof (Gutzmann) ...................................................................................................................... 37
II. Bzoch test: nazeggen van woorden ..................................................................................................... 37
III. Stembeoordeling (G, R, B, A, S, I)......................................................................................................... 38
B. Oro-nasale-faryngale inspectie ................................................................................................................ 38
I. Flexibiliteit week gehemelte bij productie van /aa/ ............................................................................ 38
C. Mondmotorische vaardigheden .............................................................................................................. 38
I. Bewust oraal sturen v/d lucht ............................................................................................................. 38
D. Perceptuele beoordeling van spraak ....................................................................................................... 39
3. Onderzoek naar taalontwikkeling bij jonge kinderen ................................................................................... 39
1. Mogelijke problemen .................................................................................................................................... 41
2. Opstart voeding na de geboorte ................................................................................................................... 41
A. Ontwikkeling in perinatale periode – voedingsreflexen .......................................................................... 41
B. Borstvoeding bij schisis ............................................................................................................................ 41
C. Flesvoeding bij kinderen met schisis ........................................................................................................ 42
D. Lepelvoeding bij kinderen met schisis ..................................................................................................... 43
E. Voeding na chirurgie ................................................................................................................................ 43
1. Belang van preventie, vroegtijdige detectie en begeleiding ......................................................................... 44
2. Diagnostiek: een permanent dynamisch diagnostisch proces ...................................................................... 44
A. Wat? ......................................................................................................................................................... 45
B. Voordelen ................................................................................................................................................ 45
C. Concrete toepassing in de praktijk........................................................................................................... 45
3. Spraak- en taalontwikkeling (herhaling) ....................................................................................................... 45
4. Theoretische kaders ...................................................................................................................................... 45
Margot Vermeersch 3
, A. Metamorfoseconcept van Xavier Tan ...................................................................................................... 45
5. Parent Focused approach (Mie Cocquyt) ...................................................................................................... 46
A. Stap 1: ouder-kind relatie ........................................................................................................................ 49
B. Stap 2: bouwen aan interacties ............................................................................................................... 49
C. Stap 3: correcte spraak- en taalpatronen ................................................................................................ 50
I. Versterkte stimulatie: concreet ........................................................................................................... 50
II. Incidental teaching: concreet .............................................................................................................. 50
1. Van indirecte therapie naar directe behandeling ......................................................................................... 53
2. Algemene behandelprincipes vanaf 3-4 jaar................................................................................................. 53
A. 4 foutencategorieën ................................................................................................................................ 53
3. Welke klank eerst? ........................................................................................................................................ 53
4. Behandelvolgorde ......................................................................................................................................... 54
A. Oefening: klanken uitlokken .................................................................................................................... 55
5. Voorbeelden .................................................................................................................................................. 55
A. Actief nasale fricatief i.p.v. /s/ ................................................................................................................. 55
B. Glottisslag i.p.v. /p/ .................................................................................................................................. 56
6. Strategieën om klanken uit te lokken ........................................................................................................... 56
7. Gebruik van lax vox ....................................................................................................................................... 57
8. Therapievormen voor fonologsiche problemen ........................................................................................... 57
A. Hodson & Paden ...................................................................................................................................... 57
C. Behandeling van hypernasaliteit (niet VPI) ................................................................................................... 57
D. Behandeling – casus ...................................................................................................................................... 58
Examen ......................................................................................................................................................... 58
Margot Vermeersch 4
