Submucous Cleft Palate

Abstract

This study aimed to investigate the age at diagnosis, palatal characteristics, and symptoms of submucous cleft palate (SMCP) and to compare the speech outcomes between 3 operative techniques for primary repair of SMCP.It was a retrospective review of 92 patients diagnosed with SMCP between 1994 and 2008, where patients were treated with 1 of 3 surgical procedures: double opposing z-palatoplasty, radical intravelar veloplasty, or pharyngeal flap.The need for a second procedure was considered a primary outcome measure, with operative failure defined by the need for a secondary operation. Postoperative speech was evaluated perceptually using the Great Ormond Street Speech Assessment.We found that SMCP was diagnosed at a mean age of 3.6 years. At diagnosis, 8% were asymptomatic, 67% had abnormal speech, 49% had recurrent otitis media with effusions, and 47% had hearing loss. Ear, nose, and throat surgery was performed on 37% without the diagnosis of SMCP being made. Subjective impression of a short palate was a predictor for secondary surgery (P < 0.02). Age at repair did not affect velopharyngeal insufficiency outcome; however, repair after 18 months of age led to a higher likelihood of developing articulatory speech errors resulting in the need for more speech therapy.In conclusion, the triad of features of SMCP is well recognized, but our study reveals that a high percentage is seen by physicians who have failed to make the diagnosis despite signs and symptoms being evident. Surgical correction is successful regardless of technique and age, but earlier recognition to prevent speech impairment should be sought.

Speech and language characteristics in individuals with nonsyndromic submucous cleft palate—A systematic review

“…In addition to structural abnormalities, individuals with SMCP may also experience difficulties with feeding, middle ear function and hearing. Impaired palatal muscles can prevent a baby from generating negative intraoral pressure required for feeding, leading to lengthened and difficult feeds accompanied by possible nasal regurgitation (Bessell et al, 2011;Ha et al, 2013). These challenges are overcome with specific feeding techniques and bottles (Bessell et al, 2011).…”

“…Despite this array of symptoms, a diagnosis of SMCP is generally only pursued when an individual presents with persistent velopharyngeal insufficiency (VPI) and disordered speech (Oji, Sakamoto, Ogata, Tamada, & Kishi, 2013;Park et al, 2000;Velasco et al, 1988). VPI is detected when a child begins to speak, and symptoms may be extremely subtle (Ha et al, 2013;Reiter et al, 2011;Sullivan, Vasudavan, Marrinan, & Mulliken, 2011).…”

“…Speech difficulties associated with VPI occur in up to 80% of individuals with unrepaired SMCP (Ha et al, 2013;Kono et al, 1981;Shprintzen et al, 1985). Defective palatal muscles prevent adequate velopharyngeal closure during speech, allowing undesired air and acoustic energy to escape into the nasal cavity.…”

General approach to velocardiofacial anomalies: a pediatric case presenting with Fallot tetralogy

“…Our case also had a short soft palate, difficulty in speaking and swallowing and her endoscopic examination in the ear-nose and throat clinic (ENT) showed velopharyngeal insufficiency. Ha and colleagues reported that the repair of the cleft palate after 18 months of age would lead to a higher risk of developing articulatory speech problems resulting in the need for more speech therapy [8]. Therefore, the children with VCFS should be consultated with plastic surgeons, orthodontists, ENT specialists and speech therapists for the monitorization and resolution of their facial and velopharyngeal problems as early as possible [6, 7, 8].…”

“…Ha and colleagues reported that the repair of the cleft palate after 18 months of age would lead to a higher risk of developing articulatory speech problems resulting in the need for more speech therapy [8]. Therefore, the children with VCFS should be consultated with plastic surgeons, orthodontists, ENT specialists and speech therapists for the monitorization and resolution of their facial and velopharyngeal problems as early as possible [6, 7, 8]. The cleft palate of our case was corrected in the fifteenth postnatal month and she has being followed by ENT specialists and speech therapists in a university hospital since then.…”