Cleft Palate

Cleft palate is a deformity of the palate that occurs during the development of the embryo and fetus. It results from the improper closure of the palatal shelves or from improper closure of the primary with the secondary palate. Cleft palate may be accompanied by a cleft lip, however, cleft lip may occur without cleft palate.

The hard palate is the bony partition between the mouth and nose. The soft palate is the muscular portion of the palate posterior to the hard palate. It serves as a valve between the oropharynx and nasopharynx. Clefts of the hard palate are accompanied by cleft of the soft palate. Cleft of the soft palate may or may not be associated with cleft of the hard palate.

Cleft palate may result in food and fluids in the mouth to be expelled through the nose. It may also interfer with developing negative pressure in the mouth to permit suckling and development of normal speech.

Cleft palate typically results in severe disorders of speech including hypernasality and inability to form plosive and sibilant sounds which require intraoral pressure.

In clefts of the soft palate, musculature that normally enters the palate from the sides and traverses the palate to midline is, instead, directed anteriorly and may attach to the posterior rim of the hard palate. This cleft configuration adds to the deformity by reducing or eliminating the ability to lift the soft palate posterosuperiorly to close off the oropharynx from the nasopharynx. The soft palate may also be foreshortened. Thus surgery for clefts of the soft palate must take into account the midline opening, the length of the palate, and the misalignment of the muscles within the soft palate. Clefts of the palate may also involve the maxillary dental arch.

Cleft lip may be unilateral or bilateral. Clefts of the lip do not usually cause serious functional problems, but do result in mild to servere facial deformity and, since the lip and alviolar arches which hold the teeth arise from the same primordium, there can be mild to severe deformities of the dental arch.

Treatment may involve multiple surgeries, orthodontia, prosthodontia, speech therapy, and myringotomy. It is essential that these treatments be undertaken in an orderly and coordinated fashion. For that reason, it is often recommended that children with cleft palate be referred to a team that specializes in the treatment of cleft lip and palate.