Cleft Palate

The basics about Cleft lip and palate:
A cleft is an opening or a hole, especially one resulting from the failure of parts to come together during pregnancy. This failure of parts to close may occur on one or both sides of the face and it may involve only the lip, only the palate or a combination of the two. These birth defects occur between the sixth and 12th weeks of pregnancy and are believed to be due to a combination of environmental and genetic factors.

In what ways does a cleft palate affect my chid's speech?
Articulation is the way in which we use our mouth (lips, tongue, teeth, etc.) to produce speech sounds. Children with cleft lip/palate are at high risk for difficulties with speech production. Often these patients will substitute sounds, distort sounds or delete sounds in speech attempts. Because most children with cleft lip and palate will have dental problems, some of these articulation errors will not be remediated until dental management is under way. However, it is important to address any articulation deficits immediately with a speech-language pathologist.

Resonance is a vibration that occurs when air is exhaled out the nose and mouth during speech production. In the cleft palate population, the most frequent resonance problems occur from excess airflow out the nose during the production of oral speech sounds. Excessive nasal airflow during speech is the result of something called velopharyngeal insufficiency (VPI). VPI means there is a space/gap between the back of the throat (pharynx) and the soft palate during speech production. In order to make most sounds appropriately, the soft palate must contract and lift to come in close contact with the back of the throat. This action directs the airflow out the mouth instead of allowing air to escape out the nose. VPI occurs in approximately 25% of cleft individuals following initial palatal repair. VPI adversely impacts speech by causing articulation difficulties and hypernasal resonance. Nasal air emissions often accompany hypernasal speech. Nasal air emissions are audible airflow (i.e., you can hear it) through the nose on certain sounds associated with reduced pressure for some of the consonants. Nasal turbulence is a severe form of audible escape and is often distracting to the listener.                                                                   

What can we do to help my child's speech?
Regular visits to a cleft palate team (every six months) are crucial for guided care in further surgery determinations, speech-language development, dental management and hearing status. Important decisions regarding further surgery for resonance issues and the need for speech- language therapy are discussed during these visits. If your child has speech-language issues, the speech-language pathologist will be able to assist you in getting consistent therapy for your child. The speech-language pathologist will also be able to provide information to the parents for continued work on these areas at home.

What long-term outcome should I expect?
With proper and consistent care from your speech-language pathologist, plastic surgeon, otolaryngologist (ENT), dentist and audiologist, you should expect your child to make great improvements and live a happy and healthy life.