The clinical features of cleft palate are due to an open hole between the nasal cavity and the oral cavity.

• During speech, there is entry of air into the nasal cavity which leads to a nasal quality in the voice. There are also other speech problems such as distorted speech.
• There are also problems in feeding. This causes marked problem in infants who require a proper suction mechanism in order to feed.
• Patients of cleft palate may also have breathing problems due to the open communication between the oral and nasal cavities.
• Cleft palate can also lead to difficulty in hearing. The tensor veli palatini is unable to open the Eustachian tube which will lead to an increased secretion of fluid in the middle ear. Infections such as otitis media are more common in these infants .
• Hearing problems in early life may also later lead to difficulty in articulation. This occurs due to inability of the children to mimic language due to defective hearing. Due to velopharyngeal inadequacy, there is an inability to produce some particular sounds that are required for normal speech.
• A marked increase is seen in the occurrence of psychological problems such as anxiety, depression, internalization, social withdrawal and aggressive behaviors in these patients later in life.

• Feeding Difficulties

  We report the cases of a father and daughter diagnosed with CPLSS who presented with respiratory and feeding difficulties at birth undergoing surgical correction. [ncbi.nlm.nih.gov]

  Health Problems Related to Cleft Lip and Palate Feeding Feeding difficulties may occur in newborns with cleft lip and/or palate as the normal anatomy of the mouth is disrupted. Each baby is different in their ability to feed. [chla.org]

  Cleft Lip and Palate Symptoms Beyond the cosmetic abnormality, other possible complications that may be associated with cleft lip and cleft palate include: Feeding difficulties. Feeding difficulties occur more with cleft palate abnormalities. [hopkinsmedicine.org]

  Furthermore, symptoms to be aware of are feeding difficulties combined with nasal regurgitation and ear problems such as conductive hearing loss and persistent otitis media. [doi.org]

  Feeding difficulties occur more with cleft palate abnormalities. Children with cleft lip but without cleft palate do not usually have feeding difficulties. [chop.edu]

• Inflammation

  Herpes simplex virus (HSV) primary infection and reactivation has been associated with the inflammation and transient decrease in immunocompetence after surgery and local trauma. [ncbi.nlm.nih.gov]

  Kids and Ear Infections An ear infection is an acute inflammation of the middle ear caused by fluid and bacteria behind the eardrum. These ear infections cause a great deal of pain. [choc.org]

  Multiple ear infections, often with resulting hearing loss, are not uncommon, and the presence of fever needs to be evaluated for possible inflammation of the middle ear. [chla.org]

• Eating Problem

  Continued What Problems Are Associated With Cleft Lip and/or Palate? Eating problems. With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. [webmd.com]

• Short Stature

  Homepage Rare diseases Search Search for a rare disease Cleft palate-short stature-vertebral anomalies syndrome Disease definition Cleft palate- short stature- vertebral anomalies is a multiple congenital anomalies syndrome described in a father and son [orpha.net]

  In a 15 year boy, showing intellectual disability, short stature, hearing loss and dysmorphic facial features, a deletion at Xq21.1 was identified by array-CGH. [ncbi.nlm.nih.gov]

  Referrals are made to genetics clinics for a variety of reasons, including birth defects, developmental delay, autism, epilepsy, short stature, in the United States, physicians who practice clinical genetics are accredited by the American Board of Medical [wikivisually.com]

• Fatigue

  Learn More About Topic Hoarseness Hoarseness (also called dysphonia) is an abnormal change in the quality of your voice, making it sound raspy, strained, breathy, weak, higher or lower in pitch, inconsistent, or fatigued, often making it harder to talk [entnet.org]

  The inadequacy of iron is related to brain functions such as fatigue, mood swings, and brain fog. These demonstrate the possible significance of iron and its insufficiency can cause depression. [lavsguide.com]

  Larger clefts of the soft and/or hard palate may not be able to generate suction as the oral cavity cannot be separated from the nasal cavity when feeding which leads to fatigue, prolonged feeding time, impaired growth and nutrition. [en.wikipedia.org]

• Pharyngitis

  According to the diagnosis, the patient suffered from pharyngeal glial choristoma and incomplete cleft palate. The surgical resection and repair were performed together. The postoperative recovery was very good. [ncbi.nlm.nih.gov]

• Cough

  On the clinical examination, coughing, sneezing, drainage of nasal discharge from the external nares and poor growth were found. Vital signs and results of blood examination were within normal ranges. [ncbi.nlm.nih.gov]

  On physical examination, coughing, sneezing, presence of nasal discharge from the external nares and poor growth were found. Vital signs and results of blood examination were within normal ranges. [doi.org]

  Your child has chills, a cough, or sounds congested. These are signs that your child may have an infection. Your child's skin is itchy, swollen, or has a rash. The medicine your child is taking may be causing these symptoms. [drugs.com]

• Nasal Voice

  Surgery can result in significant improvement, but if deformities are severe or treatment is inadequate, patients may be left with a nasal voice, compromised appearance, and a tendency to regurgitate. [msdmanuals.com]

  Some kids, however, will continue to sound nasal after cleft palate repair, and some may develop a nasal voice later on. [brennerchildrens.org]

  Some kids, however, will continue to sound nasal after cleft palate repair, and some may develop a nasal voice later on. More surgeries may be needed as children grow older and their facial structure changes. [kidshealth.org]

• Sleep Apnea

  There were 11 (21%) surgical complications, with no complete flap loss, snoring, sleep disturbance, and/or mouth breathing. All patients presented low pre- and postoperative risk for obstructive sleep apnea. [ncbi.nlm.nih.gov]

  Schwab, Genetic determinants of upper airway structures that predispose to obstructive sleep apnea, Respiratory Physiology & Neurobiology, 10.1016/j.resp.2005.06.006, 147, 2-3, (289-298), (2005). [doi.org]

• Choking

  Babies should be able to feed comfortably within a reasonable amount of time, without struggling to breathe, choking, or working very hard to get the milk out of the bottle. [urmc.rochester.edu]

  Make sure your child can swallow without choking, and gets good nutrition. Give you, your child, and your family help and support. [drugs.com]

  Commonly babies with cleft palate may gag, choke, or aspirate the milk while sucking. Babies with cleft palates are at higher risk of infections of the middle ear. The clefts lead to building up of fluid in the middle ear leading to loss of hearing. [news-medical.net]

  This can cause choking. Special nipples and bottles are available that can help. Your nurse, occupational therapist, or lactation specialist will help you figure out what works best for your baby. They may also help with feeding issues. [saintlukeskc.org]

  Is there anything we can do to prevent the mucus from causing him to choke? You need to see your doctor about that. Ear, nose and throat doctors specialize in problems involving the sinuses. [uichildrens.org]

• Dysphagia

  Learn More About Topic Dysphagia Dysphagia means that you can’t swallow well. Many factors may cause dysphagia, and most are temporary and non-life-threatening. [entnet.org]

  Related Topic Areas Aphasia Autism Craniofacial conditions Deafness Developmental speech difficulties Dysfluency Dysphagia Head and neck cancer Language disorder Learning disabilities Mental health (Adults) Social communication difficulties Social emotional [rcslt.org]

  Infants and children[edit] Infants with injuries due to complications at birth, feeding and swallowing difficulties, including dysphagia Children with mild, moderate or severe: Genetic disorders that adversely affect speech, language and/or cognitive [en.wikipedia.org]

• Heart Disease

  Congenital anomalies associated with SMMCI syndrome can include short stature, mild forms of deviation in craniofacial morphology, mild to severe intellectual disability, congenital heart disease, and cleft lip and/or palate. [ncbi.nlm.nih.gov]

  Cleft Lip And Palate Clinic Digestive Health Colorado Center For Celiac Disease Colorado Fetal Care Center Colorectal and Urogenital Care Heart Complex Congenital Heart Disease & Development Clinic Orthopedics Concussion Program Surgery Craniofacial [childrenscolorado.org]

  Human milk and breastfeeding outcomes in infants with congenital heart disease. Breastfeed Med 10, 31-37(2015). 10 Reilly, S. et al. [medela.nl]

  Instances in which this does not occur include those with complicating medical conditions, such as congenital heart disease or airway compromise. [emedicine.medscape.com]

  Cecilia Vecoli, Silvia Pulignani and Maria Andreassi, Genetic and Epigenetic Mechanisms Linking Air Pollution and Congenital Heart Disease, Journal of Cardiovascular Development and Disease, 3, 4, (32), (2016). Sally Stephens and Laura M. [doi.org]

• Malocclusion

  The authors present a 16-year-old patient with no known history of cleft palate who developed velopharyngeal insufficiency after a Le Fort I osteotomy performed for the correction of maxillary hypoplasia and a Class III malocclusion. [ncbi.nlm.nih.gov]

  Goslon yardstick Three of the authors have mentioned clinical features that they considered to be most important in categorizing the severity of malocclusion. [slideshare.net]

  When the teeth do not fit together properly (malocclusion) and there is an associated facial deformity, such as an imbalance in facial proportions. [mottchildren.org]

  […] syndrome Craniosynostosis Crouzon syndrome Pfeiffer syndrome Saethre-Chotzen syndrome Cleft lip and palate Cleft lip and palate Craniofacial clefts Pierre Robin syndrome Dentofacial and maxillofacial deformities Chin deformities Distraction osteogenesis Malocclusion [choa.org]

• Prolapse

  Cleft palate, especially when associated with mandibular hypoplasia (as with a Pierre Robin sequence ), may also cause airway difficulties because the tongue prolapses through the cleft into the nasal cavity and the posterior oropharynx. [emedicine.medscape.com]

• Arthritis

  […] cleft lip/palate may be related to a medication a mother may have taken during her pregnancy, including antiseizure/anticonvulsant medications, acne treatment medications containing Accutane®, or methotrexate, a drug commonly used for treating cancer, arthritis [my.clevelandclinic.org]

  Those taking corticosteroids, methotrexate (for psoriasis, arthritis or cancers) or isotretinoin (for acne ) are also at risk. [news-medical.net]

  Among them: anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis. [webmd.com]

  Among them: anti- seizure /anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis. [m.webmd.com]

• Fracture

  Here, we present an unoperated adult case of cleft palate that had midfacial fractures following a road traffic accident. The patient's cleft lip was repaired when he was 2 years old but the palate was not operated because of poor follow-up. [ncbi.nlm.nih.gov]

  Consultation on oral or facial lesions Evaluation and treatment of congenital (present at birth) deformities, such as cleft lip and palate and craniofacial deformities Evaluation and treatment of traumatic deformities, such as midface and mandibular (jaw) fractures [choa.org]

  Neuromuscular Clinic Cancer and Blood Disorders Neuro-Oncology Neuroscience Neuropsychology Neuroscience Neuroscience Neurosurgery Nutrition O Cancer and Blood Disorders Oncology Ophthalmology Orthopedics Orthopedic Surgery Orthopedics Orthopedic Trauma And Fracture [childrenscolorado.org]

  The hamulus can be fractured medially without interfering with eustachian tube function, yet most of the time this maneuver is unhelpful and rarely necessary. [emedicine.medscape.com]

• Eruptions

  After teeth erupt, an orthodontist can further assess a child's short and long-term dental needs. After the permanent teeth erupt, orthodontic treatment can be applied to align the teeth. Prosthodontic care. [webmd.com]

  […] multiple congenital anomalies: bilateral aplasia of the radius and thumb, left kidney agenesis, cardiac malformation cleft palate, bilateral cryptorchidism, ear anomalies, which were associated, in time, with facial hyperpigmentation, anomalies of dental eruption [ncbi.nlm.nih.gov]

• Hearing Problem

  These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders. [dbpedia.org]

  Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. [ncbi.nlm.nih.gov]

  To prevent this from happening, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year. Speech problems. [webmd.com]

• Hearing Impairment

  The patients were offered individualized ear surgery (PE tube placement) only if persistent middle ear fluid was present for over 3 months with a conductive hearing impairment. [ncbi.nlm.nih.gov]

  Furthermore, this developmental language delay occurred in the absence of hearing impairment and oral motor or structural deficits such as cleft palate. For a baby who has a cleft palate only, then she has a choice. [dictionary.cambridge.org]

  impairment); to assess and monitor hearing A nurse coordinator to provide ongoing supervision of the child's health A social worker/psychologist to support the family and assess any adjustment problems A geneticist to help parents and adult patients [webmd.com]

  impairment); to assess and monitor hearing A nurse coordinator to provide ongoing supervision of the child's health A social worker/ psychologist to support the family and assess any adjustment problems A geneticist to help parents and adult patients [m.webmd.com]

• Low Self-Esteem

  Psychological difficulties associated with physical appearance often involve low self-esteem and social withdrawal. Diagnosis and treatment of cleft palate Cleft palate may be diagnosed before birth, via ultrasound, or at birth. [britannica.com]

  Parents may suffer from denial, anger or guilt and the child suffers from a low self-esteem. [news-medical.net]

  Feeling different to their peers can result in low self-esteem, which can in turn give children behavioral problems and difficulties making friends. [clapa.com]

  There would be endless operations, the likelihood of ostracisation, bullying, low self-esteem. The shape of the face could be affected, with the entire upper jaw recessed. [theguardian.com]

• Irritability

  Soft extension of the feeding plate eliminated the risk of irritation, and the baby accepted the appliance easily. [ncbi.nlm.nih.gov]

  Palatal prosthesis also prevent the tongue's irritation and inflammatory reactions, and it might be support the wound healing procedures. [doi.org]

  Using a sippy cup or pacifier (or anything that makes them use a sucking motion) can irritate the stitches. Follow-up with your plastic surgeon. Meet your ENT surgeon for evaluation for ear (PE) tubes. 9 Months The cleft palate is repaired. [cincinnatichildrens.org]

  Most children will be a little irritable in the first couple of days after surgery, but medicine will control the pain well. You may notice some pink or red saliva on the first night, and this is normal. [childrens.health.qld.gov.au]

  Though breast milk is not irritating to the mucous membranes, nasal regurgitation makes it more difficult to tell how much milk the baby is ingesting, and can make feedings more difficult. [americanpregnancy.org]

• Speech Disorder

  As a result of deterioration of the anatomical structure of the palate, illnesses such as regurgitation, respiratory tract infections, otitis, and speech disorders may occur. [ncbi.nlm.nih.gov]

  The main purpose was to test if parent led intervention is comparable to traditional speech therapy intervention in children with cleft palate speech disorders. [cleft.ie]

  SLPs specialize in the evaluation, diagnosis, and treatment of communication disorders (speech disorders and language disorders), cognitive-communication disorders, voice disorders, and swallowing disorders. [en.wikipedia.org]

A prenatal fetal anomaly scan can lead to early diagnosis of cleft palate. After birth, the diagnosis can be easily made clinically. No investigations are necessary.

A specialized craniofacial team is needed to treat this condition. There are different treatment modalities according to the type and severity of cleft palate. If child has undergone surgery early in life, it will lead to improved hearing. If we wait for the eruption of permanent teeth before correcting the defect surgically, a lesser number of corrective surgeries will be needed later in life.

Cleft palate can be treated by the use of a prosthetic device which can fill the gap in the palate. It can also be treated by the insertion of pins in fourth or fifth month of life. With each passing day, the parents have to tighten the screw so that both the bones can come closer. If the gap is involving the maxilla, a piece of bone can be taken from a rib or the hip of the patient for transplantation.

In order to avoid speech and hearing problems, the patient should be treated as early as possible. Grommets or tympanostomy tubes can be used to aerate the middle ear [9] [10]. After surgical repair, the problem of speech is usually corrected.

Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. [ncbi.nlm.nih.gov]

Prognosis Both cleft lip and cleft palate are treatable birth defects. [encyclopedia.com]

Prognosis Treatment takes place over several years as the child grows and the palate and dentition develop. However, it is possible to achieve a normal appearance, and normal speech and eating habits, early in the process. [patient.info]

Cleft palate results from the following etiologies.

• Genetic factors and familial factors [2] [3] [4]

• Environmental factors
• Maternal epilepsy [5] [6]
• Gestational diabetes
• Use of steroids, diazepam and phenytoin during pregnancy [7]
• Pierre Robin Sequence is the most common syndrome. In this syndrome, the patients have isolated cleft palate, posteriorly displaced tongue and posteriorly placed jaw [8].

Epidemiology References:[1][2][3][4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology of oral clefts: an international perspective. In: Wyszynski, D.F., ed. Cleft Lip and Palate: From Origin to Treatment. New York : Oxford University Press ; 2002 : 127 – 158. [dx.doi.org]

This Maintenance of Certification review discusses the incidence and epidemiology associated with cleft palate deformity and specifics associated with patient care, including analgesia, surgical repair techniques, and complications associated with repair [ncbi.nlm.nih.gov]

Figueiredo, Epidemiology, Etiology, and Treatment of Isolated Cleft Palate, Frontiers in Physiology, 10.3389/fphys.2016.00067, 7, (2016). [doi.org]

Cleft palate occurs due to the inability of the palatine processes to meet during development. In incomplete cleft palate, the defect usually involves the soft palate and hard palate is attached to vomer and nasal septum. In incomplete cleft palate, there is usually a disruption in the insertion of muscle fibers. If hard palate is not attached to the nasal septum or vomer, it is referred to as complete cleft palate and both the hard and soft palates are involved. There is a primary palate in front of alveolar foramen and a secondary palate behind it.

Cleft palate can occur in either U form or V form. V form is more common in isolated cases of cleft palate whereas U form is more common in Pierre Robin Sequence.

In submucous palate, there is split uvula, a ridge in soft palate and a notch at the back of the hard palate. It can occur in association with cleft lip in which there is a gap in the lip.

A defect in the alveolus can (1) displace, tip, or rotate permanent teeth, (2) prevent permanent teeth from appearing, and (3) prevent the alveolar ridge from forming. These problems can usually be repaired through oral surgery. [webmd.com]

How can I prevent oral clefts? Although oral clefts are not totally preventable, there are some steps you can take before and during pregnancy to lower the risk. [carnegieimaging.com]

References Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, Anderson P, Mason CA, Collins JS, Kirby RS, Correa A; for the National Birth Defects Prevention Network. [web.archive.org]

Cleft palate is a developmental defect in the formation of the palate. It can involve both the soft palate and the hard palate. When both the palates are involved simultaneously, the condition is known as complete cleft palate [1].

Usually maternal, genetic and family factors play an important role. Air from the mouth escapes into the nose which leads to velopharyngeal inadequacy. Patients usually present with abnormalities in feeding, hearing and speaking. Later on in life, the incidence of psychiatric symptoms such as aggressive behaviour and depression increases. Surgical correction is treatment of choice.

Patients of cleft palate are usually infants and present with feeding problem. On examination there is a hole in the palate. With passage of time patient develops hearing, speech problems and psychiatric symptoms. Surgical repair is the choice of treatment.

Early surgical treatment leads to improved hearing and speech. Prosthetic devices, pins and in severe form, bone from other sites of body may be used to fill the hole.