Cleft Lip and Palate

key notes about cleft

- diagnosed as early as 6 weeks in utero

- can see cleft lip in ultrasound but not cleft palate

cleft lip

- separation of upper lip through nasal or oral cavity, or tooth-bearing part of maxilla

cleft palate

- hole in roof of mouth

- can be from hard to soft palate

submucous cleft

- HIDDEN hole in roof of mouth

- skin fused but bone didn't

- MD won't touch it

- trouble with feeding

- have hypernasality (nasal emissions)

- not detected til 2-3 years

least to most severe clefts

- SUBIUB

- submucous CP

- unilateral incomplete CL

- bilateral CL

- incomplete CP

- unilateral cleft L/P

- bitlateral cleft L/P

velopharyngeal insufficiency

- velo = velum

- pharyn = pharynx

- back of throat

- cannot raise velum therefore does not have proper closure

- air comes out of nose AND mouth

- even after surgery it won't be perfect

velopharyngeal dysfunction

- caused by surgery

- take too much of velum out

- ex. tonsilectomy

etiologies

- genetics

- environment

- inherent of a certain syndrome

etiology: environment

- mom's diet: need correct nutrients

- mom's lifestyle: smoking/drinking, prescription drugs, exposure to toxins, clean drinking water

surgical repair

- all done by plastic surgeon

- not every baby is a candidate

cleft lip repair

- at about 3 months if baby can withstand general anesthesia

cleft palate repair

- at about 10-12 months

- 1st reason: prevent food and liquid from exiting nose (close the hole!)

- 2nd reason: speech (need a working palate)

who is apart of the interprofessional team

- SLP (knows about swallowing and oral mechanism)

- audiologist (everything is connected, eustachian tube = ear infections)

- pediatrician

- pediatric dentist

- orthodontist

- ENT

- plastic and oral surgeon

- **social worker

- **child psychologist

SLPs role: birth to adolesence

- feeding therapy

- counseling

- assessment of speech, language, and resonance

- speech/resonance therapy

- working with reference group

feeding therapy

- working with mom from get-go

- how to use feeding tube

counseling

- may be a shock to parents

- they start playing the blame-game

assessment of speech, language, and resonance

- how much hypernasality they have

working with reference group

- talk with MD and tell them what we are working on in therapy and how client is doing in that

cleft palate and language

- delays not only in speech, but in receptive (understanding), and expressive (communicating) language

areas of weakness

- MLU

- TNW

- expressive syntax

- these decrease with age

social and emotional impact

- teasing and bullying (even from adults!)

- won't want to go anywhere where speaking is required

- body image issues (scars)

- loneliness and isolation