Cleft Lip & Palate: The Role of the SLP

Comprehensive vocabulary flashcards covering the etiology, classification, medical complications, speech and resonance manifestations, team management, and surgical/prosthetic interventions for cleft lip and palate.

Cleft Lip and Palate

The most common congenital craniofacial abnormality, resulting from an interruption in embryologic growth between the 4th and 10th week of developing embryo or fetus.

Overt Palatal Cleft

A palatal cleft that is visibly open and can be readily observed upon direct intraoral inspection.

Submucous Cleft Palate (SMCP)

A congenital cleft where the overlying oral mucosa remains intact, but the underlying velar musculature fails to attach at the midline; characterized intraorally by a bifid uvula and a blue midline discoloration.

Bifid Uvula

A split or divided uvula that serves as a common clinical intraoral hallmark of a submucous cleft palate.

Types of Cleft Lip

Classifications of upper lip clefting based on severity and laterality, consisting of unilateral incomplete cleft lip, unilateral complete cleft lip, and bilateral complete cleft lip.

Types of Cleft Palate

Classifications of palatal clefting, including incomplete cleft of the soft palate only, unilateral complete cleft of lip and palate, and bilateral complete cleft of lip and palate.

Plastic/Craniofacial Surgeon

A surgeon with specialized training in the diagnosis and surgical management of skeletal abnormalities of the skull, facial bones, and soft tissue who collaborates closely with orthodontists.

Genetic Counselor

A cleft team specialist who evaluates medical and family history, examines the child to assist in syndrome diagnosis, and counsels the family on recurrence risks in future pregnancies.

Nurse Team Coordinator

A registered nurse with pediatric cleft care specialization who coordinates patient care and acts as the direct liaison between the family and the cleft palate team.

Eustachian Tube Malfunction

A structural or muscular failure in which the auditory tube remains open or fails to drain properly because the muscles that elevate the palate also open the eustachian tube, predisposing cleft patients to otitis media with effusion.

Velopharyngeal Dysfunction (VPD)

The structural or functional inability of the soft palate (velum) to make complete closure against the posterior pharyngeal wall to separate the oral and nasal cavities during speech.

Resonance

The vocal quality determined by the balance and distribution of acoustic sound vibrations within the oral, nasal, and pharyngeal cavities during speech production.

Hypernasality

An acoustic phenomenon occurring when sound energy inappropriately couples into the nasal cavity, resulting in excessive nasal resonance on non-nasal sounds.

Nasal Air Emission

An aerodynamic phenomenon resulting in the audible or inaudible leakage of air through the nasal cavity during the attempted production of pressure consonants.

Soft Voice Syndrome

A reduction in vocal intensity resulting either directly from intraoral air pressure loss through the velopharyngeal port or from an intentional compensatory behavior to disguise hypernasality and nasal emission.

Laryngeal Hyperfunction

Excessive muscular effort within the larynx utilized as a maladaptive compensatory strategy for velopharyngeal air pressure escape, often leading to muscle tension dysphonia.

Oral Pressure Consonants

High-pressure speech sound classes—specifically stops (/p, b, t, d, k, g/) and fricatives (/s, f, z, v, sh, th/)—that are most vulnerable to disruption and error in individuals with velopharyngeal inadequacy.

Pharyngeal Flap

A secondary surgical management technique for velopharyngeal inadequacy in which a mucosal and muscular flap is raised from the posterior pharyngeal wall and attached to the soft palate.

Palatal Obturator (Bulb Obturator)

A removable dental prosthetic retainer fitted with an acrylic bulb that extends posteriorly to occlude the velopharyngeal space and prevent air escape into the nasal cavity during speech.

SLP Assessment

Oral mechanism examination

Evaluation of speech
○ Resonance: hypernasality; nasal emission?
○ Voice quality
● Language assessment
● Feeding/swallowing assessment

Surgical Procedures for Cleft Lips

• Generally repaired around 3 months of age

• - allows time for the lips to grow, results in more precise repair

• - helps restore near-normal feeding skills

• - improves childs appearance

Surgical Procedures for Cleft Palates

Cleft palates must be repaired before the baby begins to speak.
○ Generally between 9-15 months of age.
○ Helps restore near normal speech abilities.

Treatment Options for Velopharyngeal Inadequacy

Surgical procedures:
○ Pharyngeal flap: a flap of tissue from the back of the throat (pharyngeal wall) is
attached to the soft palate (velum).
○ Pharyngoplasty: tissue from the back of the throat is moved closer to the back of the palate

Palatal Obturator

Similar to an orthodontic retainer
○ A ‘bulb’ is attached to an acrylic retainer, that is held in place by the teeth.
○ The ‘bulb’ is designed to close off the space behind the soft palate (velum) and the back of the throat, thus closing off vocal airflow into the nasal cavity

Speech Treatment

Only 10% of children are likely to experience a persistent communication
disorder following cleft repair.
● Conventional articulation/phonology treatment approaches are applicable.
Goals include the following:
● Using sound play and early word productions to increase variety of
vocalization.
● Increasing consonant inventories, especially oral pressure consonants
(i.e. /p,b,t,d,k,g/).
● Increasing communication opportunities.
● Increasing vocabulary, with a focus on functional words.
● Increasing awareness of oral airflow for speech