Cleft Lip and Palate

Birth defects where the tissues in the lip and/or palate (roof of the mouth) don’t fully join before birth.

Partial/Incomplete cleft lip

Lip is split, but not through the alveolus (gum ridge)

Complete cleft

Goes through the lip, alveolus, and palate.

Submucosal cleft

Muscles don’t meet under the surface tissue of the soft palate, which may lead to speech issues.

Occult submucosal cleft

A cleft that is not visible, often diagnosed later in life, where underlying muscles do not connect properly.

Palatal Fistula

An abnormal opening in the palate that can occur after cleft repair, leading to potential challenges in feeding and speech.

• Definition: A hole between the mouth and nose after surgery.

• Causes: Poor healing or breakdown after palate repair.

• Effects: Air or food may leak through nose.

Surgical Treatment

• Lip repair (cheiloplasty): ~3 months of age.

• Palate repair (palatoplasty): ~12 months.

• Some need secondary surgeries: For velopharyngeal insufficiency (VPI) or fistula repair.

Speech assessment in cleft issues

• Focus is on articulation and resonance.

• Tests:

  • Articulation testing

  • Imaging (video fluoroscopy or nasoendoscopy)

  • Nasometry (measures nasal airflow)

Types of Speech Disorders of cleft issues

*Articulation disorders: Motor-based sound errors.

*Phonological disorders: Language-rule based errors.

*Compensatory articulation: Learned habits due to abnormal structure. Include resonance disorders: Difficulty with voice quality due to cleft affecting airflow.

Resonance Disorders

• Hypernasality: Too much sound through the nose (e.g., "baby" sounds like "maybe").

• Hyponasality: Blocked nasal sounds (like when you have a cold).

Therapy Planning

• Develop individualized strategies based on assessment findings to enhance speech clarity and resonance.

  • Reduce compensatory patterns

  • Improve oral airflow and pressure

  • Focus on easy-to-produce sounds (fricatives, vowels, glides) and enhance overall communication effectiveness.

Feeding and Cleft Palate

• Cleft palate affects feeding due to low oral pressure (hard to suck).

• Signs: Long feeding times, weight loss, and milk in the nose.

• Strategies:

  • Upright feeding posture

  • Special bottles

  • Frequent burping

Feeding Aversion in Older Kids

• Due to hypersensitivity or past bad experiences.

• May need food play therapy or desensitization. It refers to a reluctance to eat or drink that arises from previous negative experiences with food or heightened sensitivity to certain textures and tastes. Interventions often include food play therapy to create positive associations.

Role of SLP in Speech Assessment

• SLP must evaluate:

  • Articulation: Focus on pressure sounds.

  • Speech mechanism exam: Look at palate movement, pharynx, lips.

  • Nasality: Is the child too nasal or too oral?

Nasality Evaluation in Cleft Issues

• Perceptual judgment: SLPs listen to conversational speech.

• Problem: Can be unreliable—depends on listener's experience.

Instrumental Assessment:

• Nasometer: Measures oral vs nasal energy.

• Normal score: < 20.

• Hypernasal score: > 30–40.

Prosthetic Management  (Obturators)

• Obturator: A device to close gaps in the palate.

• Used when surgery isn’t possible or delays are necessary.

• Not all children are surgical candidates.

• Palatal lift: Lifts soft palate if too weak.

• Speech bulb: Fills in space if palate is too short.

Pros and Cons of Prosthetics

Advantages:

• Non-surgical.

• Adjustable.

• Removable.

Disadvantages:

• Needs cleaning.

• Can’t eat with it.

• Might fall out.

• Not good if soft palate moves too much.