Cleft lip and palate

Observable Traits

Cleft lip: A visible gap or split in the upper lip.

Cleft palate: A visible gap or split in the palate.

Bifid uvula: A split or forked uvula.

Nasal regurgitation: Food and liquid escaping through the nose.

Risk Factors

Family history: A family history of cleft lip and palate can increase the risk.

Genetic mutations: Certain genetic mutations can increase the risk.

Environmental toxins: Exposure to environmental toxins, such as tobacco smoke, during pregnancy can increase the risk.

Age Group

Cleft lip and palate can affect individuals of all ages, but it is typically diagnosed at birth or during early childhood.

Assessment

• History Taking:The SLP gathers information about the child’s medical history, including any surgeries or other interventions related to the cleft, as well as family history of clefts or related conditions.
• Oral Motor Examination: The SLP assesses the structure and function of the oral structures, including the lips, tongue, teeth, and palate, to determine any limitations in movement or function that might affect speech.
• Speech Assessment: The SLP evaluates the child’s speech sounds, articulation, intelligibility, and resonance, looking for signs of velopharyngeal dysfunction (VPD) or other speech problems.
• Language Assessment: The SLP assesses the child’s language skills, including receptive and expressive language, to identify any language delays or difficulties that might accompany the cleft.
• Feeding Assessment:The SLP may also assess the child’s feeding skills, as cleft lip and palate can sometimes affect feeding abilities.
• Listen for audible or turbulent nasal air emission: The SLP listens for excessive or abnormal airflow through the nose during speech.
• Cul-de-sac test: The SLP pinches the nostrils while the child produces speech sounds to assess velopharyngeal function.
• Instrumental Procedures:

1. Videofluoroscopy: This X-ray procedure shows the movement of the soft palate and other structures during speech, helping to identify velopharyngeal dysfunction.
2. Video-naso-endoscopy: A small camera is placed in the nose to visualize the back of the soft palate and throat during speech.
3. Nasometer: This instrument measures the amount of air coming out of the nose compared to the amount of air coming out of the mouth during speech.

Management

Although cleft lip palate is often addressed with surgery and dental and orthodontic care, the Speech-sy’s team supports any additional feeding, speech, or hearing problems.

• SLPs work with people on feeding and swallowing skills.
• Babies with a cleft lip probably won’t have trouble feeding, but babies with a cleft palate might.
• Babies with a cleft palate may have trouble breastfeeding, and they may need special bottles or nipples if they bottle-feed. SLPs can help you find the best bottle-and-nipple combination.
• SLPs also work with people on speech problems. Cleft lip may not create any speech problems, but a person with cleft palate may need help learning to speak more clearly.
• Audiologists manage hearing and balance problems. The audiologist will work with the physician to make sure that hearing loss is identified and addressed, if needed. Audiologists may help you to use amplification (like hearing aids) or other hearing technology.

 Outcomes

• Improved Speech Production
• Reduced Compensatory Articulations
• Enhanced Speech Intelligibility
• Improved Velopharyngeal Function
• Increased Confidence and Self-Esteem
• Improved Communication Skills