A Concealed Problem: Submucous Cleft Palate and Treatment of Related Speech Disturbances

Submucous cleft palate is a specialized subgroup of cleft pathologies, with a worldwide incidence of approximately 1 in 600 live births. Besides the classical triad of bifid uvula, muscle diastasis (zona pellucida) and a notch at the posterior hard palate (defined by Calnan), the anatomical presentation of submucous cleft palate may differ. Unlike overt cleft palate, because of the concealed anatomical appearance, submucous cleft pathologies may be ignored during routine evaluations. For cases with a minor deformity, speech therapy may be initiated as the first-line treatment; however, for cases necessitating surgical treatment, speech therapy must be initiated later. There are various surgical options for the treatment of submucous cleft palate. However, when speech results are taken into consideration, the timing of surgery appears to be much more important than the option selected for surgical treatment. In contrast, we believe that for cases with severe velopharyngeal insufficiency, a pharngeal flap must contribute to surgical treatment as the first-line option.