Lift your tongue, touch the roof of the mouth!
What did you feel?
The roof of the oral cavity also called the
palate. The front has the hard palate, and sliding the tongue a little back leads
to the soft palate.
What is the main purpose of the palate?
The palate separates the oral cavity and the nasal cavity. This protects the food from going into the nasal cavity while swallowing. What if there is a defect in the palate?
When there is a defect, it is called the cleft palate, which occurs when there is a midline palatal defect or incomplete fusion of the palate with the nasal septum.
A 25-year-old man presented to the ENT clinic with a childhood history of nasal
voice and regurgitation of food into the nasal cavity. The patient had no other
complaints, nor was there a history of ear infections, delayed growth, or
delayed milestones.
On examination, there were no craniofacial abnormalities. Examination of the oral cavity, a bifid uvula, was seen with a submucosal midline hard palate defect, consistent with a submucosal cleft palate. No notching of the hard palate was felt on palpation.
Incomplete velopharyngeal valvular closure was seen on nasopharyngoscopy.
The patient was referred for speech and language therapy because he refused surgical correction of the defect.
Submucosal cleft palate is a congenital midline defect of the palate due to incomplete fusion of the hard palate with the nasal septum and midline deficiency/absence of the palatal muscles of the soft palate.
A cleft palate can lead to problems such as rhinolalia (nasal voice), recurrent ear infections, and speech difficulties. However, some individuals may have no problem at all or only rhinolalia.
The most common reason for treating is nasal speech. Asymptomatic patients need not to be treated.
Reconstructive surgery under general anesthesia is the definitive treatment. If surgery is refused by the patient or not possible, then referral for language and speech therapy, antibiotics, and/or surgical insertion of tympanostomy tubes for recurrent ear infections, and special feeding techniques are the management options.
References:
Omar Bargas, M. (2020, May 28). Submucosal Cleft Palate. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1913924
