A submucous cleft palate (SMCP) happens when the roof of the mouth, or palate,
doesn't form properly when a baby is developing in the womb. This cleft is an opening
underneath the mucous membrane, the tissue that covers the palate.
A typical cleft palate is noticed when a baby is born.
Because the cleft in submucous cleft palate (PAL-it) is under the tissue, it's harder
to see. Sometimes it isn't noticed and causes no problems. In other cases, it is discovered
later and treated.
What Causes Submucous Cleft Palate?
Doctors don't always know why the muscles don't form as they should in the unborn
What Are the Signs & Symptoms of a Submucous Cleft Palate?
Usually, newborns have an oral exam soon after they're born. But a submucous cleft
palate might not be found during this exam. Some are not diagnosed until a baby has
feeding problems or a child is old enough to speak.
Doctors and parents might notice these symptoms in a child with a submucous cleft
trouble feeding as an infant (taking a long time to feed, liquid coming through
the nose, etc.)
infections and effusions (fluid buildup behind the eardrum)
speech sound errors
speech problems that make the child hard to understand
hypernasality ("nasally sounding" speech)
nasal air emissions (hearing air leak out the nose during speech)
Hypernasality and nasal air emissions are signs of velopharyngeal (vee-low-fair-en-JEE-ul)
dysfunction. This happens because the soft palate, the flexible part of the palate
back near the throat, does not close tightly during speech, which lets air and sound
escape through the nose.
An oral exam of a child with a SCMP may show:
a split in the uvula (called a bifid uvula). The uvula (YOO-vyuh-luh) is the small,
bell-shaped bit of flesh hanging at the back of the throat, in the middle of the soft
a bluish tint to the tissue along the soft palate (called zona pellucida)
a notch in the back of the hard palate
How Is Submucous Cleft Palate Diagnosed?
When a submucous cleft palate is found, the doctor will refer the child to a cleft
and craniofacial team for a full evaluation. This team includes:
a speech-language pathologist (or speech therapist), who will listen for hypernasality
and other signs of SMCP
a surgeon, who will do a full oral exam
other care providers who have specialized training in cleft palate
So that the team gets a better picture of the mouth and palate, a child might have
(nay-so-fair-en-GOS-kuh-pee): The doctor inserts a flexible tube called a scope through
the nose to see the back of the throat and how the palate moves during speech.
a videofluoroscopy (vid-ee-oh-flore-AH-skuh-pee): The doctor uses X-rays to see
how the palate moves during speech from a side view.
The results from these exams will help the team create a treatment plan.
How Is Submucous Cleft Palate Treated?
The problems caused by a submucous cleft palate vary from child to child. Some
can have speech problems and many ear infections, while others have no symptoms or
Children with SMCP fall into one of these four categories:
No surgical repair needed, no speech therapy needed.
Surgical repair needed, no speech therapy needed.
No surgical repair needed, speech therapy needed.
Surgical repair needed, speech therapy needed.
An SMCP that doesn't affect a child's speech usually is watched carefully by the
care team to make sure it doesn't cause problems as the child grows.
Kids who have more serious symptoms (like hypernasality or nasal air emissions)
usually will have their palate corrected with surgery.
Children with "cleft palate speech" usually benefit from speech-language
therapy to help correct their speech sound errors. Also, an ear, nose, and throat
(ENT) specialist can treat related ear problems — for instance, doing ear
tube surgery to drain fluid from the middle ear, prevent future ear infections,
and help hearing.
What Else Should I Know?
Doctors are cautious about doing an adenoidectomy
on kids who have a submucous cleft palate. That's because this procedure to remove
the adenoids creates more space between the soft palate and the back of the throat.
That can put kids with an SMCP at risk for velopharyngeal dysfunction.