Cleft lip and palate​ overview

Key points

  • Children with cleft palate, and/or velopharyngeal dysfunction (VPD) are at risk of; articulatory problems, abnormal hypernasal resonance, hearing problems which impact on intelligibility and acceptability of speech
  • Impaired communication may have an adverse effect on literacy, social skills, peer relationships, self-confidence and behaviour
  • Perceptual assessment and investigation of speech disorders associated with cleft palate and VPD require highly specialist skills and investigations available within regional cleft centres

What is cleft lip and palate?

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The term cleft refers to a gap in the lip or palate where the muscles have not come together properly when the baby is developing in the womb. There are different types of clefts which affect speech:

  • Unilateral cleft lip and palate (UCLP)
  • Bilateral cleft lip and palate (BCLP)
  • Isolated cleft palate (CP)

In addition, submucous cleft palate (SMCP) occurs when the muscles in the palate have not joined together properly. However sometimes this can be missed as it is difficult to spot in a baby.

Although cases of cleft lip and palate are diagnosed at birth, it is possible to diagnose before birth during the 20 week scan. Isolated cleft palate is harder to identify but should be diagnosed within 24 hours of birth. However some cases are missed and diagnosed late which have serious implications for attachment, feeding, growth and speech and language development, as well as parental anxiety. For information on how to reduce the risk of cases being missed please see the factsheet in the Resources tab.

There is also a group of patients with velopharyngeal dysfunction (VPD), usually identified in later childhood once a child has begun speaking/talking, known as non-cleft VPD.

It is important to note that VPD can be due to mislearning and may not be a structural problem at all. In all cases, a referral should be made to the specialist speech and language therapist at the nearest regional cleft centre.

Cleft lip and palate not only affects speech, but also language development, academic attainment and feeding.

Once cleft lip and palate have been diagnosed, and if surgery is needed, then it is operated on when baby is between 6 and 12 months. However not all cleft lip and palate require surgery. Feeding support, monitoring hearing and speech and language therapy are also main treatment methods.

Role of speech and language therapy for cleft lip and palate

Speech and language therapists (SLTs) are integral to the decisions regarding management, be it surgery, prosthetics or speech therapy treatment, with the objective of normal speech. Speech therapy management and intervention extends from infancy to adulthood, tailored to the needs of the individual, and shared as appropriate with parents, local SLTs and social and education authorities. Early referral to specialist speech and language therapy is instrumental as early intervention has been shown to prevent later speech problems (Scherer, Hardin-Jones and Calladine).

Specialist team therapists have a duty to undertake regular audit of speech outcomes in order to feed back to the surgeon and the team information on surgical protocols so that unsuccessful surgical practices may be addressed, and to report individual outcomes following speech related surgical, prosthetic or therapy interventions (Shaw et al, 1996).

The impact of speech and language therapy for those in cleft palate and related disorders has been significant. Improvements have been recorded in speech outcomes since the centralisation and specialisation of cleft palate services. (Sell D. et all)

Resources

For more videos visit the RCSLT YouTube channel.

Related topic areas

There are many syndromic diagnoses associated with cleft palate and velopharyngeal speech disorders (include footnotes here), with more chromosomal abnormalities discovered every year. The following are the most common:

Key organisations

References

Calladine, S. and Vance, M. (2019). A psycholinguistic approach to therapy with very young children born with cleft palate. In Harding-Bell, A. (Ed.) op. cit.

Hardin-Jones, M. and Chapman, K. (2019) Early intervention for infants and young children with cleft palate. In Harding-Bell, A. (Ed.) op. cit.

Scherer, N. J. et al. (2008). Early Intervention for Speech Impairment in Children with Cleft Palate. The Cleft Palate-Craniofacial Journal, 45(1), 18–31.

Sell, D. et al. (2015). The Cleft Care UK study. Part 4: perceptual speech outcomes, Orthodontics and craniofacial research

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