What are the different types of cleft palate?

Types of Cleft Palate

Cleft palate is classified into several distinct types based on anatomical involvement, with each type requiring specific management approaches by multidisciplinary teams.

Main Types of Cleft Palate

• Complete Cleft Palate: Involves both the hard and soft palate, creating a complete opening between the oral and nasal cavities 1
• Incomplete Cleft Palate: Affects only a portion of the palate, typically the soft palate and possibly part of the hard palate 1, 2
• Submucous Cleft Palate (SMCP): A less visible form where the palatal muscles are abnormally positioned but the oral mucosa remains intact; often associated with velopharyngeal dysfunction (VPD) 1
• Bifid Uvula: The mildest form of cleft palate, presenting as a split or bifurcation of the uvula 1
• Cleft Palate with Cleft Lip: Combined defect affecting both the palate and lip, which may be unilateral or bilateral 2
• Isolated Cleft Palate: Affects only the palate without lip involvement 3

Clinical Presentation and Diagnosis

• Diagnosis of cleft palate is strictly clinical and does not require radiographic imaging for initial identification 1
• Complete and incomplete clefts are visibly apparent during oral examination 1
• Submucous cleft palate may present with:
  • A bluish line along the midline of the soft palate (zona pellucida)
  • Bifid uvula
  • Notching of the posterior hard palate
  • Speech difficulties including hypernasality 1
• CT examination is only indicated for treatment planning purposes, not for routine diagnosis 1, 2

Associated Conditions and Syndromes

• Cleft palate may occur as an isolated anomaly or as part of a syndrome 4
• Common associated syndromes include:
  • 22q11.2 deletion syndrome (DiGeorge syndrome)
  • Pierre Robin sequence
  • Stickler syndrome
  • Treacher Collins syndrome 5, 4
• Children with 22q11.2 deletion syndrome often have submucous cleft palate and are at risk for velopharyngeal dysfunction 5
• Genetic evaluation is essential when cleft palate is associated with other anomalies or developmental concerns 6

Management Approach

• All patients with cleft palate should be managed by a comprehensive multidisciplinary team 6, 1
• Surgical repair timing:
  • Overt palatal clefts are typically repaired around age 1 year 1
  • Submucous cleft palate may be repaired later if velopharyngeal dysfunction is present 1
• Speech and language assessment should begin at 6-18 months of age and continue routinely thereafter 1
• Hearing assessment is critical as children with cleft palate have high rates of otitis media with effusion 6
• Feeding difficulties are common in infants with cleft palate and may require specialized feeding techniques 6

Common Complications and Considerations

• Velopharyngeal dysfunction may persist even after surgical repair, requiring speech therapy and possibly secondary surgical procedures 1
• Recurrent otitis media with effusion is common and may require tympanostomy tube placement 6, 1
• Speech disorders may include hypernasality, nasal emission, and articulation errors 1
• Post-surgical monitoring for obstructive sleep apnea is important, especially after velopharyngeal dysfunction-related surgeries 1
• Children with associated syndromes often require more intensive monitoring and intervention 1

Importance of Multidisciplinary Care

• Core team members should include plastic surgeons, speech-language pathologists, audiologists, orthodontists, and other specialists 6
• Regular follow-up with the cleft team is essential to monitor healing, speech development, and functional outcomes 6, 2
• Early implementation of augmentative communication may be recommended for children with significant speech difficulties 1