Cleft lip and palate

What is cleft lip and palate?

Cleft lip and/or palate is the most common congenital abnormality of the craniofacial complex. This group includes individuals born with syndromic and non-syndromic cleft palate (with/without cleft lip) which is confirmed at birth. The term cleft refers to a split or a separation.

There is also a group of patients with velopharyngeal dysfunction (VPD), usually identified in later childhood after the inception of speech, known as non-cleft VPD. Speech is affected by the constant coupling of the oral and nasal pharynx.

• 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

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.

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).