Treatment Approach for Oral Palate Malformations

Diagnosis and Initial Assessment

Diagnosis of cleft palate is strictly clinical and does not require radiographic imaging for initial identification, as recommended by the American College of Radiology 1, 2
At diagnosis, patients should undergo a comprehensive palatal examination and speech/language assessment by cleft/craniofacial specialists, according to the American Academy of Pediatrics 3, 4
CT examination is only indicated for treatment planning purposes, not for routine diagnosis, as stated by the American College of Radiology 1, 2
Speech/language assessments should begin at 6-18 months of age and continue routinely thereafter, as recommended by the American Speech-Language-Hearing Association 5, 3

Overt palatal clefts are typically repaired around age 1 year, as recommended by the American Cleft Palate-Craniofacial Association 5, 3

Submucous cleft palate (SMCP) or velopharyngeal dysfunction (VPD) should be assessed jointly with speech-language pathologists, according to the American Speech-Language-Hearing Association 5, 3
Evaluation with velopharyngeal imaging (nasendoscopy/videofluoroscopy) is recommended when VPD is clinically suspected and once adequate speech is present, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 3, 4
Surgical treatment of VPD can lead to significant improvements in intelligibility and quality of life, as reported by the American Cleft Palate-Craniofacial Association 3
Post-surgical monitoring for obstructive sleep apnea is important as it may develop after VPD-related palatal surgery, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3

Many children require intensive speech-language therapy throughout childhood, as recommended by the American Speech-Language-Hearing Association 5, 3
Progress may be slow because of cognitive/learning and behavioral differences, particularly in children with associated syndromes, as stated by the American Academy of Pediatrics 3
Early implementation of augmentative communication (e.g., sign language) is recommended to promote language use and help avoid frustration, according to the American Speech-Language-Hearing Association 3

Children with cleft palate should be managed by a multidisciplinary cleft palate team, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6
Continued monitoring for otitis media with effusion (OME) and hearing loss should continue throughout childhood, including after palate repair, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 6, 7
Tympanostomy tube insertion may be performed in children with cleft palate who have OME that is likely to persist, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6, 7
Children with syndromes (e.g., 22q11.2 deletion syndrome) often have additional factors affecting speech development and require more intensive monitoring, as reported by the American Academy of Pediatrics 5, 3

Failure to identify and address associated conditions like otitis media can lead to hearing loss and further speech development issues, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 6, 7
Inadequate speech therapy follow-up can result in persistent speech disorders despite successful surgical repair, as reported by the American Speech-Language-Hearing Association 3
Failure to monitor for potential complications like obstructive sleep apnea after palatal surgery, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3

The American College of Medical Genetics and Genomics recommends that children with 22q11.2 deletion syndrome, Pierre Robin sequence, Stickler syndrome, and Treacher Collins syndrome be evaluated for cleft palate and associated velopharyngeal dysfunction 8
Children with 22q11.2 deletion syndrome often have submucous cleft palate and are at risk for velopharyngeal dysfunction 8

Submucous cleft palate may present with bifid uvula, which is a split or bifurcation of the uvula 8