Child with Abnormal Speech and Cleft Palate

Why Does My Child with Cleft Palate Need Speech Therapy?
Children with cleft lip and palate commonly need speech therapy. Speech production requires coordination of the tongue, hard and soft palate. This coordination is achieved by the movement of the muscles within the tongue and soft palate. Children with cleft palate have an abnormal insertion and movement of the muscles within the soft palate. They may also have poor coordination of the tongue movements and its placement. This results in an abnormal speech requiring speech therapy.

When Does Speech Therapy Commence for My Child?
Your child will have a formal assessment of his/her speech and hearing during his/her initial visit with the Cleft and Craniofacial Team or through direct arrangement with a speech therapist. During each of his/her subsequent visits, regular evaluations will be performed. If your child demonstrates abnormal speech, he/she will receive speech therapy either through Sooner Start or through your child’s school. The speech pathologist on the Team will coordinate the speech therapy.

What is Velopharyngeal Incompetence?
A child with an intact soft palate has a sling of muscles in the soft palate which help close the soft palate while making sounds commencing with p,b,t,s and other consonants. The closure prevents escape of air and enables a child to pronounce these sounds correctly. In a child with a cleft of the palate, the sling of muscles in the soft palate is incomplete. This sling of muscles is repaired during closure of the palate. In spite of the repair of the sling, a small percentage of children with a repaired cleft palate continue to have escape of air with certain consonants.

How Is Velopharyngeal Incompetence Diagnosed?
While your child is in speech therapy your speech pathologist will notice escape of air during your child’s speech. A more detailed evaluation will follow during your child’s Team visit. If an air leak is detected, either a videofluoroscopy or nasoendoscopy will be performed.

What Is a Videofluoroscopy?
This is an X ray technique utilized to view the movement of the soft palate while your child is speaking. This X ray examination allows the speech pathologist and the plastic surgeon to view the movement of the soft palate and determine whether air is escaping behind the soft palate.

What Is a Nasoendoscopy?
This procedure involves passing an extremely thin flexible tube through your child’s nose and looking at the soft palate while your child is speaking.

What Happens Next?
Once a diagnosis of velopharyngeal incompetence is confirmed every attempt will be made by the speech pathologist to improve the quality of speech (articulation) prior to any surgical intervention. Surgical intervention involves an operation. The pharyngeal flap, sphincter pharyngoplasty and palatal lengthening procedures are procedures which can help this problem to reduce the air leak behind the repaired soft palate, thereby improving the speech.

What Is a Submucous Cleft Palate?
A submucous cleft is a mild variety of incomplete cleft palate. In a submucous cleft palate the mucosal seam in the soft palate appears intact. However the muscles forming the sling in the soft palate may be abnormal. This may manifest itself as velopharyngeal incompetence with air escaping behind the soft palate. If the speech is abnormal your child may need speech therapy and evaluation for velopharyngeal incompetence.