Submucous Cleft Palate

What is a submucous cleft palate?

A submucous cleft palate (SMCP) is a type of cleft palate. Your palate is the roof of your mouth. A cleft refers to a separation (or opening) in the palate. Your palate consists of the hard palate (the bony front portion of the roof of your mouth) or the soft palate (the soft back portion of the roof of your mouth). Someone with a submucous cleft palate has a cleft under their mucous membrane, which is the tissue that covers your soft palate. It happens when the soft palate muscles don’t fuse together properly during fetal development.

Not everyone experiences symptoms of a submucous cleft palate, but it does make your child more at risk for speech problems, ear infections and difficulty feeding as an infant.

How common is a submucous cleft palate?

A submucous cleft palate is rare and affects about .08% of children at birth. However, the rate might be higher because some people don’t have noticeable symptoms.

How do I know if my child has a submucous cleft palate?

It may be hard to notice a submucous cleft palate because it’s under the tissue on the roof of your child’s mouth. You may notice your baby has feeding problems, gets frequent ear infections or has speech problems. Let your child’s pediatrician know about any issues you notice so they can take a closer look.

What are the signs of a submucous cleft palate?

Some of the most common signs and symptoms in a child with a submucous cleft palate are:

• Feeding problems in infancy, like taking a long time to finish a bottle or nurse, or milk and formula coming out their nose.
• Frequent ear infections.
• Trouble making or pronouncing certain sounds.
• Nasally sounding speech.
• Air coming out of your child’s nose when they talk.

If a pediatrician looks in your child’s mouth, they may see:

• A split in their uvula (bifid uvula). This is the small ball that dangles at the back of the throat.
• A blue or gray tint to the tissue down the middle of their soft palate (zona pellucida).
• A V-shaped notch in their hard palate.

Nasally sounding speech and air coming out of their nose are signs of velopharyngeal dysfunction. It happens because the soft palate doesn’t close during speech. This lets air and sound escape through the nose. Not everyone with a submucous cleft palate has velopharyngeal dysfunction, but it’s the most common effect on speech.

What causes a submucous cleft palate?

Several factors can cause a submucous cleft palate. Genetics (inherited from your biological parents) and environmental factors are the two most common. Environmental factors involve exposing your child to something while they were still in the womb (uterus).

How is a submucous cleft palate diagnosed?

Your child’s pediatrician will first perform an oral exam. If they suspect a submucous cleft palate, they may refer your child to a speech therapist, otolaryngologist (or ear, nose and throat specialist), surgeon or other provider specializing in cleft palates. Submucous cleft palates are harder to diagnose because they’re harder to see and might not be causing severe symptoms.

These providers will work together to evaluate the extent of the issue and determine what treatment is best.

Other tests to help diagnose submucous cleft palate are:

• Nasopharyngoscopy: A procedure that involves inserting a scope through your child’s nose to see the back of their throat and palate. Some clefts are only visible this way.
• Videofluoroscopy: A way for providers to see how the palate moves using an X-ray.

How do doctors fix a submucous cleft palate?

It depends on what types of issues it’s creating for your child. Some children have speech problems and ear infections, while others have no symptoms at all.

If there are no symptoms and no speech problems, treatment isn’t necessary. However, if kids show signs of velopharyngeal dysfunction (nasally speech and air coming from their nose), they’ll need surgery to fix their soft palate. The most common surgical treatment for a submucous cleft is palatoplasty. To repair a cleft palate, your child’s surgeon reconstructs their palate to close the opening.

In most cases, your child needs speech therapy to help them learn to say certain sounds correctly. Sometimes, surgery alone can fix a submucous cleft palate and no speech therapy is needed. Your child may also get tubes in their ears to help prevent chronic ear infections, improve their hearing and help with speech development.

Studies show that adenoidectomy (removing adenoids) should be avoided in children with a submucous cleft palate. This procedure could cause more speech problems or lead to velopharyngeal issues.

Will my child need surgery for submucous cleft palate?

Your child may not need surgery to repair a submucous cleft palate. If there are no speech problems, surgery usually isn’t needed. Instead, their healthcare providers may monitor them for several years to ensure no problems arise.

Will my child need speech therapy?

Yes, in most cases your child will need speech therapy. A speech pathologist will evaluate your child and determine what speech problems are from a submucous cleft palate. Some speech problems are physical and can be corrected with surgery. Other issues are learned habits that require speech therapy to “unlearn” those habits.

Can submucous cleft palate be prevented?

Cleft palates are a congenital (born with) disorder and unpreventable. As there may be an environmental factor involved, people who are pregnant can reduce their risk of having a child with a submucous cleft palate by avoiding certain medications, drugs, alcohol and other toxins during pregnancy.

What questions should I ask my child’s doctor?

If your child is diagnosed with a submucous cleft palate, it’s normal to have questions for their healthcare provider. Some common questions to ask include:

• What caused this?
• Will my child need surgery?
• Will my child need speech therapy?
• Is this affecting my child’s hearing?
• How long will treatment take?
• Is there anything I can do to help my child at home?

A note from Cleveland Clinic

If your child has speech problems, frequent ear infections or had difficulty breast or bottle feeding as an infant, they may have a submucous cleft palate. It’s often hard to spot but can cause symptoms in some children. Talk to your child’s pediatrician and ask them to evaluate your child’s mouth and throat. In most cases, speech therapy or surgery can completely fix a submucous cleft palate.