Submucous Cleft Palate with Bifid Uvula
A
4-year-old boy was referred by his family doctor with concerns over delay in speech development. He had been unable to breastfeed and had difficulty bottlefeeding during infancy. There was also a history of nasal regurgitation and recurrent otitis media. The speech had a characteristic hyper-nasal resonance with nasal air emission and an abnormal speech pattern with compensatory articulations. Examination revealed a bifid uvula, translucency along the midline of the soft palate, and a palpable notch in the posterior margin of the hard palate (Figure). These findings, along with the inability to produce a connected speech sample are pathognomonic for establishing a diagnosis of submucous cleft palate with velopharyngeal insufficiency. The palatal defect was surgically repaired and the velar musculature repositioned. The patient made an uneventful
recovery with a perceptual improvement in speech at first follow-up. Formal speech evaluations will continue to ensure age-appropriate speech development. n Asif Hasan, BDS Medicine University of Glasgow
Andrew Gardner, MRCS Regional Maxillofacial Unit Southern General Hospital
Mark Devlin, FRCSEd Craig Russell, FRCS Royal Hospital for Sick Children Glasgow, Scotland, United Kingdom
Figure. Classic submucous cleft palate with triad of bifid uvula (large arrow), furrow along the midline of the soft palate (arrowheads), and a notch in the posterior margin of the hard palate (small arrow). The midline furrow is sometimes referred to as the zona pellucida reflecting the translucent nature of this area in some patients.
J Pediatr 2014;165:872. 0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.05.034
872
A
4-year-old boy was referred by his family doctor with concerns over delay in speech development. He had been unable to breastfeed and had difficulty bottlefeeding during infancy. There was also a history of nasal regurgitation and recurrent otitis media. The speech had a characteristic hyper-nasal resonance with nasal air emission and an abnormal speech pattern with compensatory articulations. Examination revealed a bifid uvula, translucency along the midline of the soft palate, and a palpable notch in the posterior margin of the hard palate (Figure). These findings, along with the inability to produce a connected speech sample are pathognomonic for establishing a diagnosis of submucous cleft palate with velopharyngeal insufficiency. The palatal defect was surgically repaired and the velar musculature repositioned. The patient made an uneventful
recovery with a perceptual improvement in speech at first follow-up. Formal speech evaluations will continue to ensure age-appropriate speech development. n Asif Hasan, BDS Medicine University of Glasgow
Andrew Gardner, MRCS Regional Maxillofacial Unit Southern General Hospital
Mark Devlin, FRCSEd Craig Russell, FRCS Royal Hospital for Sick Children Glasgow, Scotland, United Kingdom
Figure. Classic submucous cleft palate with triad of bifid uvula (large arrow), furrow along the midline of the soft palate (arrowheads), and a notch in the posterior margin of the hard palate (small arrow). The midline furrow is sometimes referred to as the zona pellucida reflecting the translucent nature of this area in some patients.
J Pediatr 2014;165:872. 0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.05.034
872
