Clinical Information

Did you know?

Cleft lip & palate affect approximately

  • 1:2,000 African Americans;
  • 1:1,000 Caucasians and
  • 1:500 Asians in this country?

In spite of surgical closure of the palate, many children remain unable to create adequate intraoral pressure for typical speech. This is called velopharyngeal insufficiency (VPI) and can usually be eliminated with prosthetic and/or surgical treatment. - Cleft Lip and Palate Critical Elements of Care

The goals of treatment are to:

  • repair the lip, palate, and nose;
  • achieve typical speech, language and hearing;
  • achieve functional dental occlusion and good dental health;
  • optimize psychosocial and developmental outcomes;
  • facilitate ethically sound, family-centered, culturally sensitive care

An Otoacoustic Emissions Screener (OAE) is utilized at our clinic for audiology screenings. This is the same screening given to many newborns at birth in the nursery. It measures the response of the inner ear (cochlea) to a sound presented in the ear canal. If the OAE response is present, we can be assured that hearing is normal or very close to normal. If the response is absent, then further testing is needed to determine whether or not middle ear fluid is present or if there might be a permanent hearing loss.

A tympanogram is a test used to identify middle ear fluid, which is so common in young children with cleft lip and/or palate. If fluid is present, the baby can be referred to the Ear, Nose, and Throat (ENT) doctor for follow up. It is very important to be able to identify the presence of middle ear fluid in these babies, so that they can be scheduled for middle ear ventilation tubes at their first surgery.

A Nasoendoscopy is a test that allows the doctor and speech pathologist to look at the soft palate and the back of the throat as your child speaks. Many children have problems with their speech. A person called a speech pathologist will test your child for speech problems. Sometimes a speech problem is caused by how the soft palate moves or a soft palate that is too short. With these children, the voice will sound very nasal. Sometimes it is because the soft palate and the muscles in the throat do not work together.

A nasoendoscopy may need to be done to see how the soft palate is working. For the test, a small tube is placed in your child's nose when he or she is awake. This tube is about the width of a spaghetti noodle. Children do the best with little talk about the test. Please tell your child that he/she is coming to see the doctor so he/she can look in their throat. A child with too much information may become anxious before they arrive making it hard to do the test. We will explain the procedure to them once we are ready to begin.

Procedure:

For younger children, an ointment or spray will be used to numb the nose and back of the throat. The doctor may decide not to use the nasal spray if he/she thinks the child will do well without it. The spray will feel cold and may burn for a few seconds. The doctor will then place the tube into the nose. The tube is only in the nose for about five minutes.

This lets everyone watch the picture on a television screen. The parent and child will also be able to watch the picture along with the doctor. A VCR is hooked up to the camera tube to record the picture for later use. This picture will tell if the soft palate is working right. If it is not working right, the doctor or the speech pathologist will discuss plans to treat the problem. This may be surgery and/or speech therapy.