ABSTRACT
The need for an interdisciplinary approach in the comprehensive management of individuals
with cleft lip and palate is well recognized. This article provides an introduction
to communication disorders in individuals with cleft lip and palate for members of
cleft care teams. The speech pathologist is involved in identifying those infants
who are at risk for communication disorders and also for initiating early intervention
to prevent or mitigate communication disorders caused by the cleft. Even with early
cleft repair, some children exhibit ‘cleft palate speech’ characterized by atypical
consonant productions, abnormal nasal resonance, abnormal nasal airflow, altered laryngeal
voice quality, and nasal or facial grimaces. These manifestations are evaluated to
identify those that (a) are developmental, (b) can be corrected through speech therapy
alone, and, (c) those that may require both surgery and speech therapy. Speech is
evaluated perceptually using several types of stimuli. It is important to identify
compensatory and obligatory errors in articulation. When velopharyngeal dysfunction
is suspected, the assessment should include at least one direct measure such as nasoendoscopy
or videofluoroscopy. This provides information about the adequacy of the velopharyngeal
valve for speech production, and is useful for planning further management of velopharyngeal
dysfunction. The basic principle of speech therapy in cleft lip and palate is to establish
the correct placement of the articulators and appropriate air flow. Appropriate feedback
is important during therapy for establishing the correct patterns of speech.
KEY WORDS
Articulation - Cleft lip and palate - Communication disorder - Resonance - Velopharyngeal
dysfunction
