Communication Disorders Related to Cleft Palate, Craniofacial Anomalies, and Velopharyngeal Dysfunction

Cleft lip and/or palate (CL/P) is a congenital anomaly caused by abnormal facial and/or palatal fusion in the first trimester of gestation. CL/P can occur as an isolated condition, or it may be just one component of many malformations in an inherited syndrome. In fact, cleft palate is listed as a feature of over 200 recognized syndromes. Overall, it is estimated that 1 in every 700 to 750 children born in the United States each year is affected with a cleft of the lip and/or palate. In fact, clefts of the lip or palate are among the most common of all birth defects.

A cleft lip, even though repaired, has an impact on the physical appearance of the face, which is the first impression that others have of us. Our face represents who we are, even on paper. (For example, my driver's license includes a picture of my face for identification— not my foot!) In addition, cleft lip and particularly cleft palate have the potential to significantly affect the ability to communication effectively with others.

Cleft lip and cleft palate can affect the development of communication skills in several ways. Dental and occlusal anomalies secondary to the cleft can impair articulation placement for anterior speech sounds. In addition, children with cleft palate are at risk for eustachian tube malfunction, which can result in conductive hearing loss and cause a delay in speech and language development. Most significantly, however, is the risk for velopharyngeal insufficiency (VPI) if the child was born with cleft palate (or even submucous cleft). In fact, ~30% of children born with cleft palate will demonstrate VPI, despite the palate repair.

Although the cause of clefts is understood to a point, current medical technology is not advanced enough to prevent the occurrence of these birth defects. Fortunately, most of the physical stigmata and communication problems associated with CL/P can be improved or remediated through early treatment by skilled professionals. Because the needs for remediation are complex and require multiple professionals, management of children with clefts and other craniofacial anomalies is best done through a specialty team that includes at least a surgeon, a dental professional, and a speech-language pathologist (SLP). The American Cleft Palate–Craniofacial Association has developed parameters of care, which outline the professionals who should be involved in cleft care and the recommended sequence of treatment for best outcomes.[1]

SLPs are usually involved in the care of a child born with a cleft because of the risk for early feeding problems and later communication problems. In fact, it should be kept in mind that the primary reason for surgically correcting the palate is first for speech and to a lesser degree for feeding. Unfortunately, specific course work in cleft palate is no longer required as part of the curriculum in many universities that confer degrees in communication sciences and disorders. Therefore, many SLPs have not had formal training in CL/P and are therefore unprepared when encountering clients with speech disorders secondary to cleft palate or VPI.

The goal of this issue of Seminars in Speech and Language is to provide the SLP practitioner, and even students, with a basic overview of CL/P and the management of individuals who are affected by a cleft. For the interested reader, we have provided many references and resources for further information and study.

We thank you for your interest as you read through these articles. Speaking on behalf of all of the authors, if our work in this issue can help at least one person make a difference in the life of just one child, our efforts will be worthwhile!

REFERENCES

• 1 American Cleft Palate–Craniofacial Association.  Available at: http://www.acpa-cpf.org/teamcare/parameters00rev.pdf Accessed April 5, 2011;