My nephew was born with a cleft palate, so I have a special interest in the treatment of kids with cleft lip and palate or other craniofacial differences. These kids can be some of the cutest you ever meet. In case you doubt, the above picture is photographic evidence.
They can also have some very unique speech difficulties. After a cleft repair, there can be trouble with the “valving” for speech. Essentially, there could be air escaping through the nose, or acoustic energy vibrating in the nasal cavity when it isn’t supposed to be. This could result from “insufficient” anatomy to produce speech, and in that case the condition is referred to as “velopharyngeal insufficiency,” or VPI. For a description of that, check out Seattle Children’s page on VPI. It varies, but VPI is reported in 5 to 20% of children following a palate repair (Sullivan et al 2010), or even as high as 30% (Phua & de Chalain, 2008).
But that’s not the whole story. Kids with cleft palate may also learn some speech habits that persist after the palate closure. These little ones might produce some speech sounds using the part of their tongue that lives in their throat, or could actively direct air out through their nose.
Since I am a speech pathologist, I get to say “Wow, that is cool!” right here. But it can also cause massive difficulty for the child being understood, and it needs to be treated (cool or not). When these “bad habits” form, it’s called “velopharyngeal mislearning,” and no amount of surgery will make it go away. That’s when speech therapy is called for, and that’s also why it is important for kids who had a cleft to be seen by a speech-language pathologist with special training or experience in the diagnosis and treatment of VPI. To an untrained ear, mislearning and insufficiency can be hard to tell apart.
Speech difficulties related to cleft palate call for some slightly unconventional speech therapy, another reason that it’s a good idea to seek a speech-language pathologist with a specialty in this area. We are lucky enough here at BPHT to have not one, but two speech pathologists with experience working with kids in craniofacial centers. This means we have to do rock-paper-scissors each time a new cleft kiddo comes through the door. We tried arm wrestling, but there was a clear size advantage. To close, I will translate: what I am really saying is that we are looking forward to seeing you.
By: Daniel Miller, MS CF-SLP
References
Phua, Y.S. & de Chalain, T. (2008). Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: An audit of 211 children born between 1990 and 2004. Cleft Palate-Craniofacial Journal, 45(2), 172-178.
Sullivan, S.R., Marrinan, E.M., & Mulliken, J.B. (2010). Pharyngeal flap outcomes in nonsyndromic children with repaired cleft palate and velopharyngeal insufficiency. Plastic and Reconstructive Surgery, 125(1), 290-298.
