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Advice for parents / guardians of children with an unrepaired submucous cleft palate (SMCP)

Patient information A-Z

This leaflet is for parents/guardians of babies / children who may have signs of a submucous cleft, or a confirmed submucous cleft palate which has not been repaired.

What this leaflet contains

  • An explanation of the palate's role in speech
  • An explanation of submucous cleft palate
  • Signs of palate dysfunction
  • What to do if you are concerned
  • Useful links

What is the palate's role in speech?

The palate is the roof of the mouth and is made up of 2 parts: the hard bony part at the front, and the soft, muscular part at the back. The function of the palate is to separate the nose from the mouth during talking and eating.

When we speak and swallow, the palate lifts and stretches to close the nose off from the mouth, as shown below:

Diagram of child showing the palate resting and palate lifted
Palate resting and palate lifted

Most speech sounds are oral (made through the mouth), e.g. ‘p, b, t, d, k, g, f, v, s, z, sh, ch, j’. These sounds all need the palate to lift and close, so that air does not leak inappropriately through the nose as we talk.

What is a submucous cleft palate (SMCP)?

In a structurally normal palate, the muscles which lift the palate run from side to side. An SMCP is where the palate may look normal, but the muscles run from front to back, rather than side to side. This may affect how well the palate can lift and close against the back wall of the throat. When the palate is not able to close against the back wall of the throat, this is known as velopharyngeal dysfunction (VPD).

A SMCP is not always easy to see, but some of the signs may include:

  • A double uvula (the ‘dangly’ flap of soft tissue that hangs down at the back of the throat may appear ‘split’ or in 2 parts)
  • A translucent line running through the middle of the palate
  • A v-shaped notch at the back of the hard palate (usually only detected by a clinician feeling inside the roof of the mouth)

Signs of Velopharyngeal Dysfunction (VPD)

When there are difficulties in the palate lifting and closing against the back wall of the throat, this is known as VPD.

Signs of VPD may include one or more of the following:

  • Hypernasal speech (too much air in the nose during speech, resulting in a nasal tone)
  • Audible escape of air through the nose during speech, either as a ‘puff’ of air (emission) or ‘rumbling’ sound (turbulence)
  • Weak production of oral speech sounds
  • A lack of oral sounds in speech
  • Oral sounds replaced with nasal sounds (e.g. “daddy” becomes “nanny” or “baby” becomes “may-me”)
  • Food or liquids leaking through the nose when eating or drinking

What should I do if I am concerned about VPD?

Not all children with SMCP have VPD. However, if you notice any of the signs of VPD listed above, please contact the cleft speech and language therapy team on 01223 596272.

In some cases, signs of VPD may only become apparent as your child grows. If you notice any changes in your child’s speech that cause you concern as your child gets older, please contact us.

VPD is not a cause of language delay. If you are concerned regarding how many words your child is attempting (rather than how clearly the words are being produced), please contact your community speech and language therapy service for further advice. The website I CAN's Talking Point (opens in a new tab) is also a useful resource for tips and ideas to help support language development.

Contacts / further information

Speech and Language Therapy Team
Box 46
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge Biomedical Campus
Hills Road
Cambridge CB2 0QQ

Tel: 01223 596272 (option 3)

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Contact us

Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge

Telephone +44 (0)1223 245151