A cleft lip and or a cleft palate (also sometimes called a hair lip) can cause severe speech difficulties because the apparatus to articulate many speech sounds is compromised. A cleft may be tiny (just a small hole in the palate), or large, creating an opening from the lip across the hard and soft palate. A cleft lip and palate can be unilateral or bilateral (on both sides).

Cleft lip and palate

A cleft lip and/or palate usually forms before birth. It is a separation of either, or all of the lip, hard and soft palate. Sometimes it will be minor such as a small hole in the hard palate or a small gap in the lip, but at the other extreme it can be opening at the lip all the way along the hard and soft palate, exposing the nasal cavity.

There are believed to be a number of causes. There is often a genetic link, but exposure to certain drugs, alcohol, solvents, cigarettes etc during pregnancy have all been linked with the development of cleft lip and palate.

Despite the severity of some cleft palates, modern surgery and repair can be very successful at rejoining the lip and palate, often with minimal scarring. Surgery is often carried out on the child within a few months of birth. A team approach is essential for a positive outcome and will involve a number of professionals including a surgeon, orthodontist and speech and language therapist/pathologist. Treatment will also involve speech therapy. Support services around psychosocial issues should also be involved because of the very visual nature of this disorder.

Velopharyngeal insufficiency

This occurs when the soft palate is not long or big enough to close off the nasal cavity. When this occurs, air escapes into the nasal cavity during speech causing speech articulation difficulties and speech to be very nasal (hypernasality). Velopharyngeal insufficiency is often associated with a cleft palate, but may be an abnormality of its own. Operations to lengthen the soft palate can be successful, but in less severe cases speech therapy may be sufficient.