Cleft palate is a congenital defect characterized by an opening in the palate (roof of the mouth) due to incomplete fusion of the palatal shelves during embryonic development. It can involve the hard palate, soft palate, or both, leaving a passage between the oral and nasal cavities. Cleft palate may occur with a cleft lip or in isolation; together, cleft lip and palate are among the most common birth anomalies. The spectrum of cleft palate is broad: it ranges from a complete cleft (from the gum line through the uvula) to submucous cleft palate (an underdevelopment of palatal muscles hidden by intact mucosa).
A cleft palate leads to significant functional problems because the palate is critical for sucking, swallowing, and speaking. Infants with cleft palate cannot generate normal suction, and later, children with unrepaired clefts cannot separate the oral and nasal cavities during speech, resulting in hypernasal resonance and air escape. Cleft palate is a structural communicative disorder that profoundly affects feeding and speech development.
Unrepaired cleft palate has significant clinical ramifications for feeding, speech, hearing, and dental health. Immediately, infants with a cleft palate struggle with feeding and swallowing: they cannot generate negative pressure for breastfeeding or bottle feeding, leading to poor nutrition and risk of aspiration. Parents often require guidance and specialized bottles to ensure adequate intake. As the child grows, the most notable issue is speech impairment.
A cleft palate causes velopharyngeal insufficiency (VPI) – an inability to close off the nasal cavity during speech – resulting in hypernasal voice quality and nasal air escape. Children with unrepaired or inadequately repaired palates often have a characteristic “cleft palate speech”: hypernasal resonance, audible nasal emissions, and weak production of pressure consonants (like p, t, k, s). To compensate, they may develop maladaptive articulation patterns (e.g., glottal stops, pharyngeal fricatives) that further reduce intelligibility. Even after surgical repair, about 15–30% of children have residual VPI requiring further management.
Hearing loss is another concern – the cleft in the palate can dysfunction the Eustachian tube opening, leading to chronic otitis media with effusion and conductive hearing loss in many children. This hearing issue can exacerbate speech-language delays if not managed (typically with tympanostomy tubes). Additionally, cleft palate can affect dental development: teeth adjacent to the cleft may be missing or malformed, and malocclusion is common due to maxillary growth disturbances. Psychosocially, children with cleft palate (especially if coupled with noticeable speech differences) may experience reduced self-esteem or social difficulties. In fact, untreated cleft palate and its speech disorders have been linked to reduced academic performance and fewer social opportunities in adulthood, underlining the importance of early and comprehensive intervention.
Management of cleft palate is coordinated by an interdisciplinary cleft palate team and spans from infancy through adolescence. Surgical repair of the palate (palatoplasty) is typically performed at around 9–12 months of age, before significant speech development, to create an intact palate for normal speech and feeding. The goal of surgery is to close the defect and reconstruct the palatal muscles to achieve velopharyngeal competence. After primary palatoplasty, speech development is closely monitored.
Many children will require speech therapy to correct compensatory articulation errors and optimize velopharyngeal function. Approximately half of children with repaired cleft palate need speech therapy as they learn to use their “new” palate structures. Therapy focuses on helping the child produce oral pressure sounds correctly and eliminate maladaptive patterns. The speech-language pathologist uses techniques to establish proper articulatory placement and airflow – the fundamental principle is to train correct oral articulation placements (e.g., getting the tongue or lips in the right position) and direct airflow through the mouth rather than the nose. Strategies include tactile and visual feedback (e.g. using airflow indicators or nasometry) so the child learns to reduce nasal resonance and emissions. If significant VPI persists despite therapy, the team may consider secondary surgery (such as a pharyngeal flap or sphincter pharyngoplasty) or a temporary prosthetic obturator to improve velopharyngeal closure.
Early intervention and coordinated care are critical, as early palate repair and speech therapy before school age yield the best speech outcomes and psychosocial adjustment. Treating cleft palate requires a long-term, staged approach addressing the structural repair, speech habilitation, hearing management, dentofacial orthopedics, and psychological well-being of the child.
Schaffrath, K., Ooms, M., Seidel, S., et al. "An evaluation of speech therapy care in the surrounding area of an interdisciplinary cleft lip and palate tertiary care center." Scientific Reports, 15, 5841. (2025).
Subramaniyan, B., & Nagarajan, R. "Communication disorders in individuals with cleft lip and palate: An overview." Indian Journal of Plastic Surgery, 43(S1), (2010).
Kummer, A. W. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance (3rd ed.). Delmar Cengage Learning. (2014).
