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Sunday, August 22, 2010

Back to School Screenings and Evaluations-Part 3: Submucosal Clefts

Good Morning! I hope you are well caffeinated and ready to start another week with enthusiasm.

Todayʼs entry is predominately for the “mature” SLP who has been out of school for a while. This little nugget of information has to do with submucosal clefts. In my 35 years, I can only recall having one sub-mucosal cleft on my case load, which happened in the later part of my career, at least 25 years after I had completed my education. So did I recall what to look for or what was significant when staring into that childʼs mouth? No, of course not, and letʼs be honest here, neither would you. I can remember looking and not seeing anything remarkably unusual, but fully expecting to see his entire palate missing from the way he sounded. He sounded like he had a full fledged cleft of the palate, but everything “looked ok” not what I had seen from the few cleft cases I had seen in the past. I was stumped, so I called upon a very dear university professor, who gave a day of his life to drive the 6 hour trip to my school to help me with this child. Not only did he help me, but he also instructed me so that if I ever encountered it again I would know what to do. So please allow me to share with you the simple little things I learned and/or refresh your memory if youʼve been out of school for a few years.

There are 3 clinical signs of a submucosal cleft.
1.A bifid uvula. The uvula will be split, but does not have to be split all the way. It can sometimes be divided slightly or might even just be dimpled.
2. V-notch. With a gloved hand you can run your finger down the midline of the palate and just where the soft and hard palate meet you will feel an inverted “V” This is where the palatal shelves did not completely come together.
3.Zona pellucidum. You will see a blue line running anterior to posterior down the mid-line of the palate.

NOTE: You do NOT have to have all 3 signs to have a cleft. If you come across any of these, on a child who sounds very nasal, Iʼd refer just to “rule out” a possible submucosal cleft. The child I have been talking about did not have a blue line and only a slight divide on his uvula. He did, however, have a V-notch but I didnʼt know to check for that.

Also, in my career I only had the opportunity to work with 3 children who had clefts of the lip and palate, so deciding what I should do with them usually involved much time refreshing and researching the topic. So if you are facing a similar situation and canʼt recall what you are to do with them, this website would be a good starting place.
This link provides you with a succinct outline of your role as an SLP on the cleft team, as well as what you are to do at every age from birth to adult. The site is a little gold nugget in and of itself.

I hope this helps you should you find yourself faced with a similar situation this year. If not perhaps you can keep this as a quick reference guide.

Next week, will be a very quick refresher on S/Z ratios. Have fun with your kids this week and Iʼll see you next Monday!

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