Congenital submucous cleft palate is often undetected on routine physical examination since it occurs beneath the surface of a normal mucosal covering. Often, a submucous cleft palate is associated with a bifid (cleft) uvula.
The anatomy of the submucous cleft is variable and includes partial or complete midline cleft of the soft palate musculature concealed by normal mucosa. Bony defects of the hard palate, also concealed by mucosa, vary from subtle notching at the midline of the posterior border of the hard palate to more extensive bony involvement extending further along the midline.
Submucous cleft palate is frequently asymptomatic, and the patient and clinician are not aware of its presence. Clinical symptoms, seen during early language development, present as hypernasal speech. Consultation with a speech pathologist should be considered.
[The removal of adenoids in a patient with normal speech and a bifid uvula should be approached with caution. An undiagnosed submucous cleft palate could be present. Adenoid tissue allows the anatomically compromised soft palate to close off the nasopharynx. Removing adenoids, however, may interrupt closure which would allow air to escape through the nose during speech and produce hypernasal speech.]