title: Age of diagnosis and evaluation of consequences of submucous cleft palate.
abstract: OBJECTIVE
  To evaluate the frequency of submucous cleft palate (SMCP) in a group of children with clefts. The reason for suspecting submucous cleft, age of diagnosis, effect of age on speech development, problems in speech, hearing and swallowing were compared with previous literature.
  
  
  METHODS
  Retrospective chart review: Out of 33 patients with SMCP, registered by the Groninger cleft team over approximately 20 years (1990 until July 2012), 28 non-syndromic patients with a proven diagnosis of SMCP were included: 17 males and 11 females. Speech and hearing were examined and the number of patients with SMCP and age at time of diagnosis were evaluated. The percentages of problems in resonance, articulation and hearing, present at time of diagnosis, were compared with the percentages of problems found after surgery.
  
  
  RESULTS
  Out of 800 patients with clefts, 28 patients (3,5%) were diagnosed with SMCP at a mean age of 3;9 years. All patients presented one or more symptomatic complaints at time of diagnosis: hypernasality (65%), problems in articulation (46%), conductive hearing loss (39%) and/or swallowing problems (32%). A bifid uvula was found in 92%. Following surgery, hypernasal speech and swallowing problems were no longer observed. The articulation problems remained after surgery. Age of diagnosis seems no predictor of articulation problems. An improvement in hearing was observed but normal hearing was not achieved. Pharyngoplasty appeared to be a successful and save treatment of hypernasality.
  
  
  CONCLUSIONS
  SMCP is a rare cleft palate which is, despite the presence of a bifid uvula and symptoms of velopharyngeal insufficiency, often diagnosed late. In children with a bifid uvula and mild problems in speech, hearing and swallowing, it is important to be alert to SMCP because SMCP may account for these persistent mild complaints. Therefore, early detecting of SMCP can yield profits.
authors: Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, The Netherlands. e.ten.dam@umcg.nl
authors: E
authors: E
authors: ten Dam
authors: P
authors: P
authors: van der Heijden
authors: A G W
authors: AG
authors: Korsten-Meijer
authors: S M
authors: SM
authors: Goorhuis-Brouwer
authors: B F A M
authors: BF
authors: van der Laan
mesh_terms: D000367:Age Factors; D001184:Articulation Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002675:Child, Preschool; D002972:Cleft Palate / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D042241:Early Diagnosis; D005260:Female; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis / Q000453:epidemiology*