The greatest of attention should be taken of all children’s teeth but this is especially
important in the case of a cleft lip and palate child. It is the role of the orthodontist on
the cleft team responsible for your child to monitor the growth and assist the development
of his/her teeth. The first teeth and later the permanent teeth are very important for the
success of the orthodontist’s work.
The aim of orthodontic treatment is, where possible, to align all the teeth and close all
residual spaces without the use of bridges or dentures.
Speech and/or language problems in children with cleft palate are usually associated with:
1. deficits in hearing,
2. wrong patterns of tongue movement,
3. problems of palate function, or
4. a combination of these factors.
The resulting problems are ones of language development, articulation and nasality.
Children with a cleft palate tend to use the back of their tongue too much. This results in many sounds being made far back in the mouth. With a cleft palate the normal closing action of the soft palate does not take place, resulting in air escaping into the nasal passages causing nasal sounding speech.
First contact with a speech and language therapist should be as early as 6 months of age if your child is experiencing feeding difficulties. You may even find that contact with the speech and language therapist begins earlier than this. This seems the practice favored by cleft teams in their overall care approach. The therapist can learn much at the early stages from listening to your child’s babbling pattern and observing his or her interaction with you. The therapist can also advise you on important aspects of speech and language development. Once in the system regular reviews can occur to ensure everything is developing along normal lines.
If your child is experiencing difficulties with their speech, a detailed assessment will determine a course of action, which may consist of:
1. a course of speech therapy
2. a course in therapy and an appliance in the mouth (SEE Electropalatography below),
3. corrective surgery followed by therapy, or
4. a combination of the above.
A small percentage of children present with significant speech problems despite ongoing therapy and require specialized assessment of palatal movement during speech. Two special investigations are available:
1.Videofluoroscopy involves the use of continuous x-ray during speech, assessing the movement of the palate while the child is producing speech samples. The study is recorded on videotape. In order to see the palate, a liquid material called barium is put through the nose either with a syringe or via a small tube that is put into the nose.
2.Nasendoscopy involves inserting a small scope (nasendoscope) into the child’s nose to observe palatal movement during speech.
Information from these specialized assessments can help decide on future management for speech.
The majority of children with cleft lip and palate who have initial speech problems will grow up to have normal speech if they are attended to at the appropriate time and have all the necessary speech therapy and surgical and orthodontic treatment. Approximately 10% of children with cleft palates will have nasal sounding speech which will require surgical intercession. This procedure, called a pharyngoplasty, involves a small operation to the muscles at the back of the throat, and is usually carried out between the ages of 3 to 5 years.
Electropalatography (EPG) is a technique used for recording and analysing the contact of the tongue with the hard palate during continuous speech. A central component of EPG is an artificial plate which is moulded to fit against the individual’s hard palate. The plate must be custom-made for each individual. This plate consists of electrodes, and when the tongue comes into contact with the plate, signals are conducted to a processing unit and displayed on a computer screen. The plate is constructed from a plaster cast taken of the roof of the individual’s mouth.
EPG has been found to be useful in correcting speech disorders by identifying spatial distortions which should not occur in normal speech. It therefore facilitates the speech and language therapist in the assessment of speech disorders and the individual in helping them to modify abnormal lingual gestures.
Related Post: Speech and Language Therapy Services – A crisis in Need of Resolution. Position Paper, May 2002.