A prospective evaluation of the prevalence of submucous cleft palate in patients with isolated cleft lip versus controls

Although there is an established relationship between cleft lip and overt c left palate, the relationship between isolated cleft lip and submucous clef t palate has not been investigated. To test the hypothesis that patients wi th isolated cleft lip have a greater association with submucous cleft palat e, a double-armed prospective trial was designed. A study group of 25 conse cutive children presenting with an isolated cleft lip, with or without exte nsion through the alveolus but not involving the secondary palate, was comp ared with a control group of 25 children with no known facial clefts. Eligi ble patients were examined for the presence of physical criteria associated with classic submucous cleft palate, namely, (1) bifid uvula, (2) absence of the posterior nasal spine, and (3) zona pellucida. Nasoendoscopy was sub sequently performed just after induction of general anesthesia, and the fin dings were correlated with digital palpation of the palatal muscles. Patien ts who did not satisfy all three physical criteria and in whom nasoendoscop y was distinctly abnormal relative to the control group were classified as having occult submucous cleft palate. Classic submucous cleft palate was fo und in three study group patients (12 percent), all of whom had flattening or a midline depression of the posterior palate and musculus uvulae on naso endoscopy and palpable diastasis of the palatal muscles under general anest hesia. An additional six study group patients (24 percent) had similar naso endoscopic criteria and palpable diastasis of the palatal muscles; they wer e classified as having occult submucous cleft palate. No submucous cleft pa late was identified in the control group. Seventeen patients in the study g roup had an alveolar cleft with a 53 percent (9 of 17) prevalence of submuc ous cleft palate. In the present study, classic submucous cleft palate in a ssociation with isolated cleft lip was 150 to 600 times the reported preval ence in the general population. All children with an isolated cleft lip sho uld undergo peroral examination and speech/resonance assessment no later th an the age of 3 years. Any child with an isolated cleft lip with velopharyn geal inadequacy or before an adenoidectomy should be assessed by flexible n asal endoscopy to avoid missing an occult submucous cleft palate.