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Cleft lip and palate & its impact on speech

Speaking is a specialized skill that requires interaction of many systems like lungs, brain, ear and other parts of the mouth. Mouth (oral cavity) consists of lips and palate which are very important for speaking. Due to the defective fusion of muscular structures of lips and palate, cleft lip and palate may be seen since birth. According to a recent survey in India, approximately 1 in 650 children are born with cleft lip and palate. In an estimate, yearly 35,000 children are born with cleft lip and palate in India.

What is cleft lip and palate?

            Due to the failure of fusion of muscular structures and defective muscle bundles of lip and palate, an opening or cleft will be seen on the lips and palate. This opening or cleft is called as Cleft Lip and Palate. The opening or cleft may be limited to right or left side of the lips or may be even seen medially. In general, cleft lip and palate is said to co-exist.  The size and location of the cleft varies in lip and palate. In lip, the cleft may be seen on either left, right side or medially, and is always seen on the upper lip. The cleft on the palate may be seen from the alveolar region (behind the teeth) to the soft palate.

The opening or cleft may be seen partially or there might be a complete cleft of the lip. In case of a complete cleft of lip, it might even extend up to nasal floor. If there is a partial cleft noticed, then it might just appear as an opening just above the lips.

The cleft palate may also be seen to the right or left side or even sometimes seen medially. The cleft palate may sometimes be restricted to hard palate or soft palate. Sometimes when the cleft is severe, it might even extend till the alveolus. In rare conditions, the cleft may begin with the lips and may extend up to eyes (facial cleft).

What are the causes of cleft lip and palate?

            There are no specific causes of cleft lip and palate. There are many reasons that would have caused cleft lip and palate. The physical and mental disturbances that take place during the first three months of pregnancy may be one among the factors that might result in cleft lip and palate formation. The first trimester of pregnancy is very crucial for the development of facial structures. Along with the development of lip and palate, the other facial structures such as ears and nose also develop.

There are mainly four processes that are responsible for the development of facial structures. The fronto-nasal process helps in the development of forehead and eyes, the lateral-nasal process helps in the formation of nose, the fusion of fronto-nasal, lateral-nasal, and medial-nasal processes helps in the formation of forehead, eyebrows, eyes, ears, cheeks, upper lip and nose. When the mandibulary-nasal process also combines with the fusion of other three processes, the formation of lip and facial structures gets completed. Therefore, the fusion of these four processes is very vital for the formation of lips, palate and the face.

The formation of face takes place outside and inside simultaneously. When the outer structures (nose, eyes and lips) are developing, the structure inside the mouth such as palate and tongue also develops. The parts of the palatal structures are separate during the fourth week of pregnancy, and the tongue is held between the palates. After six weeks of pregnancy, as the neck extends downwards, the jaw will drop down which leads to the tongue to rest on the lower jaw. When the tongue descends down, the part of the palate (two halves of the palate) joins together.

During this stage, due to lack of tissues or any obstruction to the fusion of the tissues, might lead to the development of formation of cleft lip and palate. This phenomenon will occur before 12 weeks, i.e., 3 months of pregnancy.

The cause of cleft lip and palate has not been specifically identified. But researchers have identified many factors that might have contributed to the formation of cleft lip and palate development. The factors are listed below:

  • Late pregnancies in women (conception after 35 years)
  • The physical and mental disturbance in pregnant women during first three months of pregnancy
  • Lack of vitamin A and folic acid during pregnancy
  • Excessive smoking and alcohol consumption by pregnant women
  • German measles and small pox in pregnant women
  • Genetic inheritance
  • Environmental insults
  • Radiation exposure

What are the associated problems seen in children with cleft lip and palate?

Feeding Problems:

Like all babies, most infants with cleft are born ready to eat by mouth. But the infant might have some problems to suck the milk because of cleft of the lip and palate. The closure of both the lips is required to suck the milk. Due to the size and place of the baby’s cleft, he/she may not have enough strength to draw or to suck milk from the breast or bottle. Children with cleft lip and palate may be unable to stay latched to the breast. Sucking of milk requires the closure of upper and lower lips and after sucking, the milk has to go inside the mouth and then to food pipe.  Babies with clefts tend to tire quickly, because they use more energy trying to suck milk. When children with cleft lip and palate are fed, the food / milk usually come out of the nose (nasal regurgitation).

Effect of Cleft Lip and Palate on Speech and Language

Speech is the most important aspect in an individual’s life. The presence of cleft lip and palate will certainly have adverse effects on speech. The lips and palate are very important for the production of certain speech sounds. The air from the lungs will be directed via vocal tract to the mouth, and with the help of lips and tongue, the air gets modified as different speech sounds. Lips are responsible for producing some speech sounds like /p/, /pʱ/, /b/, /bʱ/, /k/, /t/. Due to the presence of the cleft; the child will have difficulty to close the lips and difficulty to occlude the air which is required for the production of these sounds.

 The soft palate has a very crucial role in speech production. It serves as a differentiating factor to discriminate oral sound and nasal sound. When the soft palate is at rest, it allows the airstream to get directed to the nasal cavity and aids in the production of nasal consonants like m, n, ŋ. For the production of oral consonants, the soft palate has to get tensed and raised so as to contact the pharyngeal wall and this in turn will direct the air stream entirely into the oral cavity which will help the production of oral sounds such as k, g, t̪, d̪, etc.…. But due to a cleft of soft palate region or some structural or functional problem, the soft palate will not move posteriorly (back) and contact the pharyngeal wall, in such cases, the air escapes to the nasal cavity and the speech will perceived as Hypernasal (the speech will sound as though it is coming from nose instead of mouth).

The soft palate helps in the production of oral sounds like /k/, /g/, /kʱ/, /gʱ/, etc. But if there is a cleft in the palate, the airstream that is directed to the oral cavity from the lungs gets leaked through nose, thus speech loses its naturalness and be heard as nasal. This is the main cause of the pronunciation problem. This eventually affects speech intelligibility (speech clarity). When the child’s speech in unintelligible, it will be difficult for others to understand the speech.

Most of the time, even after the surgery of cleft palate, the speech problems are seen. The movement of the soft palate may not improve even after the surgery. The muscles of the soft palate are not able to move due to the scar on the palate. Because of this, the airstream from the lungs might escape through nose and the speech will have nasal quality and the speech clarity is also poor.

The cleft lip and palate may lead to delayed development of speech and language skills. Typically, meaningful speech and language development will be observed in children after one year. The environment of the child has to be apt for the child to acquire speech and language skills. When a child is born with cleft lip and palate, the parents will be emotionally shattered. The care and affection shown to the child may also be compromised. The emotional bonding between mother and child might get perturbed. Apart from this, the child has to be frequently hospitalized for surgery and other treatment for cleft lip and palate. This will eventually have an impact on child’s speech and language development. The presence of dental problems, might also contributes for speech and language problems.

Apart from these problems, the child might also have hearing difficulties. There is a close connection between Eustachian tube and palate. Because of the presence of cleft palate, there may be a eustachian tube dysfunction, which results in imbalance of pressure equalization. This might lead to frequent ear infections, ear discharge, foul smell from the ears, etc. If these problems are not treated on time; it might eventually lead to hearing loss. The hearing problem may vary in nature. If there is hearing loss, then some sounds may not be heard to the child, and the child might exhibit misarticulation.

Dental Problems

            The cleft lip and palate might also result in dental problems. Sometimes the cleft might extend up to alveolar ridge, which leads to dental problems among children with cleft lip and palate. The dental alignment may be affected; missing teeth, overbite, underbite, etc. might be noticed among these children. Due to the dental problems, child might also have misarticulation. For ex: if the upper front teeth are missing, then the child might have difficulty in pronouncing “s” sound.

Is Mental Retardation always seen along with cleft lip and palate?

            Children with cleft lip and palate might sometimes be associated with many problems (mental retardation, small mandible, heart diseases, auditory dysfunction, etc.) and exhibit syndromic condition. The syndromic conditions will lead to many physical and mental problems. This will have an impact on child’s overall development. Children with cleft lip and palate often suffer from inferiority complex, timid by nature and lacks self-confidence. Children with cleft lip and palate may lag behind in academic performances also. Mental retardation will result in slow development of speech and language skills. In condition where the mental retardation is seen along with cleft lip and palate, the child has to be examined and treated by a team of professionals.

The cleft lip and palate is a congenital condition, which greatly impacts the speech and language development. The structural condition, which is identified at birth has to be immediately treated to facilitate typical development of speech and language skills. If left untreated at birth, the child might have delayed speech and language development, misarticulation, hypernasality, feeding problems, auditory problems, dental problems and other psychosocial problems. therefore, it is very important to focus on early intervention in children with cleft lip and palate.

ARTICLE BY:

SAHANA MURALIKRISHNA

MVM COLLEGE OF ALLIED HEALTH SCIENCES

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Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

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The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Spirituality

The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Alumni

The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Undergraduate

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally.

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Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally.

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Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally.

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University Life

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Graduation

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Apply for Admission

Fall 2019 applications are now open

We don’t just give students an education and experiences that set them up for success in a career. We help them succeed in their career – to discover a field they’re passionate about and dare to lead it.

About Our University

We are one of the largest, most diverse universities in the USA with over 90,000 students in USA, and a further 30,000 studying across 180 countries for Kingster University.

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Education Services

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized.

Learn More

International Hubs

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized.

Learn More

Bachelor's and Master's

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized.

Learn More

University Life

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized.

Learn More

Video Tour in Kingster

Take a tour in Kingster and you will find the best university in the state. The video will take you to every places in this university.

Benefits
Self Development
Spirituality
Alumni

Why Choose Kingster?

The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Self Development

The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Spirituality

The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Alumni

The Kingster University Alumni Association is excited to announce the arrival of KU Alumni Connect. This is a new community building platform for Kinster’s alumni. It is the only place online where you can find, and connect with, all 90,000 Kingster’s alumni. All alumni are automatically enrolled!

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally. Throughout our great history, Kingster has offered access to a wide range of academic opportunities. As a world leader in higher education, the University has pioneered change in the sector.

Undergraduate

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally.

Graduated & Professional

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally.

Scholarships & Financial AID

Kingster University was established by John Smith in 1920 for the public benefit and it is recognized globally.

Donation helps us

The Campaign for the Kingster University is the largest fundraising campaign in history. With a historic $1 billion goal, the campaign is expanding U of T's global leadership capacity.

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