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Submucous cleft palate in the differential diagnosis of feeding difficulties
A L Moss1, K Jones, R W Pigott
1Department of Reconstructive Plastic Surgery, Frenchay Hospital, Bristol.
Insights
Submucous cleft palate is often overlooked. Early diagnosis in children with feeding issues is crucial, as this condition is linked to middle ear disease, similar to overt cleft palate.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Anomalies
- Speech-Language Pathology
Background:
- Submucous cleft palate (SCP) is a frequently missed diagnosis.
- SCP can present with feeding difficulties and is associated with middle ear disease.
- Understanding referral patterns is key to timely diagnosis.
Purpose of the Study:
- To review patients diagnosed with SCP over a 15-year period.
- To analyze referral patterns based on patient age.
- To highlight the association between SCP, feeding problems, and middle ear disease.
Main Methods:
- Retrospective review of 81 patients with SCP.
- Interviews conducted with 26 of the diagnosed patients.
- Categorization of patients into age-based referral groups.
Main Results:
- Feeding problems were reported in 39 of 81 patients (48%), and 22 of 26 interviewed patients (85%).
- Referral patterns varied by age: pediatricians for <2.5 years, speech therapists for 2.5-10 years.
- SCP patients exhibit a high incidence of middle ear disease, comparable to overt cleft palate.
Conclusions:
- Submucous cleft palate should be considered in the differential diagnosis of pediatric feeding difficulties.
- Early referral to a specialist cleft palate team is recommended for children with suspected SCP.
- Timely diagnosis and management can mitigate associated complications like middle ear disease.
Abstract:
Submucous cleft palate is a missed or forgotten diagnosis. We reviewed 81 patients with submucous cleft palate seen over a 15 year period; 26 of these patients were interviewed. The patients were divided into three main groups according to the referral pattern. Children under 2.5 years were referred by a paediatrician for feeding problems; children aged 2.5-10 were referred mainly by speech therapists; and those over 10 had a varied pattern of referral. Thirty nine of the 81 had problems with feeding, but of the 26 interviewed, 22 had feeding problems. Not all patients with a submucous cleft palate are symptomatic and require active treatment, but children with this condition have the same high incidence of middle ear disease as those with overt cleft palate. We suggest that the diagnosis of submucous cleft palate be included in the differential diagnosis of feeding difficulties, with early referral to a specialist cleft palate team.