The pattern of palatal rugae in submucous cleft palates and isolated cleft palates

The early diagnosis of submucous cleft palate is important. In children too young to tolerate nasendoscopy and videofluoroscopy the diagnosis depends on the clinical history and intraoral examination. We have studied the pattern of the hard palate rugae to investigate their possible diagnostic significance. Maxillary dental casts were obtained from 16 patients with submucous cleft palate, 17 patients with isolated clefts of the secondary palate, and 10 non-cleft controls. The hard palate mucosa had a unique feature in 14 (87.5%) of the submucous cleft palates: one or more of the palate rugae curved towards the region of the bony notch in the posterior border of the hard palate. The 2 cases without this rugae pattern did not have a detectable bony notch. In 100% of the isolated cleft palate cases, one or more of the rugae curved towards the anterior end of the cleft. This feature was not seen in any of the non-cleft controls. We consider this rugae pattern to be an additional diagnostic feature of submucous cleft palate.