Submucous cleft palate (SMCP)

Submucous cleft palate (SMCP) is a subgroup of cleft palate.The triad of SMCP includes (1) bifid uvula, (2) translucent zone in soft palate and (3) bony notch in the posterior edge of the hard palate.A submucosal cleft palate (SMCP) results from a lack of normal fusion of the muscles within the soft palate as the baby is developing in utero. It occurs in about 1 in 1,200 children. There is no single cause of SMCP; however, current research suggests a combination of genetic and environmental factors. The most common syndrome (genetic disorder) associated with SMCP is 22q11.2 deletion syndrome.

Some patients with SMCP will have speech problems with velopharyngeal insufficiency (VPI) or articulation errors and some have middle ear effusion. Children with cleft lip or cleft palate may also have trouble speaking and their voice may take on a nasal sound, and the speech may be difficult to understand. Frequent middle ear infections, nasal speech, and early feeding difficulties may be the first indicators that a child has a submucosal cleft palate.

All newborns undergo an examination of the mouth at birth, but it is not uncommon for the diagnosis of SMCP to be missed. In some cases, an infant may struggle with feeding or display leakage of breastmilk or formula through the nose.In other cases, feeding may progress without difficulty, but the child may develop chronic ear infections and effusions (fluid in the middle ear space), often requiring placement of ventilation tubes. Finally, a SMCP may be identified when a child’s speech is noted to have a nasal quality (hypernasality), either occurring on its own or following adenoidectomy. Regardless of when or how the diagnosis is made, it is important for all patients with a confirmed or suspected SMCP to be referred to a Cleft Lip and Palate Center or Velopharyngeal Dysfunction (VPD) Program for interdisciplinary team evaluation. The team typically includes a speech-language pathologist with specialized training in cleft palate and VPD and a surgeon with expertise in cleft palate and VPD surgery. Additional team members may also assess the child, such as a dentist, otolaryngologist, psychologist, geneticist or audiologist, based on the child’s specific needs.


If the children have the presence of VPI or recurrent otitis media surgical treatment is indicated. There are controversies on the timing and type of surgical intervention. The type of surgery should be decided according to the findings from the instrumental assessment.

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