Editing Cleft lip and cleft palate (section)

===Cleft palate===
Cleft palate is a condition in which the two plates of the [[human skull|skull]] that form the [[hard palate]] (roof of the mouth) are not completely joined. The [[soft palate]] is in these cases cleft as well. In most cases, cleft lip is also present.

Palate cleft can occur as complete (soft and hard palate, possibly including a gap in the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate). When cleft palate occurs, the [[Palatine uvula|uvula]] is usually split. It occurs due to the failure of fusion of the lateral palatine processes, the nasal septum, or the median palatine processes (formation of the [[secondary palate]]).

The hole in the roof of the mouth caused by a cleft connects the mouth directly to the [[nasal cavity|inside of the nose]].

Note: the next images show the roof of the mouth. The top shows the nose, the lips are colored pink. For clarity the images depict a toothless infant.

<gallery class="center" widths="150px" heights="150px">
File:Cleftpalate3.png|Incomplete cleft palate
File:Cleftpalate1.png|Unilateral complete lip and palate
File:Cleftpalate2.png|Bilateral complete lip and palate
</gallery>

A result of an open connection between the [[oral cavity|mouth]] and inside the nose is called [[velopharyngeal insufficiency]] (VPI). Because of the gap, air leaks into the nasal cavity resulting in a [[Hypernasal speech|hypernasal]] voice [[resonance]] and nasal emissions while talking.<ref name="Sloan">{{cite journal | vauthors = Sloan GM | title = Posterior pharyngeal flap and sphincter pharyngoplasty: the state of the art | journal = The Cleft Palate-Craniofacial Journal | volume = 37 | issue = 2 | pages = 112–122 | date = March 2000 | pmid = 10749049 | doi = 10.1597/1545-1569(2000)037<0112:PPFASP>2.3.CO;2 }}</ref> Secondary effects of VPI include speech [[Manner of articulation|articulation]] errors (e.g., [[distortions]], substitutions, and omissions) and compensatory misarticulations and mispronunciations (e.g., [[glottal stop]]s and posterior nasal [[fricative]]s).<ref>{{cite journal |author=Hill JS |title=Velopharyngeal insufficiency: An update on diagnostic and surgical techniques |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |volume=9 |issue=6 |pages=365–8 |year=2001 |doi=10.1097/00020840-200112000-00005 |s2cid=76256148 }}</ref> Possible treatment options include [[speech therapy]], prosthetics, augmentation of the posterior pharyngeal wall, lengthening of the palate, and [[Pharyngeal flap surgery|surgical procedures]].<ref name="Sloan" />

Submucous cleft palate can also occur, which is a cleft of the soft palate with a split [[uvula]], a furrow along the midline of the soft palate, and a notch in the back margin of the hard palate.<ref name="Kaplan">{{cite journal | vauthors = Kaplan EN | title = The occult submucous cleft palate | journal = The Cleft Palate Journal | volume = 12 | pages = 356–368 | date = October 1975 | pmid = 1058746 }}</ref> The diagnosis of submucous cleft palate often occurs late in children as a result of the nature of the cleft.<ref>{{cite journal | vauthors = Hanny KH, de Vries IA, Haverkamp SJ, Oomen KP, Penris WM, Eijkemans MJ, Kon M, Mink van der Molen AB, Breugem CC | title = Late detection of cleft palate | journal = European Journal of Pediatrics | volume = 175 | issue = 1 | pages = 71–80 | date = January 2016 | pmid = 26231683 | pmc = 4709386 | doi = 10.1007/s00431-015-2590-9 }}</ref> While the muscles of the soft palate are not joined, the mucosal membranes covering the roof of the mouth appear relatively normal and intact.<ref>{{cite web |title=Cleft Lip and Palate |url=https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942918&section=Overview |website=American-Speech-Language-Hearing Association |access-date=May 9, 2019}}</ref>