The clinical features of cleft palate are due to an open hole between the nasal cavity and the oral cavity.

• During speech, there is entry of air into the nasal cavity which leads to a nasal quality in the voice. There are also other speech problems such as distorted speech.
• There are also problems in feeding. This causes marked problem in infants who require a proper suction mechanism in order to feed.
• Patients of cleft palate may also have breathing problems due to the open communication between the oral and nasal cavities.
• Cleft palate can also lead to difficulty in hearing. The tensor veli palatini is unable to open the Eustachian tube which will lead to an increased secretion of fluid in the middle ear. Infections such as otitis media are more common in these infants .
• Hearing problems in early life may also later lead to difficulty in articulation. This occurs due to inability of the children to mimic language due to defective hearing. Due to velopharyngeal inadequacy, there is an inability to produce some particular sounds that are required for normal speech.
• A marked increase is seen in the occurrence of psychological problems such as anxiety, depression, internalization, social withdrawal and aggressive behaviors in these patients later in life.

A prenatal fetal anomaly scan can lead to early diagnosis of cleft palate. After birth, the diagnosis can be easily made clinically. No investigations are necessary.

A specialized craniofacial team is needed to treat this condition. There are different treatment modalities according to the type and severity of cleft palate. If child has undergone surgery early in life, it will lead to improved hearing. If we wait for the eruption of permanent teeth before correcting the defect surgically, a lesser number of corrective surgeries will be needed later in life.

Cleft palate can be treated by the use of a prosthetic device which can fill the gap in the palate. It can also be treated by the insertion of pins in fourth or fifth month of life. With each passing day, the parents have to tighten the screw so that both the bones can come closer. If the gap is involving the maxilla, a piece of bone can be taken from a rib or the hip of the patient for transplantation.

In order to avoid speech and hearing problems, the patient should be treated as early as possible. Grommets or tympanostomy tubes can be used to aerate the middle ear [9] [10]. After surgical repair, the problem of speech is usually corrected.

Cleft palate results from the following etiologies.

• Genetic factors and familial factors [2] [3] [4]

• Environmental factors
• Maternal epilepsy [5] [6]
• Gestational diabetes
• Use of steroids, diazepam and phenytoin during pregnancy [7]
• Pierre Robin Sequence is the most common syndrome. In this syndrome, the patients have isolated cleft palate, posteriorly displaced tongue and posteriorly placed jaw [8].

Cleft palate occurs due to the inability of the palatine processes to meet during development. In incomplete cleft palate, the defect usually involves the soft palate and hard palate is attached to vomer and nasal septum. In incomplete cleft palate, there is usually a disruption in the insertion of muscle fibers. If hard palate is not attached to the nasal septum or vomer, it is referred to as complete cleft palate and both the hard and soft palates are involved. There is a primary palate in front of alveolar foramen and a secondary palate behind it.

Cleft palate can occur in either U form or V form. V form is more common in isolated cases of cleft palate whereas U form is more common in Pierre Robin Sequence.

In submucous palate, there is split uvula, a ridge in soft palate and a notch at the back of the hard palate. It can occur in association with cleft lip in which there is a gap in the lip.

Cleft palate is a developmental defect in the formation of the palate. It can involve both the soft palate and the hard palate. When both the palates are involved simultaneously, the condition is known as complete cleft palate [1].

Usually maternal, genetic and family factors play an important role. Air from the mouth escapes into the nose which leads to velopharyngeal inadequacy. Patients usually present with abnormalities in feeding, hearing and speaking. Later on in life, the incidence of psychiatric symptoms such as aggressive behaviour and depression increases. Surgical correction is treatment of choice.

Patients of cleft palate are usually infants and present with feeding problem. On examination there is a hole in the palate. With passage of time patient develops hearing, speech problems and psychiatric symptoms. Surgical repair is the choice of treatment.

Early surgical treatment leads to improved hearing and speech. Prosthetic devices, pins and in severe form, bone from other sites of body may be used to fill the hole.