The hard palate is a bony structure, the soft palate is muscular. A split in the muscle or the bone of the palate which still has an intact mucous membrane over it (at the roof of the mouth) is a sub-mucous cleft or submucous cleft palate. Commonly they will be accompanied by a split (bifid) uvula (the little structure that hangs down at the back of the throat), there may also be a notch in the hard palate or a translucent patch of skin. Sub-mucous clefts are easy to miss and are sometimes called the invisible cleft palate.

Sub-mucous clefts are most significant functionally when they occur in the soft palate.

They can affect speech (the muscles of the soft palate are used in speech), causing speech delays and/or difficulty making certain sounds and resulting in nasal tones.

They can cause feeding difficulties (the muscles of the soft palate and the uvula move together to seal off the oral pharynx from the nasal pharynx before swallowing takes places). The child with a sub-mucous cleft may regurgitate milk taken in the mouth out the nose. "Submucuous clefts limit the development of negative pressure suction to the extent that they impair movement of the soft palate and the glossopalatal seal." 1 Since the nose is an open vent, if the cleft prevents the sealing off of the mouth from the nose, suction is impaired. "If the soft palate does not adequately seal against the tongue, oral suction will be interrupted prematurely. The volume of fluid per suck may then be reduced and feeding become inefficient. During sucking a 'click' is often heard as this seal is broken." 1

Coughing, sputtering and aspiration can occur. Irritation of the mucous membranes of the nose would be expected. A poorly controlled soft palate muscle may cause breathing problems ranging from poor air movement, noisy breathing, and an increased risk of apnea with bradycardia.1

All cleft palates, including sub-mucous clefts cause increased incidence of ear infections (the Eustachian tube opening is affected by the muscles of the soft palate).

Breastfeeding is always important but even more so in cases where frequent ear infection and/or chronic aspiration is a risk. If the defect impairs the infant's ability to breastfeed effectively mother should pump to increase her milk supply. An adequate milk supply depends on frequent and effective removal of milk from the breast (supply and demand). If baby can't feed at the breast (either not efficiently enough to be exclusive or not at all) mom should feed her pumped breastmilk by an alternate means. A normal bottle may also cause problems but therapeutic bottles do exist that allow feeding without the baby generating negative suction pressures. They work by the feeder exerting small pulses of positive pressure to move the milk out of the bottle and into the mouth of the baby. Feeding of breastmilk, by what ever means is effective, helps to prevent ear infections despite the continued mechanical defect with the Eustachian tube. This is because breastmilk has anti-infective properties.

Sub-mucous clefts may be surgically repaired. Breastfeeding should be supported by an experienced Lactation Consultant. Speech therapy may be needed. Ear, nose and throat specialists may be needed to manage the potentially frequent ear infections. Parents should find a cleft-palate team if they believe their child has a sub-mucous cleft.

"The removal of adenoids in a patient with normal speech and a bifid uvula should be approached with caution. An undiagnosed submucous cleft palate could be present. Adenoid tissue allows the anatomically compromised soft palate to close off the nasopharynx. Removing adenoids, however, may interrupt closure which would allow air to escape through the nose during speech and produce hypernasal speech." 2

"There are some individuals with a submucous cleft who have no apparent problems. Of importance to all persons with the submucous cleft, and their family, is the knowledge that submucous cleft has the same genetic (hereditary) risk as an obvious cleft of the palate." 3

1 Feeding and Swallowing Disorders in Infancy: Assessment and Management

If you ever do a search for more info on this condition be sure to search multiple spellings and miss spellings. I found information under sub mucus, sub-mucus, submucus as well as sub mucous, sub-mucous, submucous

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