Diagnosis of submucosal cleft palate by an otorhinolaryngologist

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Abstract

BACKGROUND: A hidden or submucosal cleft palate is a rare form of isolated clefts characterized by damage to the speech-producing structures of the articulatory apparatus with intact mucous membrane of the palate. Patients with submucosal cleft palate require special attention from an otorhinolaryngologist because this anatomical malformation leads to middle ear damage and significantly affects the hearing and quality of life of patients.

AIM: To determine additional diagnostic criteria for submucosal cleft palate and identify CT markers of submucosal cleft palate, to assess its impact on the function of the middle ear.

MATERIALS AND METHODS: The study included 16 patients with submucosal cleft palate who underwent examination and treatment at the Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan.

RESULTS: Their median age at diagnosis was 6.5 (range, 3–13) years, and 62.5% of the cases were first suspected by an ear–nose–throat specialist. During the initial examination, a significant decrease in hearing was already noted in 14 (87.5%) patients, otitis media with effusion in the mucosal stage in 21.9%, adhesive otitis media in 21.9%, and chronic otitis with cholesteatoma in 18.8%. Frequent purulent otitis media were observed in the anamnesis in 56.3% of patients (n = 9), and frequent rhinosinusitis in 87.5% (n = 14). Non-partial adenotomy was performed at the place of residence in 5 patients (31.3%), which aggravated rhinolalia. In 62.5% (n = 10) submucosal cleft palate was compensated and rhinolalia was not observed. Three CT markers of submucosal cleft palate were revealed: a wedge-shaped defect in 3D skull reconstruction, a defect of the palatine bone and a shortened vomer in the coronal projection, and displacement of the posterior nasal spine in the sagittal projection.

CONCLUSIONS: Cases of submucosal cleft palate demonstrate the need for ear–nose–throat specialist and pediatricians to know this pathology in order to conduct timely and correct comprehensive rehabilitation of patients.

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About the authors

Irina G. Andreeva

Children’s Republican Clinical Hospital

Author for correspondence.
Email: arisha.andreeva2008@mail.ru
ORCID iD: 0000-0001-9669-2707

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Pavel V. Tokarev

Children’s Republican Clinical Hospital

Email: facesurg@yandex.ru
ORCID iD: 0000-0003-2439-5492

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Damir I. Marapov

Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education

Email: damirov@list.ru
ORCID iD: 0000-0003-2583-0599

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Nikita A. Andreev

Chain of Dental Clinics “Dens”

Email: nikitosandreyev1990@gmail.com
ORCID iD: 0000-0002-1071-0896
Russian Federation, Kazan

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2. Fig. 1. Wedge-shaped defect of the hard palate on a three-dimensional computed tomography reconstructed image of the skull

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3. Fig. 2. Defect of the hard palate and shortening of the vomer in the coronal projection on computed tomography

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4. Fig. 3. Displacement of the posterior nasal spine and posterior ends of the inferior nasal conchae protruding into the lumen of the nasopharynx in the sagittal projection on RCT

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