Clinical and diagnostic aspects of submucous cleft palate in the practice of the otorhinolaryngologist and maxillofacial surgeon

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Abstract

Background: Submucous cleft palate is an uncommon type of isolated clefts. Its diagnosis is not challenging: a triangular pit due to bone loss along the midline of the hard palate; a translucent mucosal duplication region in the midline soft palate, causing its muscle impairment, nasalizatio, and a bifid uvula. In case of the compensated submucous cleft palate and unclear clinical signs, diagnosis is challenging.

Aim: To determine clinical signs (markers) of X-ray computed tomography and magnetic resonance imaging for the diagnosis of submucous cleft palate.

Methods: A retrospective analysis of 21 medical records of patients with submucous cleft palate was conducted in 2019–2024. All patients underwent conservative and surgical treatment under the compulsory health insurance plan. All patients underwent X-ray computed tomography or magnetic resonance imaging.

Results: Magnetic resonance imaging showed a linear hypointense structure along the midline due to the intermittent levator muscles of the soft palate. X-ray computed tomography identified three typical markers of submucous cleft palate, including a triangular palate defect on a 3D reconstructed image of the skull; a palate defect in the frontal view and a shortened vomer; anterior displacement of the posterior nasal spine and a large nasopharyngeal space in the sagittal view. Patients seek medical help for upper airways infections from an otolaryngologist much earlier. Our study showed significant differences in the age of diagnosis of the submucous cleft palate by otorhinolaryngologists and other medical professionals (p = 0.015).

Conclusion: Otorhinolaryngologist can detect manifestations and effects of submucous cleft palate and suspect the defect much earlier than other medical professionals. A promising path in identifying submucous cleft palate is to use radiologic imaging methods in routine practice. Timely detection of the submucous cleft palate will allow earlier rehabilitation to improve the quality of life and speech.

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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
SPIN-code: 4233-6217

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Damir I. Marapov

Kazan State Medical Academy

Email: damirov@list.ru
ORCID iD: 0000-0003-2583-0599
SPIN-code: 5926-0451

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
SPIN-code: 2760-7606

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Andrey N. Rudyk

Kazan State Medical Academy

Email: anruonco@gmail.com
ORCID iD: 0000-0002-7309-9043
SPIN-code: 6578-8613

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Elena V. Urakova

Kazan State Medical Academy

Email: anvu@rambler.ru
ORCID iD: 0000-0003-1140-6412
SPIN-code: 3629-0860

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

Roza Yu. Ilyina

Kazan State Medical Academy

Email: ilroza@yandex.ru
ORCID iD: 0000-0001-8534-1282
SPIN-code: 5820-1789

MD, Cand. Sci. (Medicine)

Russian Federation, Kazan

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2. Fig. 1. Triangular defect of the hard palate in a 3D reconstructed image of the skull using X-ray computed tomography (arrow).

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3. Fig. 2. Defect of the hard palate (arrow) and short vomer in the coronal view in an X-ray computed tomography image.

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4. Fig. 3. Anterior displacement of the posterior nasal spine, short vomer and posterior ends of the inferior nasal turbinates protruding into the lumen of the nasopharynx (arrow) in the sagittal view in an X-ray computed tomography image.

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5. Fig. 4. Hypointense linear structure along the midline of the palate (arrow) in T2 view in a magnetic resonance image.

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