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

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.