Based on International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), overall prevalence of cleft lip and/or palate are 9.92 per 10, 000 birth between years 2000 till 2005.

The characteristics of the individual with cleft

The individual with cleft can be identified by two ways:-

1. The lip and /or palatal structural

   The abnormality is more noticeable when the patient has yet to undergo any surgery. Upon reconstructive surgery on the lip and/ or palate, scars would be visible.

   • Types of cleft 
     • • Cleft lip
       • Cleft lip and/or palate

     Clefts could be resulted from the following syndromes:- Van der Woude syndrome Goldenhar syndrome Treacher Collins syndrome Moebius syndrome Crouzon syndrome, Apert syndrome. Down syndrome Velocardiofacial syndrome Pierre Robin sequence Turner syndrome Ectrodectyly, ectodermal dysplasia,cleft lip/palate syndrome (EEC) Orofacialdigital syndrome

2. Speech

• • Hypernasal speech

    There are two types of speech sound based on the nasality via oral and nasal.

    Oral sounds: -all vowels. All consonants except “m”,n, “ny” dan “ng”

    Nasal sounds: The sounds of “m”, n,“ny” dan “ng”

    For individuals with cleft lip and palate, the speech would more likely to sound like speech. Hypernasal is an excessive air emission while producing the speech.

  • Velopharyngeal insufficiency (VPI)

    Upon the completion of the surgery, the individual with cleft needs to undergo speech and language therapy in order to differentiate the oro-nasal sounds. The VPI might occur after the repair or post-surgery. VPI occurs when the soft palate is not functioning sufficiently to close the space between oral and nasal region. Therefore, the hypernasal is still noticeable.

Who is involved in the management of cleft?

The management of cleft are made right from birth age until teenager. The professionals who are involved in cleft management are:-

The role of Speech-Language Therapist

The management of individual with cleft lip and/or palate should be started from birth and it involves multidisciplinary team. The role of Speech-Language Therapist is to manage speech and language, including assessments and therapeutic procedures.

The assessment contains:-

• Feeding and swallowing assessment
• Oro-motor examination
• Pre-verbal skills assessment
• Language skills assessment
• Resonance

Generally, the therapeutic procedure depends on the structural condition of the cleft.

• For the individual with cleft lip only
  • To improve the lips seal for feeding
  • To improve the labial sounds i.e, “p”, “b” and “m”

• For individual with cleft lip and palate
  • To improve the sucking ability while bottle feeding. Special bottle is used (for newborn baby).
  • To differentiate oro-nasal sounds (using certain techniques and instrument).

The therapeutic procedure should include receptive and expressive language training (if necessary) if the individual with cleft is diagnosed with one of syndrome problems.

The surgery to repair the cleft is very important. The sooner it is done the better since it will affect the progress of speech and language therapy in the future. If the treatment is delayed, a speech – language therapist will not be able to proceed with any structural problems indeed.

The cleft management team should involve the parents throughout the cleft management process. The parents could also participate in the therapeutic session of speech-language therapy and conduct the home-based programme at home. CLAPAM is one of the non-government organisations where parents could join and be part of the program.

References

1. www.clapam.org.com
2. www.asha.org
3. http://www.slideshare.net/BilinguisticsInc/success-with-speech-sound-disorders-071111-slideshare
4. Cleft Palate Craniofac J. 2011 Jan;48(1):66-81. doi: 10.1597/09-217. Epub 2010 Apr 6. Prevalence at birth of cleft lip with or without cleft palate: data from the International Perinatal Database of Typical Oral Clefts (IPDTOC) : http://www.ncbi.nlm.nih.gov/pubmed/20507242
5. http://www.transformingfaces.org/
6. Revista Brasileira de Epidemiologia, version ISSN 1415-790X Rev. bras. epidemiol. vol.14 no.1 São Paulo Mar. 2011:
   http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2011000100014
7. http://www.slideshare.net/khairunnisamohammad1/kery-dygsheyr
8. http://www.seattlechildrens.org/medical-conditions/chromosomal-genetic-conditions/vpi/
9. www.handsofmercy.ph.org