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A 5-year-old girl presented with a suspected palatal abnormality, first observed by her general practitioner during a routine examination at 4 years. She had a history of conductive hearing loss on a background of recurrent otitis media, however her hearing had improved since grommet insertion at 4 years and 8 months. Her middle ear dysfunction was thought to be due to abnormal palatal muscles that also control Eustachian tube drainage. No difficulties with breast feeding or nasal regurgitation were reported. She was referred to a cleft specialist team to be assessed by a cleft surgeon, speech language therapist and ear, nose and throat specialist. On oral examination, she presented with a bifid uvula at rest (figure 1).1 2 An overt submucous cleft palate (SMCP) was confirmed through palpation and inspection of her palate during phonation of ‘ahh’ and ‘ah-haa’, which allowed for visualisation of soft palate elevation. Speech assessment revealed typical resonance (ie, no hypernasality) and no nasal air …
Contributors JOB took the photographs and drafted the manuscript, with support from NK, RPT and ATM. RPT diagnosed the submucous cleft palate.
Funding This work was supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship (1105008) and Centre of Research Excellence (CRE) in Speech and Language (SLANG) (1116976) awarded to ATM and Murdoch Children’s Research Institute Postgraduate Health Research Scholarship awarded to JOB. This work was also supported by the Victorian Government’s Operational Infrastructure Support Programme.
Competing interests None declared.
Patient consent Parental/guardian consent obtained.
Ethics approval Royal Children’s Hospital Melbourne Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.