These children also have hypernasal speech and cannot form fricatives. Six muscles function to close the velopharyngeal port. The palatopharyngeus, palatoglossus, levator veli palatini, tensor veli palatini, and musculus uvulae make up the muscular palate. In the cleft palate patient incomplete fusion occurs at the palatal aponeurosis preventing the union of the muscular mass required for secondary palatal formation and function. The goals of cleft palate repair are to ensure an acceptable aesthetic result, allow satisfactory facial growth, and, most importantly, to allow for as near-normal speech production as possible.
Diagnosis relies primarily on the ear of a well-trained speech pathologist.
Cine radiography and nasal endoscopy have supplanted acoustic and nasal emission techniques as the primary adjunctive assessment measures. Lateral, basal, frontal and Towne view videofluoroscopy with supplemental barium injected into the nasal ports provide dynamic assessment of velopharyngeal function. The Towne view is the most useful of the four projections. Nasal endoscopy allows the physician to directly visualize velopharyngeal function in the dynamic state. The seventy-degree Hopkins rod is the gold standard for visualization but is poorly tolerated in children less than 10 years old.