Cleft lip and palate patients are particularly prone to speech disorders and ear disease, and may have significant airway abnormalities. The otolaryngologist is uniquely qualified to oversee the management of these disorders, and at times is the primary reconstructive surgeon as well. The otolaryngologist performs a complete head and neck examination on new patients in the cleft palate clinic. The head is inspected for symmetry, the auricle and external canal for development and location. A facial analysis is helpful to identify abnormalities of facial symmetry and harmony.
Otologic examination includes pneumatic otoscopy and tuning forks.
Anterior and posterior rhinoscopy will identify clefting, septal abnormalities, intranasal masses, and choanal atresia. Oral cavity examination will identify any cleft, dental arch abnormalities and tongue anomalies such as bifid tongue, macroglossia, glossoptosis, or lingual thyroid. In addition, malocclusion, hemifacial hypertrophy or atrophy, and facial clefting are documented. The upper airway tract is evaluated by assessing the adequacy of phonation, cough, and deglutition, and by auscultating and palpating the neck. Other errors include stop, glides, and nasal semivowels.