The classical signs of a submucous cleft are that the uvula (the dangly bit at the back of the soft palate) is split, there is a bony gap at the back of the hard palate and the midline of the soft palate may look very thin - translucent. However, not all have these classical signs.

 Submucous clefts may not be recognised at birth. If not they may be diagnosed at a later age because:

  • There may be feeding difficulties in infancy
  • Speech development may be delayed and speech nasal
  • Hearing may be affected and the diagnosis made by an ENT surgeon
  • Sometimes after adenoidectomy which may be done to improve hearing. The adenoids on the back of the throat camouflage the fact that the palate is not functioning normally and the speech becomes nasal when they are removed.
  • Sometimes they are discovered as an incidental finding. Not all submucous palates cause problems with speech or feeding.

The diagnosis can be confirmed by investigations such as lateral videofluoroscopy and nasendoscopy. If surgery is indicated, this usually involves an operation to correct the muscles of the soft palate. Sometimes a second operation is needed if the first is not completely successful.