The SATB2 protein plays an important role in the development of the jaw. Low levels of it lead to abnormalities of the palate (roof of the mouth). They occur in 76% of people and include high arched palate, cleft palate (45%), velopharyngeal insufficiency and bifid uvula (3%).
A high arched palate is most common and means a narrow and unusually tall roof of the mouth. In mild cases it doesn’t have to cause problems. In more pronounced forms it may affect feeding, speech and dental alignment (dental crowding and malocclusion).
Cleft palate is present in 45% of newborns. It occurs when the palate doesn’t fuse properly in the midline during fetal development. This can be seen looking into the opened mouth, where it presents as a gap or split in the roof of the mouth. As there is no cleft in the lip or jaw, it’s not visible from the outside. Sometimes, the cleft is under the oral mucosa (lining) and isn’t visible at all, which is called a submucous cleft. This can be felt upon oral examination.
A cleft palate is usually discovered during the newborn physical examination directly or soon after birth. It may cause problems with:
- feeding: the baby may be unable to breastfeed or feed from a normal bottle as it can’t form a good seal with the mouth
- hearing: the baby may be more vulnerable to ear infections and a build-up of fluid in the ears (glue ears) which may affect hearing
- speech: when not repaired, the cleft palate can lead to unclear or nasal-sounding speech when the child is older
Management:
A cleft palate is treated by a cleft team, that draws up a care or treatment plan. This plan includes feeding support, attention for hearing and speech and language development, and a surgical correction usually at the age of 6 to 12 months. Also see: Cleft lip and palate - NHS
When a high arched palate is causing problems, it can be treated with palatal expanders or other orthodontic treatments. This should be done while the jaw is still developing, until about 15 years of age.
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