Submucosal Cleft Video

Learn about submucosal cleft and related conditions in pediatrics. Dr.David C. Hoffman - Oral & Maxillofacial Surgery School of Dentistry: NY Univ.- College of Dentistry Residency :Oral & Maxillofacial Surgery Univ. Texas Health Science Center Pa...
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Interviewer: When I first was in practice, which is a lot of TNAs, tonsillectomy surgery, and we have a little red flag and we saw that the EULI lip was split and the palate was high-arched. It is about submucosal cleft. What is that? Doctor: If you will look inside somebody’s mouth, the first thing you see is her teeth and when you open it wide you will see the roof of their mouth. The roof of their mouth has two areas, the front which the hard palate and the back which is the soft palate. At the back of the soft palate, there is going to be a little thing that hangs down called the EULI lip. Now, there are certain times when we have a problem with that soft palate or the EULI lip and the EULI lip instead of being one little piece that hangs down can be split and soft palate cannot be completely formed and it would look as though it was almost clear or translucent. We can see light through it. That is known as a submucosal cleft. Now what does that mean? A submucosal cleft is when the muscles that make up the soft palate are not in the right place. The covering of the soft palate is complete, so when you look at it, you do not see a defect, but underneath that covering, there is four muscle anatomy and the muscles do not work right. What happens when the muscles do not work right is the palate does not close tight against the back of the throat. That is known as nasal speech. So for example, when children want to say or anybody wants to say certain words that they have to, do not let any air escape through their nose, say the difference between A and E and you could ask somebody say – they cannot distinguish those two vowels A and E and you are going hear air come out their nose. Interviewer; Are we going to consider tonsillectomy surgery, it is a little bit of a red flag if we are very concerned about it and all surgeons like you should be involved in discussion because sometimes if you do that surgery, that you thing just get weaken and split. Doctor: The issue of tonsils and adenoids, tonsils are the two lumps down the side of your mouth and adenoids are a little long, that is on the back of your throat, if the patient has a problem with a cleft, the school of thought is be careful because if you take out the tonsils or the adenoids, you may weaken the airway or given this nasal siege. Interviewer: So a person like you specializing in the area could be involved just to make the right decision so we do not get – Doctor: I like to work closely with an ear, nose and throat, pediatric doctor and we make decisions because the reverse is true. Sometimes, I need to use some of the structures around the tonsils to improve speech and so I will have the EENT doctor remove the tonsils and then come back a couple of months -- Interviewer: So we go back to the original premise, a team approach seems to be the best approach, more minds, more people specialties you think would give you the best positive results you wish, is that correct? Doctor: Yes. You want a team and you want a team that is a fairly large volume of patience because there is no substitute for experience of the teams that you see a handful of patients now and then just – it is hard to keep the interest level up and your esteems level up.

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