Minuscule Submucous Cleft Palate

Otitis media is almost universal in cleft palate patients, at least during infancy. A lesser cleft manifestation, the occult submucous cleft palate, is identifiable in living patients by surgical dissection or flexible fiberoptic nasopharyngoscopy. We addressed the hypothesis that an even more subtle form of submucous cleft palate, involving both an abnormal musculus levator veli palatini and an abnormal musculus uvulae, is associated with otitis media. We studied 35 adult human cadaver specimens for histologic and infrared photographic transillumination evidence of what we have identified as the minuscule submucous cleft palate. None of the specimens had evidence of clinical otitis media, or clinical abnormality of the palate. Approximately one fifth of the specimens had evidence of minuscule submucous cleft palate: minimal bulk of the musculus uvulae and haphazard organization of the fibers of the musculus levator veli palatini. These data support the nasopharyngoscopic inference that in occult submucous cleft palate, there is both hypoplasia of the musculus uvulae and abnormal orientation of the fibers of the musculus levator veli palatini. Although not significant statistically, a trend was suggested for minuscule submucous cleft palate to be associated with indicators of prior otitis media.