Orofacial Clefts and Dysphagia: A Closer Look.
In anatomical terms, cleft is an abnormal opening in the body. A cleft lip or palate means that either (or both) of the two have a hole where there shouldn’t be. The cleft can affect the upper lip, the nose, the hard palate and soft palate.
The various orofacial clefts may cause swallowing problems in different phases of the swallow and different types of dysphagia: the cleft lip cause sucking problems in the preparatory phase, the cleft palate in the oral transitory phase, and velopharyngeal insufficiency in the pharyngeal phase. Without adequate closure of the palate, the oral phase of the swallow becomes disrupted. There is no wall for the tongue to create the bolus against. The food ingested could potentially be entering the airway. Food or liquid taken into the oral cavity can come out of the nasal passages (nasal regurgitation).
Because of the opening between the mouth and nasal cavity, the infant is unable to create suction to pull liquid out.
It is common for an infant with a cleft palate to have difficulties initiating and maintaining suction during feeding. Because of the opening between the mouth and nasal cavity, the infant is unable to create suction to pull liquid out. Trying to create suction with a cleft palate can be compared to drinking liquid from a straw with a hole in it. Most infants who have a cleft palate are working very hard to maintain suction during feeding. This can mean a longer feeding time due to the difficulty and slowness of pulling the milk from the bottle. In addition, the infant may also exert more energy during feeding. It is important to ensure that the infant does not expend more calories through energy exertion than calories taken in through feeding. Feeding time should not take longer than 30 minutes.