HESI Pediatric Nursing Practice Test 2026: Cleft Lip and Palate Case Study

Submucous cleft palate is when the mucosa covers the palate, but the muscles in the midline of the palate are not properly fused. The key clue is that the mucosa remains intact, yet you can see signs that point to an occult defect. The typical signs are a bifid uvula and a notch along the posterior edge of the hard palate. Sometimes a thin midline translucency, called a zona pellucida, can be seen as well. Because the mucosa hides the underlying issue, feeding and speech problems may not be obvious at first, but the child can develop velopharyngeal insufficiency leading to hypernasal speech, nasal regurgitation, and higher risk of ear issues from Eustachian tube dysfunction. This combination—intact mucosa with a bifid uvula and posterior notching—best describes a submucous cleft palate, distinguishing it from a clearly visible mucosal defect or a cleft lip only.