Submucous cleft with a congenital palatal perforation

Congenital palatal fistula is a rare anomaly. We are reporting a rare case of congenital palatal fistula with a submucous cleft palate successfully operated on with satisfactory functional results. A 14-year-old male presented to us with a palatal fistula with submucous cleft palate since birth. The child was born by full-term normal vaginal delivery at a hospital in a rural area with normal birth weight, antenatal, and postnatal period were uneventful. His complaints were nasal regurgitation and hypernasal speech and recurrent episodes of secretory otitis media. A detailed video nasopharyngoscopy was done. On intraoral examination, fistula of 7 cm by 4 cm in the midline involving palatine bone of hard palate and anterior part of soft palate suggestive of congenital fistula with aberrant insertion of palatal muscles and bifid uvula-Calnan’s triad suggestive of submucous cleft palate. Veau–Wardill–Kilner V-Y pushback palatoplasty (oxford technique) with three-layer closure was performed. Three-layer closure (nasal mucosal layer, palatal muscular layer, and Oral mucosal layer) was achieved without tension, and the hook of the Hamulus was also fractured. The patient was discharged on postoperative day 5, tolerating adequate oral intake. At 2 months was found to have well-healed palate and had attained good velopharyngeal function (on video nasopharyngoscopy). Hypernasality in speech also improved with speech therapy at 1 year of follow-up. Although very few cases of congenital fistula of palate have been reported, the incidence appears to be high. Any child presenting with speech abnormalities and velopharyngeal insufficiency should be thoroughly investigated for the presence of submucous cleft palate. These patients need to be referred to well-equipped centers so that they are repaired at the earliest before speech develops and have better speech outcomes. The general population needs to be made aware of the pros and cons of the surgery and the consequences of delaying the surgery.