A bifid uvula is an abnormal split or division in the uvula, or tissue that hangs down at the end of the soft palate in the roof of the mouth. A bifid uvula is usually identified at birth when a doctor looks at the inside of a baby’s mouth to check the uvula.
In some cases, it is discovered before birth on an ultrasound. At other times, it can take a little longer or be an incidental finding not associated with any health problems.
However, sometimes a bifid uvula is an indication of a submucous cleft palate. This is when there is a cleft or split in the palate under the thin membrane of tissue that covers the roof of the mouth.
Because it is covered by the mucosal layer, it can be difficult to see the cleft. Also, it may involve just the soft palate or extend to the hard palate.
A submucous cleft palate can occur without a bifid uvula. This form has less muscular tissue than the palate of someone who does not have the condition. It can also lead to some medical problems.
Genetic, environmental, and toxic factors may be possible causes for a child being born with a bifid uvula. However, the definitive cause is unknown.
If it is genetic, then the likelihood of a child having it will depend upon the number of people affected in a family, and how closely they are related to the child.
Bifid uvula occurs between the 7th and 12th week of pregnancy because of an error in the fusion of the uvula.
For environmental and toxic causes, some risk factors have been identified as increasing the chance of having a baby with a cleft palate.
The following examples might contribute to the likelihood, though this is unclear:
There are no medical complications with a bifid uvula if it is an isolated condition.
However, it is important to eliminate the association with a submucous cleft, as that can have clinical repercussions.
To further diagnose this, a doctor may conduct nasopharyngoscopy. This procedure is when a small tube is placed in the nose to look at the palate.
A submucous cleft can lead to speech problems with a child often having abnormal nasal speech. In these cases, a submucous cleft palate may not be diagnosed until the child starts talking.
Another complication of submucous cleft palate is problems with swallowing. Again, this is caused by the lack of muscular tissue, and the baby may have trouble feeding or regularly regurgitate.
It may be apparent shortly after birth that a child has a submucous cleft if they have a weak suck, are taking a long time to feed, or milk comes out of their nose as they feed.
Usually, there are no problems with breathing caused by a bifid uvula, and, in many cases, the infant can show no obvious complications.
A bifid uvula is benign, and therefore its mere presence does not necessitate treatment.
However, it is essential that a child born with a bifid uvula is examined for a possible submucous cleft palate. If present, the cleft palate is monitored closely and any treatment needed is coordinated in future years.
Submucous cleft palate may or may not require surgery, depending on the degree of symptoms.
The most common reason for treatment is due to abnormal speech. For those with speech problems, it will often cause a nasal sound as air escapes through the nose.
Treatment can range from monitoring speech development and intervening if there are any delays or errors, to speech therapy, or surgery.
A person may also have a condition known as velopharyngeal insufficiency or VPI if they have a submucous cleft palate.
VPI is when the soft palate does not reach the back of the throat to produce normal-sounding speech.
In this scenario, surgery is needed to repair the palate and close the cleft. Even after this, 20 percent of children still experience problems with VPI.
In some cases, as an alternative to surgery, a dentist can make a special appliance that fits into the mouth and attaches to the teeth to help with speech problems.
If an infant is having trouble with feeding and swallowing, then this can sometimes be solved through techniques shown to the parent by a feeding consultant.
Those with a submucous cleft palate can also often experience problems with fluid in the ears and related infections, which can reduce their hearing ability.
Ear problems will need to be treated by a doctor or ear, nose, and throat specialist. Treatment can include antibiotics or the insertion of ventilating tubes into the eardrum.
For most people, having a bifid uvula causes no complications, and they can lead a normal and healthful life.
For others who have a submucous cleft, it can cause problems ranging from speaking and eating to being able to hear.
The important thing is that it is diagnosed and assessed as early as possible to avoid permanent problems and so that appropriate treatment can start.