The field of speech and language pathology (SLP) expanded to a wide range of specialities, leading to a global trend to decrease the time spent on specific courses on children with cleft palate, with or without cleft lip (CP±L) in SLP education programmes. The lack of CP±L courses has resulted in a global shortage of well-trained SLPs to deliver high-quality services to this population. Therefore, alternative training formats are needed. This study aimed to assess the training needs of Flemish speech and language pathologists (SLPs) working with children with CP±L by examining: (1) their current employment situation, experience and perceived competence regarding CP±L; (2) their preferences for the content, sources and organisation of continuing education on CP±L and (3) potential incentives and barriers to attend continuing education on CP±L. A self-constructed online survey in QualtricsXM, based on existing literature, was utilised. The study employed a descriptive, quantitative approach, supplemented with open-ended questions to enrich and deepen the quantitative data. The 158 respondents had a mean work experience of 10 years, a median of 7 years and a mode (most frequently occurring value) of 5 years. Of these 158 respondents, 132 (83.5%) were young SLPs with professional experience ranging from 0 to 15 years. Of these, 53.8% (85/158) had previously treated one or more children with CP±L, of whom 71 (83.5%) had a caseload of 0-3 children within the last 5 years. The mean caseload for the 85 SLPs with experience was 4.74 cases, with a median of one child and a mode of one. Of the 85 respondents with experience, 9.4% (8/85) felt highly competent in treating feeding problems, while 58.8% (50/85) felt highly capable in treating speech and language problems. However, 60% (95/158) of the SLPs would refer children with CP±L, especially when having feeding problems or severe speech and language problems, such as compensatory articulation disorders (CADs) or submucosal cleft, as they feel a lack of competence. Two-thirds (63.6%, 96/151) of the respondents who answered this question expressed a desire for continuing education in the assessment and treatment of children with CP±L. Although many Flemish SLPs perceived themselves as highly competent in treating speech and language problems in children with CP±L, they reported a lack of competence in treating complex or severe cases. They expressed a strong demand for specific, highly practical continuing education on CP±L, taught by experts in the field and with personal guidance. Based on the existing literature, our experience with CP±L and the results of this survey, we developed a continuing education programme on CP±L as an alternative educational format, tailored to the needs of Flemish community SLPs. What is already known on the subject Treating children with CP±L is complex and requires high-quality care from specialised SLPs with sufficient clinical experience. However, there is a global trend to reduce dedicated coursework on CP±L in SLP training programmes. Instead, the subject is often briefly covered in general courses or offered as an elective. As a result, there is a shortage of well-trained SLPs, creating an urgent need for alternative training formats. What this paper adds to the existing knowledge This study reveals that Flemish Community SLPs feel insufficiently trained to assess and treat children with CP±L who exhibit complex or severe problems, such as feeding problems, compensatory articulation disorders (CAD), velopharyngeal insufficiency or submucosal cleft palate. They have a strong need for theoretical knowledge and practical continuing education, preferably provided by experts in CP±L. They want a 1-day or multi-day training course that utilises extensive video footage, personal coaching, opportunities to observe experts and even an internship. Additionally, they want an online platform to collect and disseminate all knowledge and expertise. What are the potential or actual clinical implications of this work? Given the global decline in specific CP±L courses in SLP programmes, SLPs feel inadequately prepared to assess and treat these children correctly. This increases the risk that no results will be achieved or that undesirable results will occur. To prevent this, alternative training formats are needed. Based on this needs analysis, a training programme was developed for community SLPs, tailored to their needs to enable them to provide high-quality speech therapy services.

Microspherophakia is a rare congenital lens abnormality characterised by increased anterior-posterior thickness and reduced equatorial diameter, giving the lens a spherical shape. Iris coloboma, typically involving the inferonasal iris, results from incomplete fetal fissure closure. To our knowledge, this is the first reported case of microspherophakia with bilateral atypical (temporal) iris coloboma. An early adolescent patient underwent a syndromic evaluation for multiple congenital anomalies. Ophthalmological examination revealed bilateral temporal notches of the pupillary rim with intact collarettes, suggesting coloboma and strongly pigmented lens zonules with phacodonesis. Additional findings included inguinal hernia, submucosal cleft palate, mitral valve prolapse, microcephaly and high myopia. Management focused on glasses and periodic intraocular pressure monitoring due to preserved visual acuity. This case underscores the variable presentation of probable connective tissue disorders, with atypical ocular features like microspherophakia, temporal iris coloboma and lens subluxation.

The velopharynx is comprised of complex musculature that works together to achieve closure of the velopharyngeal port during deglutition and speech. Failure of this mechanism results in velopharyngeal dysfunction, manifesting as nasal regurgitation and hypernasal speech. A thorough evaluation with a multidisciplinary team of otolaryngology and/or a surgeon trained in cleft/craniofacial surgery and speech languagy pathology can identify the underlying cause and relevant anatomy, which should be incorporated into decisions regarding surgical techniques. The most common surgical approaches for VPI are pharyngeal flap, sphincter pharyngoplasty, and Furlow palatoplasty, but many alternative techniques can be utilized depending on patient factors and new surgical concepts.

There are many techniques from which to choose in cleft palate repair. The decision of which to use varies from surgeon to surgeon and may be tailored based on the type of cleft palate and surgeon training or preference. The goal of cleft palate repair is to improve speech resonance, while minimizing complications. Repair techniques are ever evolving to reduce complications and improve success rates as measured by fistula formation and velopharyngeal insufficiency.

Hidden or submucosal cleft palate (SCP) is a rare form of isolated cleft that is characterized by rhinolalia in the presence of an apparently intact palate. To analyze the age of detection of SCP in children and evaluate the impact of its presence on the middle ear and speech development of patients. 17 patients with SCP were examined and treated in the departments of otorhinolaryngology and maxillofacial surgery of the Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan. The duration of observation of patients ranged from 1 to 4 years. The median (Me) age of diagnosis of SCP was 7.18±3.83 years (95% CI 5.21-9.14), of which in 10 patients (58.8%) SCP was first suspected by an otorhinolaryngologist. When analyzing the age of detection of SCP depending on the detection of otitis media with effusion (OME) and epitympanitis, we established statistically significant differences (p=0.007; p=0.043, respectively). When assessing the dependence of the probability of OME on the age of detection of SCP using ROC analysis, an ROC curve was obtained that characterizes the dependence of the probability of OME on the age of detection of SCP. The resulting model was statistically significant for OME (p=0.011). When analyzing the comparison of the age of detection of SCP depending on the presence of speech delay, statistically significant differences were established (p=0.029). The analyzed data from patients with SCP indicate serious changes in the middle ear: from OME to the presence of cholesteatoma. The presence of SCP affects not only the clarity of spoken speech, but also contributes to its delay. The data obtained demonstrate a direct relationship between the severity of manifestations in the middle ear and the age at which the diagnosis of SCP was made by an otorhinolaryngologist. Скрытая, или подслизистая, расщелина нёба (СкрРН) представляет собой редкую форму изолированных расщелин, которая характеризуется ринолалией при внешне неповрежденном нёбе. Проанализировать возраст выявления СкрРН у детей и оценить влияние ее наличия на среднее ухо и речевое развитие пациентов. Были обследованы 17 пациентов со СкрРН, проходивших обследование и лечение в отделениях оториноларингологии и челюстно-лицевой хирургии ГАУЗ «Детская республиканская клиническая больница Минздрава Республики Татарстан». Длительность наблюдений составила от 1 года до 4 лет. Медиана (Me) возраста установления диагноза СкрРН составила 7,18±3,83 (95% ДИ 5,21—9,14) года, у 10 (58,8%) пациентов СкрРН впервые заподозрена врачом-оториноларингологом. При анализе возраста обнаружения СкрРН в зависимости от выявления экссудативного среднего отита (ЭСО) и эпитимпанита нами установлены статистически значимые различия (p=0,007; p=0,043 соответственно). При оценке зависимости вероятности ЭСО от возраста выявления СкрРН с помощью ROC-анализа получена ROC-кривая, характеризующая зависимость вероятности ЭСО от возраста обнаружения СкрРН. Полученная модель статистически значима для ЭСО (p=0,011). При анализе сопоставления возраста обнаружения СкрРН в зависимости от наличия задержки речи установлены статистически значимые различия (p=0,029). Проанализированные данные пациентов со скрытой расщелиной нёба указывают на серьезные изменения в среднем ухе: от экссудативного среднего отита до холестеатомы. Наличие скрытой расщелины нёба не только влияет на четкость произносимой речи, но и способствует ее задержке. Полученные данные демонстрируют прямую зависимость тяжести проявлений в среднем ухе от возраста установления диагноза скрытой расщелины нёба врачом-оториноларингологом.