High arched palate

High-arched palate refers to when the hard palate or roof of the mouth is narrow and tall. The structure of a baby’s mouth develops very quickly in utero and continues to be formed during the first year of life. High-arched palate can be a congenital condition that is present from birth.

There are a number of other syndromes that have high-arched palate as one of their symptoms, including:

• Crouzon syndrome
• Down syndrome
• Apert syndrome
• Treacher Collins syndrome
• Marfan syndrome
• Incontinentia pigmenti
• Pallister–Hall syndrome ¹

In some cases, high-arched palate can also develop after birth due to certain behaviors. Chronic and excessive thumb sucking and pacifier use can contribute to the narrowing of the hard palate, as can breathing through an open mouth more often than not. This happens because an infant’s tongue helps to develop the shape of the roof of the mouth by filling and gently maintaining the shape of the palate. If the mouth is constantly open and the tongue is not resting in the roof of the mouth, or if something narrower such as a pacifier or thumb is resting there instead, then it will form its shape around that structure instead. This means the palate will continue to narrow and heighten instead of broadening in the shape of the tongue.

High arched palate causes

High-arched palate can be a congenital condition that is present from birth.

There are a number of other syndromes that have high-arched palate as one of their symptoms, including:

• Crouzon syndrome
• Down syndrome
• Apert syndrome
• Treacher Collins syndrome
• Marfan syndrome
• Incontinentia pigmenti
• Pallister–Hall syndrome ¹

In some cases, high-arched palate can also develop after birth due to certain behaviors. Chronic and excessive thumb sucking and pacifier use can contribute to the narrowing of the hard palate, as can breathing through an open mouth more often than not. This happens because an infant’s tongue helps to develop the shape of the roof of the mouth by filling and gently maintaining the shape of the palate. If the mouth is constantly open and the tongue is not resting in the roof of the mouth, or if something narrower such as a pacifier or thumb is resting there instead, then it will form its shape around that structure instead. This means the palate will continue to narrow and heighten instead of broadening in the shape of the tongue.

High arched palate symptoms

Symptoms of a high-arched palate:

• Feeding difficulty: In order for babies to feed through a bottle or breast, a suction seal needs to be made between the mouth and nipple or teat. High-arched palates make it difficult to create this suction and this is often the first signs of high arched palates.
• Nasal breathing: If the palate is too tall then it moves into the space of the nose. This means that the nasal passage becomes smaller than it should be, causing the individual to breathe through their mouth (open-mouthed breathing) and more expansion in the upper palate.
• Nasal congestion: Smaller nasal passages become congested and swollen and are difficult to clear. This again causes mouth breathing and the potential for upper respiratory infection.
• Sleep difficulties: High arched palates can cause snoring due to difficulty nose breathing. As the condition progresses, the potential for a child developing sleep apnea increases. Many patients with high-arched palate have to sleep on their side to get enough oxygen, and snoring is common.
• Speech difficulties: Individuals may have difficulty producing certain speech sounds that require the upper palate to make contact with the tongue such as the ‘s’ and ‘sh’ sounds. Older children may struggle with speech (specifically consonants) and develop a speech impediment for any sounds that utilize the upper palate in contact with the tongue.
• Structural changes: narrowing between the eyes and a down-turned mouth can occur due to these internal changes happening within the skull.
• Poor oral health: High-arched palate can cause swollen gums and crowding of the teeth due to a narrowed mouth. This, in turn, can lead to more tooth decay in hard-to-reach areas of the mouth and eventually lead to periodontal disease.

High arched palate diagnosis

A high-arched palate diagnosis is often made visually. For many babies, it is quite obvious that the palate is higher than usual.

Researchers have also developed a consistent, if complicated, measurement system to quantify what it means to have a high-arched palate (which, in addition to calling it a vaulted palate, they also refer to as a pseudo-cleft). Researchers looked at several different measurements – palate shelf length, shelf width, arch height, and arch angle – to determine what the mean (middle) measurement of these features was. They identified a high-arched palate as one that has measurements that are two standard deviations above the mean measurement.

This measurement eliminates guessing in favor of a consistent and measureable diagnosis. For new parents (or anyone who has waited anxiously for test results), this proper diagnosis can offer a sense of relief and a path forward towards high-arched palate treatment.

High arched palate treatment

High-arched palate treatment can be tricky. In the absence of any other symptoms and with a baby who is having no feeding difficulties, treatment may be unnecessary. If your baby or child is having challenges due to a high-arched palate, here are some high-arched palate treatments to try ².

Tongue repositioning and strengthening exercises (Oral Myofunctional Therapy)

The tongue is key in most oral functions, from swallowing to speech. A tongue that is broad and flat has difficulty forming consonants and contributes to a narrow palate.

Some basic tongue repositioning exercises can help to strengthen and retrain the tongue back to its proper position. Only attempt these after talking to your dentist.

Palate expander

If a high-arched palate has caused no problems in infancy but begins to trouble your adolescent as they begin orthodontic treatment, your orthodontist may recommend a palate expander. A palate expander is an appliance that spans the upper palate. A key inserted into the expander helps to gradually open the palate up.

Oral-maxillofacial surgery

If these treatments are unsuccessful and a high-arched palate is beginning to cause speech or respiratory issues, you may want to consider oral-maxillofacial surgery to expand the upper palate arch. This will not necessarily shrink the height of the arch but will open the upper palate and create more space for the nasal passages. This could help relieve congestion and make breathing easier. It may also ease any sleep apnea that has developed.

References

1. Tsukamoto M, Hitosugi T, Yamanaka H, Yokoyama T. Bifid epiglottis, high-arched palate, and mental disorder in a patient with Pallister-Hall syndrome. Indian J Anaesth. 2018;62(10):825-827. doi:10.4103/ija.IJA_317_18
2. Wishney, M., Darendeliler, M.A., Dalci, O. (2018) Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence. Australian Dental Journal, 64: 135– 144. https://doi.org/10.1111/adj.12690