Morphological and Semantic Challenges of Confirming Cleft Palate In a Case Study from CA-ALA-329

Primary Investigator:   Erik Savage

Faculty Sponsor:   Dr. Elizabeth Weiss

Burial 92, a young adult Native American woman from the CA-ALA-329 site, is recognizable by the eruption of a central incisor and a small extra tooth in her upper lip area. The roof of her mouth is similarly divided into right and left halves, and these abnormalities have been interpreted as a skeletal example of cleft palate. Using photos of Burial 92 as evidence, a dentist proposed that the unusual features could be explained without assuming she had a cleft palate. This prompted a new review of the physical evidence to reconsider the earlier interpretation.

This new investigation identified physical evidence that was inconsistent with clinical “cleft palate”.  Clinical literature suggests divisions should be smooth-edged, uninterrupted, and found in predictable locations. However, Burial 92’s divisions contain jagged edges and small sections that appeared intact. The location of the division in her lip area is more consistent with MCL (median cleft lip) than typical cleft palate. Typical presentation in the mouth is symmetrical, but her right maxilla was more affected than her left. Hyperdontia is often associated with cleft palate, but Burial 92’s extra teeth may have forced the incisor through a lip area that had been intact. In addition, the evidence of infection in the roof of the mouth might be at least indirectly caused by trauma resulting from these unusual eruptions. Given these facts, the additional assumption of a pre-existing cleft palate is unwarranted.

A shared, interdisciplinary understanding of “cleft palate” would improve the consistency of classifications. The clinical term “cleft palate” applies only to a specific set of facial structures that normally fuse early in the development of an embryo. Ironically, this means the term “cleft palate” may deliberately exclude many palates that are arguably cleft. Early childhood diagnosis and treatment is problematic for bioarchaeologists, who rely on skeletal evidence and confirmed examples for comparison. More collaboration between clinicians and anthropologists could improve consistency, especially by the development of differential diagnostic criteria focusing on skeletal presentations.

A poster summarizing the results of this investigation received the 1st Place award in the Student Poster Competition at the 2017 Southwestern Anthropological Association (SWAA) conference.


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