Sally was born with a cleft lip and palate. She is now 4 yea…

Sally was born with a cleft lip and palate. She is now 4 years old and has had many surgeries to address the cleft.  However, she continues to struggle with sound productions, specifically production of palatal sounds, and alveolar sounds.  Additionally, nasal emissions are present in her speech.  Thus, the most likely diagnosis is: