Cleft lip and palate: causes and correction

The birth of a baby is a long-awaited moment for many. But there are times when good news is accompanied by events for which parents did not prepare in advance. Such surprises include congenital anomalies and defects that obscure the birth of a child.

Cleft lip and palate are the most common congenital facial defect. Anomalies are popularly referred to as the "bunny lip" (cleft lip) and the "cleft palate" (cleft palate). Their formation occurs in the first trimester of pregnancy, from 5 to 11 weeks of embryonic development.

Etiology

"Hare lip" refers to an anomaly that is characterized by a partial or complete absence of fusion of the tissues of the upper lip. It can develop as an independent state, or it can be combined with a cleft sky.

"Wolf's mouth" - a gap, lack of fusion of the sky in its central or lateral part. It can be located in a specific area (anterior bone tissue or soft tissue of the posterior palate) or extend along its entire length.

A number of factors can adversely affect the mother’s body during pregnancy, resulting in the appearance of such an anomaly as cleft lip and palate. The causes of the pathology are as follows:

1. Hereditary predisposition - a person born with a cleft is likely to pass this state by inheritance to his child in 7-10% of cases.
2. Diseases of viral origin transmitted by the mother in the first trimester of pregnancy (rubella, cytomegalovirus, herpes virus infection, toxoplasmosis).
3. The heavy environmental and radiation situation in the area of ​​a woman’s residence at the time of bearing a child.
4. Chronic diseases and taking drugs with teratogenic effects against them.
5. Bad habits of the mother (alcohol abuse, smoking, drug use).

Classification of cleft lip and palate

Based on the anatomical and physiological characteristics, a classification of crevices was developed. For convenience, we will present the information in a table.

Diagnostics

Pathology is determined during pregnancy. Congenital cleft of the upper lip and palate is visualized already at 16-20 weeks of embryonic development. If all 3 main ultrasound examinations, the baby turns away from the sensor of the device so that it is difficult to make out structures, there may be a false examination result.

Reviews of parents who subsequently had children with congenital anomalies confirm the possibility of false results, and in both directions. Some were told that the baby would be born sick, but in the end the baby was no different from his peers. Or, on the contrary, the parents were confident in the good health of the baby, and he was born with pathology.

Feeding a baby with an anomaly

Before it comes to fixing the problem, you need to resolve the issue with the baby’s nutrition. Feeding children with cleft lips and palate has its own characteristics, so mothers must adhere to rules that vary depending on the form of pathology.

If the child has only an anomaly in the structure of the lip, then he will not have problems with the capture of the nipple by the lips and suction. The cleft lip and palate or only the palate requires a certain modification of the baby to eat, because milk can flow into the hole between the nasal and oral cavity, and there is no necessary pressure for the sucking process.

As milk enters the nasal cavity, the air also enters the oral cavity and, accordingly, into the stomach. Kids need a long horizontal position after eating, so that excess air bubbles come out. The first months of life are accompanied by frequent colic, regurgitation, and can even reach vomiting.

Feeding Rules:

1. Use either breastfeeding or bottle feeding (there is no need to feed from a cup or spoon).
2. Massage the mammary glands before feeding. This will increase the amount of milk received reflexively, and the baby will not have to make much effort.
3. Follow feeding rules on demand. More often put the baby to the chest.
4. Carry out a digital compression of the areola, which allows to increase the bulging of the nipple. If necessary, use special pads, matching the size of the child's oral cavity.
5. If you feel the baby is unsaturated, collect the remaining milk with a breast pump and feed it from the bottle. The nipple is also selected individually, taking into account the anatomical features.

Treatment principles

Children with cleft lip and palate need surgical intervention. This is necessary not only to eliminate a cosmetic defect, but also to restore the function of the digestive tract and respiratory system.

The timing of operations, their number, the amount of intervention is determined directly by the surgeon. Cleft lip and palate is eliminated by the following methods:

• cheiloplasty;
• rhinocheyloplasty;
• rhinocheilognoplasty;
• bicycle repair;
• palatoplasty;
• bone grafting.

All these types of interventions relate to primary surgery for congenital clefts. In the future, secondary operations may be required, which are part of the correction of appearance and residual phenomena.

Rhinocheiloplasty

This is a surgical intervention to restore the anatomical and physiological characteristics of the nose and upper lip. Cleft upper lip and palate is not eliminated by such an intervention, but for the correction of the "bunny lip" rhinocheiloplasty is considered the operation of choice.

The tasks of surgeons:

• restoration of the muscular apparatus of the upper lip;
• red border correction;
• the formation of the normal dimensions of the vestibule of the mouth;
• restoration of the correct location of the wings of the nose;
• symmetry correction;
• the formation of the bottom of the nasal passages.

In most cases, such techniques are used so that scars and scars are as small as possible. The correctly selected intervention technique, the degree of primary deformation of tissues and cartilage and the proper management of the postoperative period are factors that determine the need for secondary surgery after the patient is fully restored.

A one-sided pathological process allows the operation to be carried out after the child reaches 3 months of age, and a bilateral one after six months. After plastic surgery, the child is fed either with a spoon or through a nasogastric tube, which depends on the general condition and age of the patient. After 3-4 days, you can return to the method, which is used constantly.

Rhinocheilognoplasty

Children with cleft lips and palate can get rid of the pathology with the help of such an intervention. This operation is aimed at eliminating the anatomical disorders of the nose, upper lip and alveolar bone. Allows correction of end-to-end defects. Bilateral cleft lip and palate is one of the indications for rhinocheilognoplasty.

The optimal period for the operation is children's age, until a permanent bite is fully formed, and eruption of the upper canines has not yet occurred.

Veloplasty

Cleft upper lip and palate is restored using the simultaneous use of several surgical techniques. Specialists combine the elements of chelorinoplasty and veloplasty (correction of the soft palate). Intervention is carried out with the following objectives:

• restoration of swallowing function;
• correction of breathing processes;
• restoration of phonation and speech.

If a child can learn to eat so that food does not get from the oral cavity to the nose, then things are worse with the speech apparatus . Serious changes in speech are not amenable to self-correction. This is an important moment in the first few years, when the child learns to speak and forms his individual abilities (sing, read poetry).

Cycloplasty is performed from 8 months of age. Usually, the operation is well tolerated, and after 1-2 days the baby can eat on its own.

Palatoplasty

Children with cleft lips and palate (the disability of such babies is in question) may need several stages of the operation, which are carried out at certain intervals. If a birth defect affects not only the lip, alveolar bone and soft palate, but also the hard palate, this condition is an indication for paloplasty.

After correction of the anatomy of the soft palate, the gap in the solid automatically narrows. By 3-4 years, it becomes so narrow that you can restore integrity without significant traumatic disorders. This two-step correction has the following advantages:

• early restoration of conditions for the normal development of speech function;
• a barrier to disturbances in the areas of growth of the upper jaw area.

One-stage recovery is possible, but in this case, the risk of underdevelopment of the upper jaw increases.

Bone grafting

This operation is performed by a surgeon, but is coordinated with an orthodontist. It is carried out during the period of change of temporary bite to a permanent one (7-9 years). During the intervention, an autograft is taken from the patient's tibia and transplanted into the cleft area of ​​the alveolar process. The graft allows you to restore the integrity of the bone of the upper jaw and create optimal conditions for the eruption of permanent teeth.

Secondary surgery

Cleft lip and palate is a congenital anomaly that can leave a mark on a person's face throughout his life. Most patients need secondary plastic surgeries, the purpose of which is as follows:

• correction of appearance;
• restoration of speech function;
• elimination of abnormal messages between two cavities (nasal, oral);
• movement and stabilization of the upper jaw.

1. The upper lip

Most patients who want to perform upper lip correction focus on the fact that a scar remains after the initial intervention. The desire to eliminate it leads to the surgeon. It must be remembered that any scar or scar can be made less noticeable, reduced in size, but it is completely impossible to get rid of it.

Frequent deformations:

• unnatural bending of the red border;
• asymmetry;
• violation of the functions of the muscle apparatus;
• pathological fullness.

2. Nose

Anomalies of the upper lip are combined with deformation of the nose. Secondary nose surgery is required for almost all patients. The degree of deformation depends on the severity of the primary pathology. In order to correct asymmetry, aesthetic appearance, restoration of the nasal septum, rhinoplasty is performed.

Minor changes that need to be corrected can be made in early childhood. Extensive interventions are allowed only after 16-17 years, when the skeleton of the face is fully formed.

3. Soft palate

The result of complex clefts and their primary surgery may be velopharyngeal insufficiency. This is a pathological condition, accompanied by a nasal voice, slurred speech. Surgical manipulations are aimed at eliminating a speech defect.

The operation is allowed at any age, but before that it is better to consult a speech therapist and confirm the impossibility of editing the speech in other ways.

It is impossible to prematurely evaluate the result of surgery in the soft palate, since the muscular apparatus of this area is very sensitive to external interventions, which means that cicatricial changes after primary surgery are always significant. To restore functional features, the following manipulations are performed:

• repeated muscle grafting without or with simultaneous lengthening;
• soft palate using a pharyngeal flap.

A feature of the late postoperative period is the work with a qualified speech therapist and an audiologist.

4. Oronasal fistulas

This is a common problem in patients operated on for cleft palate and lip. The fistula is a hole between two cavities. Frequent localization is the area of ​​the alveolar ridge, hard palate. At an early age, such holes cause food to enter the nose, but children learn to control the condition. Also the result is a nasal and slurred voice.

The elimination of oronasal fistulas is performed by bone grafting with the formation of the bottom of the nasal passages.

Conclusion

Cleft lip and palate, the disability of which remains in doubt, refers to congenital conditions. In the case of a combination of bilateral severe pathology with other anomalies, disability is possible.

The presence of a single pathology without concomitant anomalies of an innate nature is indicated as such that does not interfere with a person’s self-care and is not accompanied by deviations in other areas (mental, mental, sensory). In such clinical cases, the patient is not recognized as disabled.