Cleft lip and cleft palate are congenital malformations of the mouth and face. These deviations are formed during pregnancy, even in the early stages of the fetal development process in the mother’s womb. Deformations occur in the case of insufficient tissue in the lips and mouth. Existing fibers are not connected properly.
What the deformations look like
A cleft lip is a cleft on both sides of the upper lip due to physiological abnormalities. The defect has the appearance of a narrow gap or hole in the skin. The cleft is often located not only on the upper lip, but also spreads to the nasal region, and can also affect the bone tissue of the upper gum and jaw.
What is a cleft palate? This deviation has the form of a hole or a crevice. It is observed both in soft and in hard sky. This defect in the oral part of the face is quite common. For every thousand newborns, there is one case of such a pathology. Often, deviation is observed in conjunction with cleft lip.
At present, scientists are aware of three genes whose mutations contribute to the formation of a cleft palate. Research in this area is ongoing. Indeed, a gene defect in the process of development of a deviation is determined in only 5% of cases of the described disease.
Sky splitting options
In the case of the development of a cleft palate, cleavage of the palate can be complete - both in hard and soft tissues, and incomplete - in the form of a hole. Pathology often proceeds together with a bifurcation of the tongue (referring to the process of the posterior soft palatine tissue). Bifurcation occurs due to the unnatural connection of the lateral and medial processes with the nasal septum. The cleft palate in a child is considered one of the most common birth defects.
Cleft palate: causes of formation
The formation of the cleft palate is due to a genetic predisposition. In the course of the development of pathology, the effect on the fetus of the mother’s harmful habits: alcohol and narcotic drugs, smoking is also clearly traced. In case of deficiency in the diet of folic acid and with obesity of a pregnant woman, there is also a risk of defective formation of the upper jaw of the fetus.
A cleft palate can also develop in the baby in the womb due to the unfavorable environment of the expectant mother, her presence of acute infections or toxicosis, and mental or mechanical injuries.
Manifestations of the cleft palate
The cleft palate in children causes problems from the very moment they are born. During labor, amniotic fluid aspiration may occur in the baby's airways. The process of air intake into the body of a newborn with a cleft palate is difficult, the process of sucking is impossible, as a result of which the child may lag behind its peers in development and weight. Until the time of surgical intervention to correct the pathology, the baby is fed with the help of specially designed spoons that are put on the bottles.
Cleft palate leads to impaired functions of the upper respiratory tract, digestive system, to inhibition in the development of speech and hearing. All these deviations may well lead to a decrease in the child’s self-esteem.
Symptomatology
In children with such a pathology as a cleft palate, speech is altered due to a disturbed natural process of formation of sounds. There is rhinolalia. This is a process of distorting the timbre of the voice and pronunciation of sounds due to improper closing of the sky and pharynx. In this case, the inhaled air freely passes through the nose, into which the consumed drinks and food penetrate. Through palatine cleft, fluid can penetrate into the Eustachian tubes, which leads to the development of sinusitis and otitis media. Also, with a cleft palate, teeth and bite are deformed, as a result of which the chewing process is disrupted.
What should be done if the child has a cleft palate
The cleft palate in children can be successfully corrected in case of timely treatment by parents for medical help from a specialist. The success of therapy in many respects depends not only on the doctors, but on the persistence, perseverance and patience of the patient’s relatives. To achieve a positive result, you must strictly adhere to all the doctor's recommendations. If this pathology is found in the child, it is necessary to show it to the surgeon so that the doctor can draw up a treatment plan.
Diagnostics
A defect in the cleavage of the palate can be detected with the help of a planned ultrasound screening of the fetus already at about the 15th week of pregnancy. But the volume and form of the lesion can be considered only after the birth of the baby. If an ultrasound examination revealed a cleft palate in an unborn baby, then additional research methods are required. This deviation is fraught with pathologies of the development of the cranium, hearing impairment, impaired breathing and smell. The diagnosis of “cleft palate” is established immediately after the birth of the baby. In this case, the degree of defect and its type are determined by examining the baby's pharynx.
Principles of therapy for cleft palate
The treatment of the cleft palate is carried out exclusively by the surgical method. In this case, several cosmetic operations are performed. Uranoplasty is preferred - the surgical method, during which the soft palate is lengthened, its muscles join in the right direction, and the middle section of the pharynx narrows.
The process of sucking a newborn after an operation is practically impossible, since there is strong pain, there is a risk of severe scarring and wound healing slows down. Therefore, you should first teach your baby to eat with a special spoon.
Therapeutic tactics
Depending on the degree of cleavage of the cleft palate, the surgeon chooses the tactics of the therapeutic process.
For patients with the correct shape of the dentition in the upper jaw, uranoplasty is recommended by specialists aged two years or older. In this case, the cleft of the sky should be incomplete.
In case of violation of the integrity of the process of the alveoli and narrowing of the upper jaw previously, before the operation, it is recommended to conduct treatment at the orthodontist. These deviations are caused by through clefts of the sky. Uranoplasty in this case is carried out no earlier than 4-6 years.
Rare cases of therapy, when the cleft palate has bilateral clefts, accompanied by tissue defects, have two stages. First of all, it is necessary to perform plastic soft and hard palate to narrow the middle section of the pharynx. The second stage of treatment is carried out after six months. It consists in closing the cleft of the hard palate (its front part) and the process of the alveoli. At the same time, bone tissue plastic surgery is performed.
Uranoplasty method
How is the operation performed? The cleft palate is corrected by restoring the natural anatomical structure of the palate and pharynx. The classic version of uranoplasty is Limberg surgery. At present, this is the main way to eliminate a congenital defect in the sky. If a cleft palate is combined in one case with a cleft lip, then cheiloplasty is additionally performed. This is an operation in which the upper lip is adjusted.
Prior to uranoplasty, its careful planning is carried out separately in each specific case. In this case, an individual selection of plastic material is performed to eliminate splitting of the palatine tissue. Modern methods of uranoplasty and highly qualified surgeons are able to restore the natural, full structure of the upper jaw and larynx in approximately 95% of patients.
The radical method of uranoplasty with cleft palate
Sometimes the "cleft palate" disease requires a radical correction of the hard and soft palate. In this case, a complex set of tasks is solved. This is the restoration of the natural continuity of the tissues of the sky and their sizes, and the elimination of improper attachment of muscles, and their connection in the usual position. Also, a set of tasks during uranoplasty includes the prevention of nerve damage that provides muscle contraction, as well as the stable fixation of the shape, structure and functions of organs undergoing surgery.
Such a radical method of therapy is recommended for patients aged 3 to 5 years in the presence of through holes in the palate, at 6 years of age - through. Carrying out this operation can cause a delay in the development of the jaw, if carried out earlier. Gentle methods of uranoplasty can be used to treat a cleft palate already at the age of 2 years.
Preoperative period
In the period preceding uranoplasty, it is recommended that children wear a “floating” obturator, which contributes to the normal process of breathing, nutrition, and the formation of normal speech. This special prosthesis can be removed 12-14 days before surgery.
Postoperative period
In the postoperative period, after the cleft palate is corrected, the patient needs bed rest for 2-3 days, eating exclusively in pureed form and drinking plenty of water. It is necessary to carefully care for the oral cavity - before and after eating it should be irrigated with a weak solution of potassium permanganate. Several times during the day you need to inflate balloons. 2 weeks after the operation, it is necessary to regularly conduct a special set of exercises and massage the soft palate with your fingers.
In order to prevent the development of infection, complex antibiotic therapy is used 5-7 days after uranoplasty. To stop the pain syndrome, painkillers are used.
After surgery, a scar remains on the face. The patient is discharged from the hospital 3-4 weeks after uranoplasty.
Features of surgical intervention
The cleft palate in humans causes repeated operations after uranoplasty. Such an intervention should be carried out no earlier than a year later. These treatment methods are aimed at eliminating postoperative defects. About 12 months is enough to restore blood flow in the soft and bone tissues.
In the case of a sufficiently large area of the cleft palate, when it is not possible to block the cleft with local tissues, muscle-mucous patches from the tongue or cheeks are used. However, the treatment of this pathology does not end at the stage of surgery. Additionally, classes with a speech therapist, a defectologist are required. Necessarily need treatment at the orthodontist, who controls the development of the jaw and, if necessary, ensure the ratio of dental arches.
Help of a speech therapist and otorhinolaryngologist
A speech therapist will help deliver correct speech to patients diagnosed with cleft palate. This specialist consults with patients who have reached the age of two. It regulates external respiration by various methods.
An otorhinolaryngologist should conduct systematic monitoring of children with a cleft palate. With this pathology, chronic diseases of the ENT organs can develop, which occur 10 times more often than in healthy children. This happens due to the communication of the oral cavity with the nasal cavity and due to disturbances in the structure of the palate and pharynx. To prevent the development of complications, timely treatment and prevention of tonsillitis, pharyngitis, rhinitis, otitis media should be carried out.
Cleft lip and cleft palate: problems associated with deviations, their solution
Difficulty eating
In the presence of palatine cleft, fluid and food can enter through the nose back into the mouth. To transport food and drinks in the right direction, specially designed nipples and bottles are used in the process of feeding the baby.
Sometimes with a cleft palate, children have to set up an artificial sky. It is used before surgery to facilitate food intake and sufficient satiety of the child.
Ear space infections and deafness
Children with cleft palate tend to develop and accumulate fluid in the middle ear. Therefore, they more often than usual develop ailments of the hearing aid, and sometimes the ability to hear sounds disappears altogether. To prevent such complications, tubes specially designed for drainage of fluid are installed on the eardrum. A hearing quality assessment should be done at least once a year.
Speech problems
In the presence of a wolf's mouth, the voice sounds bad. This problem is solved by surgical intervention or with the help of a speech therapist.
Tooth problems
With clefts of the lips and palate , caries often form on the teeth and their curvature or displacement occurs. Such deviations are corrected by the intervention of a dentist or orthodontist.