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 overshadow the birth of a child.
Cleft lip and palate is the most common congenital facial defect. In the people, anomalies are called "hare lip" (cleft lip) and "cleft palate" (cleft palate). Their formation occurs in the first trimester of pregnancy, from 5 to 11 weeks of embryonic development.
Etiology
"Hare lip" is called an anomaly, which is characterized by a partial or complete absence of fusion of the tissues of the upper lip. It can develop as an independent condition, or it can be combined with cleft palate.
"Wolf's mouth" - gap, non-closure 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 run along the 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:
- Hereditary Predisposition - A person born with a cleft has a 7-10% chance of passing the condition on to their child.
- Diseases of viral origin suffered by the mother in the first trimester of pregnancy (rubella, cytomegalovirus, herpes infection, toxoplasmosis).
- Severe environmental and radiation situation in the area of residence of a woman at the time of bearing a child.
- Chronic diseases and taking teratogenic drugs against their background.
- Mother's bad habits (alcohol abuse, smoking, drug use).
Classification of cleft lip and palate
Based on the anatomical and physiological features, a classification of clefts was developed. For ease of perception, we will present the information in the form of a table.
| Group | Subgroups | Features of subgroups |
| Individual cleft lip | Submucosal | 1 side, 2 sides |
| Incomplete (with or without nose deformity) | 1 side, 2 sides | |
| Full | 1 side, 2 sides | |
| Separate cleft palate | Those that affect only the soft palate | Submucosal,incomplete, complete |
| Those that affect the soft and hard palate |
Submucous, incomplete, complete |
|
| Complete cleft palate and alveolar process | 1 side, 2 sides | |
| Clefts of the anterior soft palate, upper lip and alveolar process | 1 side, 2 sides | |
| Perforating clefts affecting the upper lip, alveolar process, hard and soft palate | On 1 side | Right hand, left hand |
| 2 sides | ||
| Cleft lip and palate (photo below) of an atypical nature | ||
Diagnosis
Pathology is determined during pregnancy. Congenital cleft lip and palate is visualized as early as 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 see the structures, there may be a false result of the examination.
Reviews from 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 child was no different from his peers. Or, on the contrary, the parents were confident in the good he alth of the baby, and he was born with a pathology.
Feeding a baby with an anomaly
Before it comes to fixing the problem, the baby needs to be fed. Feeding children with cleft lip and palate has its own characteristics, so mothers must adhere to the rules, which vary depending on the form of pathology.
If a baby has only an anomaly in the structure of the lip, then he will not have problems with lip grabbing and sucking. Cleft lip and palate or only palate requires a certain modification of the baby for eating, since milk can flow into the hole between the nasal and oral cavities, and there is also no necessary pressure for the sucking process.
As milk enters the nasal cavity, so the air similarly enters the mouth and, accordingly, the stomach. Toddlers 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 may even vomit.
Feeding rules:
- Use either breastfeeding or bottle feeding (no need for cup or spoon feeding).
- Massage the mammary glands before feeding. This will increase the amount of reflex flow of milk, and the baby will not have to make much effort.
- Follow the rules of feeding on demand. Breastfeed more often.
- Perform finger pressure on the areola to increase nipple protrusion. If necessary, use special pads, selecting the size of the child's mouth.
- When the baby feels unsatisfied, collect the rest of the milk with a breast pump andbottle feed. The nipple is also selected individually, taking into account the anatomical features.
Principles of treatment
Children with cleft lip and palate need surgery. 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 volume of intervention is determined directly by the surgeon. Cleft lip and palate are corrected by the following methods:
- cheiloplasty;
- rhinocheiloplasty;
- rhinocheilognatoplasty;
- bicycle plastic;
- palatoplasty;
- bone grafting.
All of these interventions are classified as primary surgery for congenital clefts. In the future, secondary operations may be required, which are part of the correction of appearance and residual effects.
Rhinocheiloplasty
This is a surgical intervention to restore the anatomical and physiological features of the nose and upper lip. A cleft lip and palate is not repaired by such an intervention, but for the correction of the "hare lip" rhinocheiloplasty is considered the operation of choice.
Surgeon Tasks:
- restoration of the muscular apparatus of the upper lip;
- red border correction;
- formation of the normal size of the vestibule of the mouth;
- restoring the correct position of the wings of the nose;
- symmetry correction;
- formationthe bottom of the nasal passages.
In most cases, such techniques are used so that scars and scars are as little noticeable as possible. Correctly selected intervention technique, the degree of primary deformation of tissues and cartilage, and the correct management of the postoperative period are factors that determine the need for secondary surgery after the patient's full recovery.
One-sided pathological process allows the operation to be performed when the child reaches 3 months of age, bilateral - after six months. After plastic surgery, the child is fed either from 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 that is used constantly.
Rhinocheilognatoplasty
Children with cleft lip and palate can get rid of the pathology with the help of such an intervention. This operation is aimed at eliminating anatomical disorders of the nose, upper lip and alveolar process. Allows for correction of through defects. Bilateral cleft lip and palate is one of the indications for rhinocheilognatoplasty.
The optimal period for the operation is children's age, while the permanent bite is not yet fully formed, and the eruption of the upper canines has not yet occurred.
Cycloplasty
Cleft lip and palate is restored using several surgical techniques simultaneously. Specialists combine elements of cheilorhinoplasty and veloplasty (correction of the soft palate). The intervention is carried out with the following goals:
- restoration of swallowing function;
- correction of breathing processes;
- restoration of phonation and speech.
If a child can learn to eat in such a way that food does not get from the oral cavity into 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 develops his individual abilities (singing, reciting poetry).
Veloplasty is carried out from the age of 8 months. Usually, the operation is well tolerated, and after 1-2 days the baby can eat on his own.
Palatoplasty
Children with cleft lip 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 congenital defect has affected not only the lip, alveolar process and soft palate, but also the hard palate, this condition is an indication for palatoplasty.
After correcting the anatomy of the soft palate, the gap in the hard palate automatically narrows. By the age of 3-4, it becomes so narrow that it is possible to restore integrity without significant traumatic disorders. This two-stage correction has the following advantages:
- early restoration of conditions for the normal development of speech function;
- Barrier for disorders in the growth zones of the upper jaw area.
One-stage recovery is possible, but in this case, the risk of underdevelopment of the upperjaw.
Bone grafting
This operation is performed by a surgeon but coordinated with an orthodontist. It is carried out during the period of change of temporary occlusion to permanent (7-9 years). During the intervention, an autograft is taken from the patient's tibia and transplanted into the area of the alveolar process cleft. The graft allows you to restore the integrity of the upper jaw bone 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 require secondary plastic surgery, the purpose of which is:
- appearance correction;
- restoring speech function;
- elimination of abnormal messages between two cavities (nasal, oral);
- moving and stabilizing the upper jaw.
1. Upper lip
Most patients who want to correct the upper lip, focus on the fact that after the initial intervention there was a scar. The desire to eliminate it and leads to the surgeon. It must be remembered that any scar or scar can be made less noticeable, reduced in size, but it is impossible to get rid of it completely.
Frequent deformations:
- unnatural curvature of the red border;
- asymmetry;
- violation of the functions of the muscular apparatus;
- abnormally full.
2. Nose
Anomalies of the upper lip are combined with the deformity of the nose. Secondary nasal 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, and restore the nasal septum, rhinoplasty is performed.
Minor changes that need correction can be made in early childhood. Extensive interventions are allowed only after the age of 16-17, when the facial skeleton is fully formed.
3. Soft sky
Complex clefts and their primary surgery can result in velo-pharyngeal insufficiency. This is a pathological condition, accompanied by a nasal voice, slurred speech. Surgical manipulations are aimed at eliminating the speech defect.
Surgery is allowed at any age, but before that it is better to consult a speech therapist and confirm the impossibility of correcting speech in other ways.
It is impossible to assess the result of the operation on the soft palate prematurely, 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 carried out:
- repeated muscle plasticity without or with simultaneous lengthening;
- plasty of the soft palate using a pharyngeal flap.
A feature of the late postoperative period is work with a qualified speech therapist and audiologist.
4. Oronasal fistulas
This is a common problem in patients operated on for cleft palate and lip. A fistula is an opening between two cavities. Frequent localization - the area of the alveolar process, hard palate. At an early age, such holes cause food to enter the nose, but children learn to control the condition. It also results in a nasal and slurred voice.
Oronasal fistulas are eliminated by bone grafting with the formation of the bottom of the nasal passages.
Conclusion
Cleft lip and palate, a disability in which remains in question, refers to congenital conditions. In the case of a combination of bilateral severe pathology with other anomalies, disability may be obtained.
The presence of a single pathology without concomitant anomalies of a congenital nature is indicated as such that does not prevent a person from serving himself independently and is not accompanied by deviations in other areas (mental, psychic, sensory). In such clinical cases, the patient is not recognized as disabled.
