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 development of the fetus in the mother's womb. Deformities occur when there is not enough tissue in the area of the lips and mouth. The existing fibers are connected incorrectly.
What the deformations look like
Cleft lip is a cleft of both sides of the upper lip, caused by physiological abnormalities. The defect looks like a narrow gap or hole in the skin. The cleft is often located not only on the upper lip, but also extends into the nasal region, and can also affect the bone tissue of the upper gum and jaw.
What is the cleft palate? This deviation has the form of a hole or a crevice. It is observed in both soft and hard palate. This defect of the oral part of the face is quite common. For every 1,000 newborns, there is one suchpathology. Often the deviation is observed in conjunction with a cleft lip.
At the present time, scientists know three genes whose mutations contribute to the formation of the cleft palate. Research in this area is ongoing. After all, a gene defect in the development of a deviation is determined in only 5% of cases of the described disease.
Sky split options
In the case of the development of the cleft palate, the splitting of the palate can be complete - both in hard and soft tissues, and incomplete - in the form of a hole. Pathology often proceeds in conjunction with a bifurcation of the tongue (meaning 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 congenital abnormalities.
Wolf mouth: causes of formation
The formation of the cleft palate is due to genetic predisposition. It is also clearly seen in the process of development of the pathology that the mother’s addictions affect the fetus: alcohol and drug use, smoking. In the case of a deficiency in the diet of folic acid and obesity of a pregnant woman, there is also a risk of inferior formation of the upper jaw of the fetus.
The cleft palate can also develop in a child in the womb due to the unfavorable environment surrounding the expectant mother, the presence of acute infections or toxicosis, mental or mechanical injuries.
Manifestations of the cleft palate
Wolf mouthcauses problems for children from the moment they are born. During labor, aspiration of amniotic fluid into the baby's airways may occur. The process of air entering the body of a newborn with a cleft palate is difficult, the sucking process is impossible, as a result of which the child may lag behind in development and weight from his peers. Until the moment 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 dysfunction 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.
Symptomatics
Children with such a pathology as the cleft palate, due to the disturbed natural process of the formation of sounds, speech is changed. There is rhinolalia. This is a process of distortion of the timbre of the voice and pronunciation of sounds due to improper closing of the palate and pharynx. In this case, the inhaled air freely exits through the nose, into which the consumed drinks and food penetrate. Through the palatine cleft, fluid can enter the Eustachian tubes, which leads to the development of sinusitis and otitis media. Also, with the cleft palate, the teeth and bite are deformed, as a result of which the chewing process is disturbed.
What to do if your child has a cleft palate
The cleft palate in children can be successfully corrected if parents seek medical help in a timely manner.specialist. The success of therapy largely depends not only on doctors, but on the perseverance, perseverance and patience of the patient's loved ones. To achieve a positive result, it is necessary to strictly adhere to all the recommendations of the doctor. If this pathology is found in a child, it is necessary to show it to a surgeon so that the doctor can draw up a treatment plan.
Diagnosis
You can detect a cleft palate defect with the help of routine ultrasound screening of the fetus already at about the 15th week of pregnancy. But the volume and shape of the lesion can be considered only after the birth of the baby. If the cleft palate is found in an unborn child during an ultrasound examination, then additional research methods are required. This deviation is fraught with pathologies of the development of the cranium, hearing impairment, deterioration in breathing and smell. The diagnosis of "wolf palate" is established immediately after the birth of the child. In this case, the degree of the defect and its type are determined by examining the baby's throat.
Principles of cleft palate therapy
The treatment of the cleft palate is carried out exclusively by the surgical method. There are also several cosmetic surgeries. Preference is given to uranoplasty - a surgical method in which the soft palate is lengthened, its muscles are connected in the right direction, and the middle part of the pharynx narrows.
The process of sucking a newborn after the operation is practically impossible, as this causes severe pain, there is a risk of rough scarring and slows downwound healing. Therefore, you should first teach the baby to eat from a special spoon.
Treatment tactics
Depending on the degree of splitting of the cleft palate, the surgeon chooses the tactics of the therapeutic process.
Uranoplasty is recommended for patients with a regular upper jaw dentition at the age of two years and older. In this case, the cleft palate must be incomplete.
In case of violation of the integrity of the process of the alveoli and narrowing of the upper jaw, it is recommended to carry out treatment with an orthodontist before the operation. These deviations are caused by through cleft palate. Uranoplasty in this case is performed 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 surgery of the soft and hard palate in order to narrow the middle part of the pharynx. The second stage of treatment is carried out six months later. It consists in closing the cleft of the hard palate (its anterior part) and the process of the alveoli. At the same time, bone tissue grafting 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 the Limberg operation. At the present time, this is the main way to eliminate a congenital defect of the palate. If the wolf's mouth is combined in one case with the cleft lip,then cheiloplasty is additionally performed. This is an operation during which the upper lip is corrected.
Before uranoplasty, careful planning is carried out separately in each specific case. In this case, an individual selection of plastic material is carried out to eliminate the splitting of the palatine tissue. Modern methods of uranoplasty and highly qualified surgeons are able to restore the natural, full-fledged structure of the upper jaw and larynx in approximately 95% of patients.
Radical method of uranoplasty for cleft palate
Sometimes the "cleft palate" disease requires a radical correction of the hard and soft palate. At the same time, a complex set of problems is solved. This is the restoration of the natural continuity of the tissues of the sky and their size, and the elimination of improper muscle attachment, and their connection to their normal position. Also, the complex of tasks during uranoplasty includes the prevention of damage to the nerves that provide muscle contraction, as well as the stable fixation of the shape, structure and functions of the organs undergoing surgery.
Such a radical method of therapy is recommended for patients aged 3 to 5 years in case of non-through clefts in the sky, at 6 years old - through. This operation can cause a delay in the development of the jaw, if performed earlier. Gentle methods of uranoplasty can be used to treat cleft palate as early as the age of 2 years.
Preoperative period
In the period precedinguranoplasty, 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.
Period after surgery
In the postoperative period, after the cleft palate is corrected, the patient needs bed rest for 2-3 days, eating only pureed food 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. You need to inflate balloons several times during the day. 2 weeks after the operation, it is necessary to regularly carry out a special set of exercises and massage the soft palate with your fingers.
In order to prevent the development of infection, 5-7 days after uranoplasty, complex antibiotic therapy is used. Painkillers are used to relieve pain.
After the operation, a scar remains on the face. The patient is discharged from the hospital 3-4 weeks after uranoplasty.
Features of surgery
The cleft palate in humans causes repeated operations after uranoplasty. Such intervention should be carried out no earlier than one year later. These methods of treatment are aimed at eliminating postoperative defects. Approximately 12 months is enough to restore blood flow in soft and bone tissues.
In the case of a sufficiently large area of the cleft palate, when it is not possible to blockcleft with local tissues, muscular-mucous flaps 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, defectologist are required. Treatment by an orthodontist is required, which controls the development of the jaw and, if necessary, will provide the ratio of the dental arches.
Help speech therapist and otorhinolaryngologist
Speech therapist will help to put the correct speech to patients diagnosed with "cleft palate". This specialist consults with patients who have reached the age of two. He regulates external breathing in various ways.
The otorhinolaryngologist should conduct systematic monitoring of children with cleft palate. With this pathology, chronic diseases of the ENT organs can develop, which occur 10 times more often than in he althy 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, it is necessary to timely treat and prevent tonsillitis, pharyngitis, rhinitis, otitis media.
Cleft lip and palate: problems associated with deviations, their solution
Difficulty eating
With a cleft palate, fluid and food can pass through the nose back into the mouth. Specially designed nipples and bottles are used to transport food and drinks in the right direction during the feeding process.
Sometimes with a cleft palate, children have to install an artificialsky. It is used before surgery to facilitate food intake and sufficient saturation of the child.
Ear space infections and deafness
Children with cleft palate tend to develop and accumulate fluid in the middle ear. Therefore, they often develop hearing ailments more often than usual, and sometimes the ability to hear sounds disappears altogether. To prevent such complications, tubes specially designed for fluid drainage are installed on the eardrums. Hearing quality testing should be done at least once a year.
Speech problems
With a cleft palate, the voice sounds bad. This problem is solved by surgery or with the help of a speech therapist.
Tooth problems
With cleft lip and palate, caries often forms on the teeth and their curvature or displacement occurs. Such deviations are corrected with the intervention of a dentist or orthodontist.
