Cleft palate is the most common congenital deformity. The defect is expressed in the divergence of the tissues of the upper lip and / or palate. It occurs when parts of the face do not fuse together properly during the development of the fetus in the womb. Patients with this malformation require special care. The development of speech, feeding, growth of the face and jaw, the appearance of the dentition are just a few important stages in the life of a child, with which certain difficulties may arise. A significant number of patients have associated syndromes that can lead to heart disease, limb disease, or other systemic defects.
Incidence rate
Cleft palate can be diagnosed as early as the 17th week of pregnancy with an ultrasound. Many studies have been carried out, but the exact environmental and genetic factors that play a role in the development of the defect are still not known.
About halfof all affected babies are born with cleft palate, a quarter with cleft lip, another part with cleft lip and palate. Boys are more likely to have cleft lip or combined cleft lip and palate, while girls are more likely to have cleft palate.
Etiology
The formation of the palate begins at the end of the fifth week of pregnancy. At this stage, the sky consists of 2 parts: front and back. The fusion of the hard palate begins from the eighth week. The process is completed between the 9th and 12th weeks of pregnancy.
All parents have a 1 in 700 chance of having a child with cleft palate. Hereditary cases are between 2.5 and 10%.
As previously mentioned, the etiology of cleft palate is not well understood. However, there is evidence that external factors may play a role in the development of the defect. These include:
- use of alcohol or drugs during the formation of the organs of the embryo;
- smoking during pregnancy;
- maternal obesity;
- lack of folic acid during pregnancy;
- taking certain medications while carrying a child (eg Methotrexate).
Mechanical clefts can occur through direct impact on the fetus. Genetic mapping of families with inherited forms of cleft palate has shown that newborns have a defect in the TBX22 gene, which is involved in the development of the palate.
Diagnosis
Most open crackshard and/or soft palate are found at birth. Usually they appear with the appearance of difficulties in feeding the baby. Sucking may be impaired due to the inability to properly latch onto the breast, bottle, or nipple. A cleft palate can also lead to breathing difficulties as the tongue gets trapped in the nasal cavity and back of the throat.
Partial fissures of the soft palate may not be diagnosed in newborns due to the absence of symptoms. Early manifestations are nasal reflux of liquid or food. At a later age, speech disorders are observed.
Symptoms
The cleft can look like a hole in the back of the soft palate, and also widen towards the throat until the upper part is almost completely separated. In addition to affecting appearance, cleft lip and palate can also cause a number of related symptoms, which are described below.
- Feeding problems. Because of the cleft, the baby cannot suckle and swallow milk. This problem is solved with a special bottle.
- Ear infections and hearing loss. In children with cleft palate, fluid builds up in the middle ear, leading to hearing loss and infections.
- Speech and language problems. If the cleft palate is not repaired after surgery, it will lead to speech problems later in life.
- Dental he alth. Cleft lip and palate can cause changes in the structure of the mouth and lead to problems with tooth development, making children more vulnerable to cavities.
- Psychological trauma.
Methodstreatment
The main type of treatment for cleft palate is a surgical operation - uranoplasty. Most often, this procedure is performed before the patient is 1 year old. In some cases, surgery may be postponed to a later period for medical reasons. For example, due to congenital heart disease or airway obstruction. There are several methods of surgical repair of palate defects:
- Radical Limberg Uranoplasty.
- Sparing plastic surgery proposed by L. E. Frolova and A. A. Mamedov.
The plastic surgeon combines the muscles and tissue of the palate to close the hole. This procedure is performed under general anesthesia only.
Due dates
Uranoplasty is an operation to correct a defect in the hard palate. There is no consensus regarding the age restrictions for the operation. Some surgeons consider the optimal age for such a manipulation to be 10-14 months. The opinion of the majority is unanimous: all operations should be done at preschool age.
Most often, cleft repair is performed before the age of 1 year, before significant speech development occurs.
The operation can be carried out in 1 or 2 stages. If the doctors decided to correct the defect at once, then the procedure is carried out at the age of 11-12 months. In other cases, the 1st stage of cleft correction is performed first at 3-4 months. During this period, the soft palate is restored. As the child growsthe size of the cleft can decrease by 7%. Next, uranoplasty is performed for children at the age of 18 months. Two-stage repair is suitable for patients with a large cleft.
When the correction of palate defects is delayed until a later age, the operation consists in applying a flap. This can help close the defect and compensate for speech disorders.
The purpose of uranoplasty is to separate the mouth and nose. It consists in creating a waterproof and hermetic valve. It is necessary for the normal development of speech. Uranoplasty of the palate is also necessary to maintain the proportions of the face with the growth of the child and the correct formation of the dentition. Early correction of defects reduces the risk of speech delay. However, one of the negative effects of having surgery at an early age may be limiting the growth of the upper jaw.
Preparation
Before uranoplasty, children should be assessed according to the following criteria:
- sufficient level of hemoglobin and platelets;
- no infections and inflammatory diseases;
- no injuries;
- full-term;
- absence of congenital heart disease and other systemic diseases.
Defect elimination
Uranoplasty is a technique for restoring a defect in the hard palate. For both cleft lip and palate, surgical repair begins with incisions in the tissue on each side of the cleft. During a cleft palate operation, the surgeon transfersmucous membrane and muscle into the open space, covering the palate. During the operation, defects associated with cleft lip, such as correction of the shape of the nose, can also be corrected.
Limberg Uranoplasty
This is a reconstructive operation to repair a cleft palate. The procedure takes place in 3 stages:
- Closing the inner layers that form the nose pad.
- Closing the middle layers made up of the muscles at the back of the palate.
- Suturing the oral mucosa.
When carrying out Limberg uranoplasty, all these 3 stages are combined in one operation. The method is named after Professor Alexander Alexandrovich Limberg. The scientist wrote many works in the field of restoration of cleft palate, mandible using L-shaped osteotomies and bone grafts. Radical uranoplasty simultaneously restores the shape and function of the hard palate.
Limberg surgery is performed on older children (10-12 years old). The disadvantage of the method is a long recovery due to the use of traumatic techniques during surgery, as well as the late age of patients.
Sparing plastics
Babies under 2 years of age are usually operated on using a sparing technique, which allows the child to develop speech skills. Radical uranoplasty affects the slowing of jaw growth.
The sparing plasty method is based on the gradual elimination of defects. Up to a year - these are operations to correct the lips and on the soft palate. At the age of 2-3 years -correction of defects in the hard palate. With bilateral pathology, surgery to correct the cleft on one side and the other is performed with a difference of 2-3 months.
Post-operative period
After palatal surgery, patients need to maintain a diet limited to liquids and soft foods that do not require chewing. The use of bottles and nipples is also prohibited. Feeding is carried out using a syringe, catheter or soft (silicone) spoons. Normal diet and feeding can be resumed after 10-14 days, depending on the type of surgery. After 3 weeks, all restrictions are lifted.
Nasal congestion and pain that may occur after uranoplasty are relieved by medication. Oral hygiene should be carried out by rinsing with clean water. Thorough brushing can be resumed after 5-7 days.
After discharge from the hospital, the patient should be examined every 7-10 days for 3 weeks. If fistula formation or damage to the postoperative wound occurs during this period, subsequent correction can be carried out no earlier than after 6 months. This is necessary to restore the blood supply to the tissues.
Some aspects:
- The recovery period after uranoplasty takes up to 3 weeks. All this time it is necessary to be under the supervision of a doctor.
- Antibiotics are prescribed to prevent infection.
- The stitches dissolve on their own after a while.
- Discharge of blood from the nose and mouth, swelling -these are normal signs of the postoperative period.
Possible Complications
Uranoplasty is an operation with risks and complications, for example:
- airway obstruction;
- seam divergence;
- bleeding;
- fistula formation.
Long-term complications may include the following symptoms:
- speech disorder;
- Misalignment of teeth;
- otitis media (inflammation of the middle ear);
- hypoplasia (underdevelopment) of the upper jaw.
Observation
Depending on the age of the child, the follow-up and treatment plan consists of the following steps:
- Babies under 6 weeks of age should be screened for cleft lip and palate, hearing screening and feeding evaluation.
- At 3 months, cleft lip surgery is performed.
- at 6-12 months - cleft palate repair surgery.
- Speech assessment at 18 months of age.
- at 3 also speech grade.
- 5 years: assessment of speech development.
- at 8-11 years old: placement of a bone graft in the gums (alveoli).
- Orthodontic treatment is carried out from 2 to 15 years old.
After completing these steps, the patient should undergo regular check-ups to assess their he alth and eliminate possible complications.
Reviews
After uranoplasty, children experience a significant improvement in the quality of lifepatients. Parents note that the correction of the defect eliminates difficulties with nutrition and breathing. Reviews about uranoplasty are mostly positive, regardless of the method of operation.
