Cleft lip and palate: causes and correction

The birth of a baby is a welcome moment for many. But there are cases when joyful news is accompanied by events, to which parents did not prepare in advance. Such surprises include congenital anomalies and defects that cloud the child's appearance.

Cleft lip and palate is the most common congenital defect of the face. In the people, the anomalies are called "bunny lip" (cleft lip) and "wolf mouth" (cleft palate). Their formation occurs in the first trimester of pregnancy, from 5 to 11 weeks of embryonic development.

Etiology

"Bunny's 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 state, and can be combined with a cleft palate.

"The wolf's mouth" is a rupture, the non-opening of the sky in its central or lateral part. It can be located in a certain area (anterior bone tissue or soft tissue of the posterior palate) or run along the entire length.

On the mother's body during pregnancy can be adversely affected by a number of factors, resulting in the appearance of an anomaly, such as cleft lip and palate. The causes of the pathology are as follows:

1. Hereditary predisposition - in a person born with a cleft, there is a probability of transferring this condition to the inheritance of his child in 7-10% of cases.
2. Diseases of viral genesis, transferred by the mother in the first trimester of pregnancy (rubella, cytomegalovirus, herpesvirus infection, toxoplasmosis).
3. Heavy environmental and radiation situation in the area of residence of a woman at the time of bearing a child.
4. Chronic diseases and administration of drugs with a teratogenic effect against their background.
5. Harmful habits of the mother (alcohol abuse, smoking, use of narcotic drugs).

Classification of cleft lip and palate

On the basis of anatomical and physiological characteristics, a classification of clefts was developed. For the convenience of perception, we will present the information in the form of a table.

Group	Subgroups	Subgroup Features
Separated cleft lip	Submucosal	On the one hand, from 2 sides
	Incomplete (with deformation of the nose or without it)	On the one hand, from 2 sides
	Complete	On the one hand, from 2 sides
Separated cleft palate	Those that affect only the area of the soft palate	Submucous, incomplete, complete
	Those that affect the area of soft and hard palate	Submucous, incomplete, complete
Complete cleft palate and alveolar process	On the one hand, from 2 sides
Clefts of anterior part of soft palate, upper lip and alveolar process	On the one hand, from 2 sides
Through crevices affecting the upper lip, alveolar process, hard and soft palate	From one side	Right-hand, left-sided
	From 2 sides
Cleft lip and palate (photo below) of an atypical nature

Diagnostics

Pathology is determined even during pregnancy. The congenital cleft of the upper lip and palate is visualized already at the 16-20th week of embryonic development. In case all three basic ultrasound examinations the kid turns away from the sensor of the device so that it is difficult to make out the structures, there may be a false result of the examination.

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 was born sick, and as a result, the child was no different from his peers. Or, on the contrary, parents were sure of the strong health of the baby, and he was born with pathology.

Feeding a child with an anomaly

Before it comes to eliminating the problem, you need to solve the issue with the nutrition of the baby. 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 the child has only an anomaly of the structure of the lips, then problems with the gripping of the lips of the nipple and suction it will not. Cleft lip and palate or only the sky requires a certain modification of the baby to eat, since 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, so the air enters the oral cavity and, accordingly, into the stomach. Toddlers need a long horizontal position after eating, so that extra air bubbles come out. The first months of life are accompanied by frequent colic, regurgitation, may even reach vomiting.

Feeding rules:

1. Use either breastfeeding or feeding with a bottle (from a cup or spoon to feed it is not necessary).
2. Massage the mammary glands before feeding. This will increase the amount of reflexively supplied milk, and the baby will not have to exert much effort.
3. Observe the rules of feeding on demand. It is more often to put the baby to the chest.
4. To carry out finger squeezing of the areola, which allows increasing the bulging of the nipple. If necessary, use special pads, choosing the size of the mouth of the child.
5. When feeling unsatisfied, the remainder of the milk should be collected by the breast pump and fed from the bottle. The nipple is also selected individually, taking into account anatomical features.

Principles of treatment

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

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

• Cheyloplasty;
• Rhinoheyloplasty;
• Rhinoheylognathlasty;
• Veloplasty;
• Palatoplasty;
• Bone plastic.

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

Rhinoheyloplasty

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

Tasks of Surgeons:

• Restoration of the muscular apparatus of the upper lip;
• Correction of the red border;
• Formation of normal size of the vestibule of the mouth;
• Restoration of the correct arrangement of the wings of the nose;
• Symmetry correction;
• Formation of the bottom of the nasal passages.

In most cases, such techniques are used so that scars and scars are as little visible as possible. Correctly selected technique of intervention, the degree of primary deformation of tissues and cartilage, and the correct management of the postoperative period are factors determining the need for secondary surgery after complete recovery of the patient.

A one-sided pathological process allows an operation to be performed after reaching the 3-month age of the child, a bilateral one after six months. After plastic the baby 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, which is used constantly.

Rhinoheylognatoplasty

Children with cleft lip and palate can get rid of pathology with the help of such intervention. This operation is aimed at eliminating anatomical disorders of the nose, upper lip and alveolar process. Allows to correct the through defects. Two-sided cleft lip and palate - one of the indications for rhinoheylognatoplasty.

The optimal period of the operation is the child's age, while the permanent bite is not fully formed yet, and also the eruption of the upper canines has not occurred.

Veloplasty

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

• Restoration of the swallowing function;
• Correction of respiration processes;
• Restoration of phonation and speech.

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

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

Palatoplasty

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

After correcting the anatomy of the soft palate, the crevice in the solid automatically narrows. By 3-4 years it becomes so narrow that it is possible to restore integrity without significant traumatic disturbances. This two-stage correction has the following advantages:

• Early recovery of conditions for the normal development of speech function;
• Barrier for violations in areas of growth of the area of the upper jaw.

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

Bone plastic surgery

This operation is performed by the surgeon, but is coordinated with the orthodontist. It is performed during the period of the temporary bite change to a permanent (7-9 years). During the intervention, take the autograft from the tibia of the patient and transplant it into the cleft of the alveolar process. The transplant allows 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 - a congenital anomaly that can leave a mark on the face of a person throughout his life. Most patients need a secondary plastic surgery, the purpose of which is to:

• Correction of appearance;
• Restoration of speech function;
• Elimination of abnormal messages between two cavities (nasal, oral);
• Movement and stabilization of the upper jaw.

1. Upper lip

Most patients who want to correct the upper lip focus their attention on the fact that after the primary intervention a scar remained. Desire to eliminate it and leads to a surgeon. It must be remembered that any scar or scar can be made less visible, 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 muscular apparatus;
• Pathological fullness.

2. The nose

Abnormalities of the upper lip are combined with deformation of the nose. Secondary nose surgery is required for almost all patients. Degree of deformation depends on the severity of the primary pathology. Rhinoplasty is performed to correct asymmetry, aesthetic appearance, restoration of the nasal septum.

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

3. Soft sky

As a consequence of complex clefts and their primary surgery, velo-pharyngeal failure may result. This pathological condition, accompanied by nasal voices, indistinct speech. Surgical manipulations are aimed at eliminating the 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 estimate the result of the operation in the soft palate prematurely, since the muscular apparatus of this region is very sensitive to external interventions, which means that cicatricial changes after primary surgery are always significant. To restore the functional features, the following manipulations are carried out:

• Repeated muscular plasty without or with one-stage elongation;
• Plastic soft palate using a pharyngeal flap.

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

4. Oronasal fistulae

This is a common problem for patients who undergo surgery for cleft palate and palate. Fistula is the opening between two cavities. Frequent localization is the area of the alveolar process, the hard palate. At an early age, such a hole causes food to enter the nose, but the children are trained to control the condition. Also, the result is a nasal and vague voice.

Elimination of oronasal fistulas is carried out by bone plastic with the formation of the bottom of the nasal passages.

Conclusion

Cleft lip and palate, disability at which remains in question, refers to congenital states. In the case of a combination of bilateral heavy pathology with other anomalies, disability can be obtained.

The presence of a single pathology without accompanying anomalies of a congenital nature is indicated in such a way that it does not prevent a person from self-serving and is not accompanied by deviations in other spheres (mental, psychic, sensory). In such clinical cases, the patient is not recognized as an invalid.