Wolf's mouth

Cleft palate is a congenital developmental anomaly that manifests itself as non-closure of the hard and soft parts of the palate, resulting in a connection between the nasal and oral cavities.

The defect is caused by delayed fusion of the vomer with the outgrowths of the upper jaw. The frequency of pathology reaches 0.1% among newborn children.

The cleft may be complete, when there is an unfused area of the soft and hard areas, or incomplete - when only an opening in the palate is observed. Among all congenital mutations, cleft palate is considered a common anomaly, which is sometimes noted with bifurcation of the uvula.

The causes of cleft palate include a genetic defect that occurs in the TBX22 gene. However, there are factors that contribute to the formation of this defect. These include mutagenic effects on the fetus, both from the outside world and the body of the expectant mother. Smoking, alcohol consumption and drug use during pregnancy play a special role in the occurrence of mutation.

Also, do not forget about diseases such as endocrine pathology, metabolic disorders and insufficient intake of folic acid. The risk of pathology increases in the presence of toxicosis in the pregnant woman, previous infectious pathologies, mental or mechanical injuries.

It is worth noting that it is in the first three months of pregnancy, when the fetus is especially vulnerable, that the structures of the maxillofacial apparatus are laid down. The negative impact of damaging factors during the first trimester leaves the most significant imprint on the health of the fetus.

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Causes of cleft palate

Despite the assumptions about the genetic path of pathology development, it is still customary to separately identify factors that increase the risk of this pathology. Over many years of research, several predisposing factors have been identified. These include aggravated responsibility, when cases of pathology development have already been observed in the family. If one of the parents in the family had a cleft palate, then the risk of this pathology in the baby increases 7 times in relation to other children.

If the parents have this developmental defect, the probability of the child developing a cleft palate ranges from 10% (if the pathology is observed in one of the parents) to 50% (if both).

The causes of cleft palate also lie in the lifestyle of the pregnant woman, because smoking, drinking alcohol and drugs have a negative impact not only on the formation of cleft palate, but also on the development of the entire body as a whole. Statistics indicate that smoking 1 to 10 cigarettes a day by a pregnant woman increases the likelihood of cleft palate by 30 times. At the same time, a pack of cigarettes increases the risk to 70%.

One should not forget about various diseases of infectious genesis, intrauterine infections, concomitant chronic pathology of the expectant mother, including sexually transmitted infections. All of the listed pathological conditions and disorders of organs and systems are the background for the occurrence of cleft palate.

Among the environmental factors that have a negative impact, it is necessary to note the professional hazards of both parents, living in areas contaminated with radioactive or chemical radiation. In addition, the likelihood of developing not only anomalies of the maxillofacial region, but also other organs during the first pregnancy after 35 years increases. The process of bearing a fetus itself is quite difficult for a woman, not counting possible complications during childbirth.

The reasons may include metabolic disorders with the development of obesity, taking medications in high doses, especially those drugs that are contraindicated during pregnancy. Concomitant factors include insufficient intake of folic acid, exposure to stressful situations with a disruption of the psycho-emotional state and toxicosis of pregnant women.

Taking these factors into account, it can be concluded that a mutation can be formed as a result of the harmful effects of a large number of factors, including being an accidental breakdown. The genes found through research are guilty only in 5% of cases, and therefore further research continues.

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Signs of a cleft palate

From the moment of birth, the signs of a cleft palate can complicate the process of labor, as there is a risk of aspiration of amniotic fluid by the baby's respiratory organs. The breathing process causes a lot of difficulties for the baby, sucking is practically impossible.

As a result, the child cannot fully develop due to insufficient oxygen supply and the development of hypoxia of the brain. The lack of adequate nutrition also slows down the growth of the baby, which threatens the development of rickets and underdevelopment of organs. Such children lag behind their peers, since their physical and mental levels are at a lower level of development.

Feeding a baby with an anomaly requires a special approach, because it requires a special spoon that is put on the bottle. Thus, speech and hearing suffer, which significantly reduces the child's self-esteem, not counting the visual defect.

Speech formation is complicated by the incorrect growth of teeth, and the expression of speech disorders is represented by rhinolalia. Due to incorrect bite, the chewing process is disrupted, due to which food is not thoroughly ground and is poorly digested in the stomach.

The defect of the palate causes free transport of inhaled air from the nasal to the oral cavity. The same thing is observed during eating, when liquid and food can enter the nasal cavity. In addition, liquid can be thrown into the Eustachian tubes and nasal sinuses through the cleft, causing otitis or sinusitis.

The development of frequent respiratory diseases is caused by the lack of warming of air and its purification as it passes through the upper respiratory tract.

Cleft lip and cleft palate

Cases of formation of a harelip parallel to a cleft palate are registered quite often. In addition to the anomaly of the upper lip, other mutations in the structure of the facial part and the apparatus for ensuring the auditory function are noted.

Cleft lip and cleft palate are formed in the first trimester of pregnancy, when all organs are laid down. Developmental anomalies are observed when there is not enough tissue for the normal formation of facial structures, or it does not grow together properly.

A cleft lip is a cleft in the upper lip that visually resembles a narrow opening in the skin. In some cases, the non-closure extends to the nasal area and the bone structures of the upper jaw and gums.

A palatal defect or so-called cleft palate may involve the hard and soft parts in the pathological process. These anomalies are localized on one or both sides of the oral cavity. Due to the fact that the formation of the palate and lips is noted separately, developmental anomalies may be noted together or separately from the cleft palate.

The cleft lip mutation is considered the fourth most common among congenital developmental anomalies. The causes of the combined developmental anomaly are still unknown, and therefore there is no prevention to prevent these mutations. There is an opinion that genetic factors in combination with environmental factors play a certain role in the formation of cleft lip with a wolf part. The risk of development in children is especially increased if the mutation is observed in parents or relatives.

In addition, there is a certain risk when a pregnant woman uses certain medications. They increase the likelihood of abnormal development of the lip and palate. Among these drugs, it is worth highlighting anticolvusants, drugs that include accutane, as well as cytostatics used to treat cancer, such as methotrexate. Also, the appearance of a mutation in the fetus can be provoked by viruses or other chemicals. Quite often, these mutations can be one of the manifestations of a disease.

Cleft palate in children

In most cases, it is such a congenital pathology as cleft palate that causes many problems in children. The cleft in the palate is laid down during intrauterine development, in particular in the first 3 months of pregnancy. Sometimes there is a mutation of cleft palate in combination with harelip.

Based on the severity of the pathological process, 4 types of pathology are distinguished. Thus, the mutation can manifest itself as non-closure of the soft part of the palate, soft in combination with the hard part, as well as complete non-closure of both areas on one side or on both.

When diagnosing a mutation, the doctor only needs to perform a visual examination and assess the severity of the process, in particular the impairment of breathing, speech and swallowing functions. In addition, with the help of instrumental diagnostic methods, the diagnosis is confirmed, and hearing loss, anomalies in the structure of the skull, patency of the nasal passages and many other defects are established.

In approximately 75% of all cases, cleft palate in children is the only developmental anomaly. However, if it is present, it is recommended to start treatment as early as possible to avoid disruption of other organs and systems.

Cleft palate in newborns

Since cleft palate in newborns is not so rare, sometimes in combination with other defects, scientists around the world are trying to find the genes that cause the development of the mutation. At the moment, only 3 genes are known that are responsible for the congenital developmental anomaly. However, of all cases, they play a leading role in only 5%, in the remaining 95%, the breakdown is noted in other information carriers.

Cleft palate leads to many problems from the moment of birth. Even during labor, there is a risk of the baby aspirating amniotic fluid into the respiratory tract. In addition, there are disturbances in the respiratory function itself and the act of sucking the breast, as a result of which the baby lags behind in development and does not gain enough weight for his age. The brain experiences hypoxia, that is, insufficient oxygen supply as a result of inadequate breathing, which leads to a delay in both physical and mental development. Feeding of such children is carried out with a special spoon, which is put on the bottle.

A cleft palate interferes with normal digestion, breathing, speech development, auditory function, and is also the cause of a child's low self-esteem. Impaired speech occurs due to abnormal tooth growth, which manifests itself as open rhinolalia.

Children often have respiratory diseases, as the air that enters the respiratory tract is cold, not humidified and not purified. In addition, the inhaled air freely exits through the nose, and food products also enter the nasal cavity through the defect, which leads to frequent sinusitis.

Cleft palate syndrome

The formation of a gap in the soft and hard parts of the palate occurs during pregnancy, particularly in the first trimester. The developmental anomaly may be the only pathology in the baby or be a clinical sign of another disease. Thus, cleft palate can be observed in such syndromes as Stickler or Loeys-Dietz.

Cleft palate syndrome causes disturbances in many functions of the body. Thus, through the gap in the palate, food and liquid can freely penetrate into the nose during feeding, developing sinusitis. Food getting into the Eustachian tube leads to the development of such a complication as otitis.

The digestion process is also disrupted due to improper bite formation due to improper development of teeth. The baby requires special feeding, since sucking the breast in the neonatal period or using a regular spoon does not allow for swallowing food.

As for the respiratory function, the act of inhalation does not provide sufficient oxygen to the lungs, which leads to hypoxia of the brain and the development of complications. In addition, unhumidified, unpurified and unwarmed air immediately enters the respiratory tract, which contributes to frequent inflammatory processes.

Despite the severity of the situation, with the help of surgical intervention and further work of a speech therapist, ENT doctor and neurologist with the child, it is possible to restore the impaired functions.

Diagnosis of cleft palate

Considering that the developmental anomaly is formed in utero, when the organs and systems are laid down and developed, early diagnostics of cleft palate is carried out during pregnancy, when the term reaches 14-16 weeks. Each pregnant woman undergoes a routine ultrasound when registering, with the help of which the fetus and existing developmental anomalies (if any) are visualized. Such studies are periodically repeated throughout the pregnancy, since not all mutations can be detected during the first ultrasound.

In addition, it helps control the growth and development of the fetus, which is also very important. However, cleft palate cannot always be diagnosed at this stage, and its severity can only be determined after the baby is born.

Accurate diagnostics are carried out after the doctor examines the child's pharynx after birth. Often there is a combined pathology, when in addition to a cleft palate there is a harelip, but do not be upset, because the defects can be hidden with the help of a surgical operation even before complications develop.

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Treatment of cleft palate

For a long time, cleft palate has been treated surgically, which effectively closes the alveolar ridge, the upper lip defect, and then performs plastic surgery of the upper palate. However, in addition to surgery, the help of speech therapists, otolaryngologists, pediatricians, neurologists and many other specialists is needed in order to restore impaired functions and prevent new complications.

Before the operation, newborns have difficulty sucking on the breast, so special obturators are used to prevent food and liquid from being thrown into the nasal passages.

Of course, the operation requires extensive experience of maxillofacial surgeons, since the baby's oral cavity is small, which complicates surgical intervention. In this case, preference is given to veloplasty, when the soft palate is sutured. Such an operation is allowed at the age of 8 months.

In some cases, surgical treatment is carried out using several operations. Depending on the severity of the developmental anomaly, surgical intervention can be performed either after a year or at the age of 5-7 years.

Already after the first operation, a significant improvement will be noticeable, which will allow the process of breathing and digestion to be normalized. In the future, with the help of plastic surgery, the visual defect is eliminated, which increases the child's self-esteem. However, after the operation, treatment is required from a speech therapist, dentist, otolaryngologist to eliminate the complications and impaired functions that were caused by this pathology.

Cleft palate surgery

In order to restore the normal structure of the alveolar process and lip, plastic surgery of the palate is performed. The operation for cleft palate is performed no earlier than 6 months, and together with the rehabilitation process takes about 5 years. It is recommended to perform operations in stages, when the first surgical intervention ensures the elimination of the defect, which allows for the restoration of respiratory and digestive function, and further operations are necessary to correct the visual defect.

Timely treatment allows avoiding such serious complications as brain damage due to insufficient oxygen supply to tissues. After surgery, the help of a speech therapist, dentist, neurologist, ENT doctor and other specialists is required to restore physiological functions.

The operation is performed by the method of uranoplasty, in particular by the Limberg method. This surgical intervention is considered the most effective today. If in addition to this pathology there is such a defect as a harelip, then the operation is performed by the method of cheiloplasty.

A positive effect from uranoplasty is noted in 95% of patients. In the postoperative period, it is necessary to observe bed rest for the first few days, eat pureed food and drink a lot of alkaline liquid. Using a solution of potassium permanganate, rinse the mouth after eating. It is also necessary to inflate balloons 3-4 times a day, and starting from the third week - perform a special set of exercises and massage the soft palate.

To prevent infection of the postoperative wound, you need to take antibacterial agents for 7 days, and to reduce the severity of the pain syndrome - painkillers. After uranoplasty, a scar may remain on the face.

Prevention of cleft palate

Effective prevention of cleft palate has not yet been developed, as there are no methods that would affect genetic information. However, with the help of some recommendations, it is possible to reduce the risk of developmental anomalies in a baby.

When planning a pregnancy, a woman is recommended to undergo a thorough examination to identify existing contraindications. This concerns infectious diseases, as well as organ pathology, which can have a negative impact on the development of the fetus.

Before pregnancy, it is necessary to take folic acid in a dosage of 400 mcg, and when pregnancy occurs, the dosage should be increased to 600 mcg.

A mandatory condition is the refusal to take medications that are prohibited during pregnancy. If a woman needs to constantly take any medications, for example, antihypertensive or hypoglycemic, then the doctor must select the optimal medications and doses to avoid negative effects on the fetus.

Prevention also includes abstaining from alcohol, drugs and smoking. In addition, a woman should pay more attention to walks in the fresh air, avoid stressful situations and get enough sleep.

Cleft palate prognosis

In most cases, the prognosis for cleft palate is favorable, provided that surgical intervention is performed. This closes the defect in the palate and restores respiratory and digestive function. Further treatment is required from a speech therapist, ENT specialist, neurologist and dentist to eliminate complications that were associated with the developmental anomaly.

Of course, the treatment course takes more than one year, but ultimately the child becomes the same as his peers, which increases his self-esteem. The first operation eliminates the defect, and the subsequent ones are aimed at correcting visual anomalies.

If a cleft palate is detected in the fetus during pregnancy, it is necessary to reassure the expectant mother and explain that the defect is easily corrected and that the prognosis is favorable. Even in the case of combined pathology with a cleft lip, all the same, with the help of surgical intervention, the baby will not differ from other children either physically or mentally.

Cleft palate is not a threat to the life of the baby, provided that timely treatment and assistance are provided during labor. This developmental anomaly requires a special treatment approach for 5 years, which will ultimately ensure the desired result.

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