A cleft palate is the most common congenital deformity. The defect is expressed in the discrepancy of the tissues of the upper lip and / or palate. This occurs when certain parts of the face do not connect together properly during fetal development in the womb. Patients with this malformation need special care. The development of speech, feeding, growth of the face and jaw, the appearance of the dentition - these 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 defects, limb diseases, or other systemic defects.
Disease frequency
Cleft palate can be diagnosed already in the 17th week of pregnancy using ultrasound. Many studies have been conducted, but the exact environmental and genetic factors that play a role in the development of the defect are still not known.
About half of all affected infants are born with cleft palate, a quarter with cleft lip, and the other with cleft lip and palate. In boys, a cleft lip or a combined cleft of the lip and palate is more common , and in girls a cleft of the palate.
Etiology
Sky formation 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 ends between the 9th and 12th weeks of pregnancy.
For all parents, the chance of having a child with a cleft palate is 1 out of 700. Inherited cases range from 2.5 to 10%.
As mentioned earlier, the etiology of cleft palate is not entirely understood. However, there is evidence that external factors may play a role in the development of the defect. These include:
- alcohol or drug use during embryo formation;
- smoking during pregnancy;
- mother's obesity;
- folic acid deficiency during pregnancy;
- taking certain medications while carrying a child (for example, Methotrexate).
Mechanical clefts can occur through direct exposure to the fetus. Genetic mapping of families with hereditary forms of cleft palate showed that the TBX22 gene, which is involved in the development of the palate, is damaged in newborns.
Diagnostics
Most open cracks in the hard 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 grab the chest, bottle or nipple. A cleft palate can also lead to shortness of breath, as the tongue enters the gap of the nasal cavity and posterior pharyngeal wall.
Partial soft palatal fissures may not be diagnosed in newborns due to lack of symptoms. Early manifestations are nasal fluid or food reflux. At a later age, speech disorders are observed.
Symptoms
The cleft may look like a hole in the back of the soft palate, and also expand to the throat until the upper part is completely separated. In addition to affecting the appearance, cleft lip and palate can also cause a number of related symptoms, which are described below.
- Problems with feeding. Due to the cleft, the baby cannot suck and swallow milk. This problem is solved using a special bottle.
- Ear infections and hearing impairment. In children with cleft palate, fluid accumulates in the middle ear, which leads to hearing loss and infections.
- Speech and language problems. If the cleft palate is not restored after surgery, this will lead to problems with speech at an older age.
- Dental health. Cleft lip and palate can cause changes in the structure of the mouth and lead to problems with the development of teeth, which makes children more vulnerable to caries.
- Psychological trauma.
Treatment methods
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 for surgical repair of palate defects:
- Radical uranoplasty according to the Limberg method.
- Gentle plastic proposed by L. E. Frolova and A. A. Mamedov.
A plastic surgeon combines the muscles and tissue of the sky to close the hole. This procedure is performed only under general anesthesia.
Dates
Uranoplasty is an operation to correct a hard palate defect. There is no consensus on the age limit for surgery. Some surgeons consider the age of 10-14 months to be the optimal age for this type of manipulation. The opinion of the majority is the same: at the preschool age all operations must be done.
Most often, cleft correction 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 doctors decided to correct the defect at the same time, the procedure is carried out at the age of 11-12 months. In other cases, the first stage of the correction of the cleft is performed first at 3-4 months. During this period, restore the soft palate. As the child grows older, the size of the cleft can decrease by 7%. Next, uranoplasty is performed for children aged 18 months. Two-stage plastic is suitable for patients with a large cleft.
When the correction of defects in the palate is postponed to a later age, the operation consists in applying a flap. This can help close the defect and compensate for speech impairment.
The purpose of uranoplasty is the separation of the oral cavity and nose. It consists in creating a waterproof and tight valve. It is necessary for the normal development of speech. Uranoplasty of the palate is also necessary to maintain the proportions of the face during 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 surgery at an early age may be limiting the growth of the upper jaw.
Training
Before conducting uranoplasty, children need to assess their health status according to the following criteria:
- a sufficient level of hemoglobin and platelets;
- lack of infections and inflammatory diseases;
- lack of injuries;
- full-term;
- lack of congenital heart disease and other systemic diseases.
Defect repair
Uranoplasty is a technique for repairing a hard palate defect. Both for cleft lip and palate, surgical correction begins with incisions in the tissue on each side of the cleft. During surgery on a cleft palate, the surgeon transfers the mucous membrane and muscle into the open space, covering the sky. During surgery, defects associated with cleft lip, such as correction of the shape of the nose, can also be eliminated.
Limberg Uranoplasty
This is a reconstructive surgery to remove a cleft palate. The procedure takes place in 3 stages:
- Closure of the inner layers that form the nasal lining.
- Closure of the middle layers consisting of muscles on the back of the sky.
- Suturing of the oral mucosa.
When conducting Limberg uranoplasty, all these 3 stages are combined in one operation. The method is named after Professor Alexander Alexandrovich Limberg. The scientist has written many works in the field of restoration of the cleft palate, lower jaw using L-shaped osteotomies and bone grafts. With radical uranoplasty, the shape and function of the hard palate is simultaneously restored.
The operation according to the Limberg method is performed in older children (10-12 years). The disadvantage of this method is a long recovery due to the use of traumatic techniques during surgery, as well as the late age of patients.
Gentle plastic
For children under 2 years old, as a rule, they perform surgeries according to the gentle method, which allows the child to develop speech skills. Radical uranoplasty affects the slowdown of jaw growth.
The gentle plastic method is based on the phased elimination of defects. Up to a year is surgery to correct lips and in the soft palate. At the age of 2-3 years - correction of defects of the hard palate. With bilateral pathology, an operation to correct a cleft on one or the other side is carried out with a difference of 2-3 months.
Postoperative period
After palatine uranoplasty, patients need to maintain a diet limited in fluids and softened foods that do not require chewing. The use of bottles, the nipple 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 operation. After 3 weeks, all restrictions are removed.
Nasal congestion and pain that may occur after uranoplasty are stopped with medication. Oral hygiene must be done by rinsing with clean water. After 5-7 days, thorough brushing can be resumed.
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 blood supply to tissues.
Some aspects:
- The recovery period after uranoplasty takes up to 3 weeks. All this time you must be under the supervision of a doctor.
- Antibiotics are prescribed to prevent infection.
- Sutures dissolve independently 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 associated with risks and complications, for example:
- airway obstruction;
- discrepancy of seams;
- bleeding;
- fistula formation.
Long-term complications may include the following symptoms:
- speech impairment;
- incorrect positioning 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:
- newborns up to 6 weeks old should be screened to diagnose cleft lip and palate, a hearing test and nutritional assessment.
- at 3 months, an operation is performed to correct lip cleft.
- at 6-12 months - surgery to restore the cleft palate.
- at the age of 18 months, speech assessment is performed.
- at 3 years also a speech assessment.
- 5 years: an assessment of the development of speech.
- in 8-11 years: the installation of a bone graft in the gum (alveoli).
- From 2 to 15 years old, orthodontic treatment is performed.
After completing these steps, the patient should undergo regular examinations to assess the state of health and eliminate possible complications.
Reviews
After uranoplasty, children experience a significant improvement in the quality of life of patients. Parents note that correction of the defect eliminates difficulties with nutrition and breathing. Reviews about uranoplasty are mostly positive regardless of the method of operation.