Cleft lip: causes. Causes and treatment of pathologies of cleft palate and lips

A congenital defect of the hard and soft palate (cleft palate pathology) is a common malformation of the face in infants. In the world every day about a hundred babies are born with this anomaly, most of which are boys. It manifests itself as a gap in the middle part, connecting the oral cavity with the nasal cavity. Half of the children with this defect have a cleft lip defect. At timely treatment cracks in the sky in a child are not dangerous to the life and health of the baby. Qualified medical assistance in the correction of such defects allows you to get a free project "Towards Life".

Causes of the formation of "cleft palate" in humans

Experts do not have a consensus on the question of why children are born with " cleft palate". The appearance of a defect is associated with the presence of one or more provoking factors:

inferiority of germ cells of parents: age over 40 years, hereditary gene mutations;
infections and chronic diseases mothers: rubella, chicken pox, herpes, syphilis, chlamydia, etc.;
chemical intoxication: alcohol, drugs, smoking, chemicals, etc.;
physical impact: amniotic fluid pressure, overheating of the body, radiation, falls, blows to the stomach, etc.

Often the cause of the "cleft palate" is a metabolic disorder in the early stages of pregnancy, when it is accompanied by a lack of vitamins and minerals. minerals, toxicosis, lack of oxygen, the threat of miscarriage. To provoke a cleft palate in newborns, antibiotics, sleeping pills and sedative medications, drugs for thyroid diseases, tumors, and arthritis can be taken. Increase the risk of defect psychological factors: stress, prolonged experiences, lack of rest.

Types and manifestations of anomalies

The defect in newborns is manifested by a complete cleft of the soft and hard palate, passing through, or a small crack only on soft tissues. According to the degree of bifurcation, the defect is classified into:

full- with splitting of soft and hard tissues up to the incisal hole;
incomplete- with a cleft only in the soft palate or with partial splitting of the hard palate;
through- one- or two-sided clefts of the hard and soft palate with inclusion alveolar process;
hidden- the gap cuts only the muscles while maintaining the oral mucosa.

"Wolf palate" in newborns, in addition to a cosmetic defect, is accompanied by a number of symptoms indicating disorders of vital important functions organism. From the moment the baby is born, there are violations of sucking and swallowing food. Shallow breathing is formed, leading to oxygen deficiency, a tendency to inflammation of the middle ear, which negatively affects hearing. With the active growth of the baby, disorders are detected speech apparatus(pronunciation of sounds through the nose), lag in the development of all body structures.

Diagnosis of defect

Intrauterine development of the bones of the face of the fetus suggests their fusion at the 7-8th week of pregnancy. The formation of the oral cavity and nose goes parallel. Violation of these processes can become a break in normal development, causing anomalies, and the cause of the "cleft palate" in children. By 2 months, the upper jaw is finally formed in the embryo from halves growing towards each other. The delay in their fusion leads to a defect that is diagnosed in the womb.

A planned ultrasound examination reveals a defect at the 14-16th week of pregnancy. The volume, shape of the lesion and the complexity of the disease can only be assessed after the birth of the baby. The diagnosis of "cleft palate" in a newborn child is specified by examining the pharynx, next additional research. Their goal is to determine possible pathologies development of the skull, respiratory failure, smell, hearing and sound production.

What should the parents of a baby with such an anomaly do?

The main thing is not to panic at the thought that my child has a cleft palate, and not to try to terminate the pregnancy. It is not worthwhile, risking the health of the mother, to postpone the birth of a baby because of a defect that is successfully treated with drugs. modern surgery. Abortion is too high price, especially if the cause of the defect is hereditary, and it can manifest itself when next pregnancy. timely surgery congenital cleft palate makes this anomaly safe for the life and health of children.

It is important to seek qualified medical care to specialists to correct the defect and prevent the development of numerous complications, including:

respiratory failure leading to hypoxia (lack of oxygen);
frequent infections and colds that weaken the immune system;
speech and hearing disorders;
retarded growth and development of the jaw.

How and where to treat a cleft palate?

To eliminate external defects, to restore the functionality of the oral and nasal cavities in a newborn (it is doubtful, the operation is performed at the age of two years) allows surgery for cleft palate, cosmetic plastic surgery of the face. During surgical operation join in correct position palatine and pharyngeal muscles, the integrity, normal shape and functioning of all structures are restored. The volume of surgical interventions and the appropriate age for this is determined by the type of anomaly and the complexity of the case.

After thorough examination the surgeon chooses one of the tactics for treating children with cleft palate:

Uranoplasty (corrective surgery) from the age of 2 years - for incomplete clefts in children with correct dentition upper jaw.
Uranoplasty at 4-6 years old with preoperative orthodontic therapy - with a narrowed upper jaw and splitting, including the alveolar process.
Two-stage correction (plastic surgery of soft tissues with narrowing of the pharynx and after 6-8 months, surgery on the hard palate with an alveolar process with simultaneous bone grafting).

Stages of uranoplasty

Before the operation, the baby must first learn how to eat from a spoon. Sucking after surgery for splitting the soft and hard palate in a child causes pain, worsens wound healing and scarring. Correction is performed under general anesthesia due to the proximity of the airways and the need for complete immobility of the patient. If the opening cannot be closed local tissues, plastic surgery is performed with flaps taken from the cheeks or tongue. Conducting repeated surgical interventions is possible not earlier than after six months, necessary for tissue repair and blood supply.

The operation for cleft hard and soft palate is carried out in several stages:

Detachment on both sides of the gap of plastic material to close the hole.
Elongation of soft tissues due to cutting off the mucous membrane of the nasal cavity.
Stitching the gap at the midline.
Reducing the pharynx in the middle section by moving its lateral tissues to the middle.
Gradual suturing (first on the nasal mucosa, then on muscle tissues and oral mucosa) treated with an antiseptic solution.
Attachment of a plate that protects against infection.

rehabilitation period

Duration postoperative rehabilitation determined by the complexity of the case and the age of the patient. If your child was born with a "cleft palate", be prepared for the fact that his treatment will not be limited to surgery. The restoration of many functions depends on the quality of the rehabilitation measures. In a hospital, they are aimed at improving the patient's well-being, organizing proper nutrition, preventing disorders in the upper respiratory tract, preventing infectious diseases and complications.

In the future, the baby needs:

additional treatment by an orthodontist for the correct ratio of the sizes of the dental arches and the development of the upper jaw;
systematic observation of an otolaryngologist to control the communication of the oral and nasal cavities, the functioning of the respiratory and hearing organs, and the prevention of ENT diseases;
classes with a speech therapist for staging correct breathing, sound extraction, articulation, correction of speech defects;
consultations of a defectologist to identify a possible developmental delay.

Help for the Towards Life project

The volume of rehabilitation measures, the number of doctors involved in the treatment, and the cost of surgery for "cleft palate" in known medical centers should not diminish your determination to improve the health of the child. A significant part of the work on restoring functions ( breathing exercises, exercises for the development of the speech apparatus, preventive actions etc.) after consulting specialists, you will be able to perform with the baby on your own at home. Your perseverance and patience is an important component of success in treatment.

The wolf's mouth is an anomalous structure of the sky, in the middle of which a gap is clearly visible. This pathology is congenital, in the presence of which newborn babies cannot fully eat and they are somewhat disturbed. respiratory function. This is due to the fact that there is no septum between the cavities of the mouth and nose, from which the consumed food and liquid enters the nose. Very few children are born with such an ailment, for one thousand babies there is only one who has such a syndrome.

The causes of the wolf's mouth are more often - unhealthy image the life of the expectant mother during pregnancy, as well as a number of certain factors that affect the life of a woman during this period. In the first few months, the fetus is most susceptible to the influence of various pathological processes, and it is during this period that deformation of this type begins. For the first time, such an ailment can be detected during an ultrasound scan by a woman in late pregnancy, but, unfortunately, it is impossible to influence the progression of the cleft palate.

With this disease, the gap in the hard and soft palate varies in size. But despite this, there are modern and effective methods deliverance from such evil.

Etiology

The causes of such a disease are directly related to the lifestyle and environment in which a pregnant woman lives. The wolf mouth is formed with the following etiological factors:

abuse of alcohol, nicotine or drugs;
passive smoking (differs even more pernicious influence than usual);
a critical increase in body weight of a woman during pregnancy;
certain environmental living conditions with high air pollution;
influence of radioactive exposures;
genetic predisposition. If in the family one of the parents already had cases of the occurrence of a wolf's mouth, then there is a high probability of repeating the expression of the disease.

Physicians have proven that big difference between the parents of the baby is the cause of the expression of such a syndrome. But only on condition that the man is much older than the girl who herself has not reached the age of twenty-five, or, conversely, when a woman over forty years of age became pregnant from a young guy.

In addition, the causes of the disease can be of a different nature:

physical. These include early abortions, uterine tumors, abdominal injuries in the early stages of pregnancy, an unsuccessful attempt to get rid of the child on their own, prolonged pastime under the direct influence of sun rays, a visit by a woman to saunas, baths or solariums, due to which there is a high probability of overheating of the fetus;
chemical - insufficient air supply to the fetus, very severe toxicosis, infectious inflammatory diseases, malnutrition, which contains a small amount of vitamins, calcium and iron, uncontrolled medication;
mental - constant stress to which a woman is exposed during such a period of life, insufficient time for rest, strong physical exercise, bad experience of a previous pregnancy.

Varieties

According to the size of the gap that formed, the wolf mouth in children happens:

hidden - inferiority in the structure is observed only in the soft palate, but the mucous membrane is intact;
incomplete - the gap affects the soft palate and part of the hard;
complete - a hole on both the soft and hard palate;
through - accompanied by the formation, touches both skies. This type of pathology can be unilateral and bilateral.

Symptoms

In addition to a visible violation of the integrity of the palate and lips, the cleft palate is accompanied by the following symptoms:

respiratory failure;
difficulty during breastfeeding because a newborn baby cannot fully suck and swallow;
hearing loss, which only increases with age;
speech disorder - the child speaks indistinctly and quietly;
delayed growth and development. Caused by the fact that the body does not enter enough oxygen, and this delays the development of many body structures;
constant and lack of mood, because the child notices his difference from other children, who can mock him. But it is much worse when an adult pays attention to such a feature and starts to mock him. That is why it is worth starting the treatment of the cleft palate syndrome as early as possible.

Most of the above symptoms are observed in a child from the very first day of birth.

Complications

Complications of such a disease appear only in the case of a protracted course of symptoms and untimely treatment. Possible complications cleft palate can become:

severe deterioration or complete loss of hearing;
malocclusion;
curvature of the teeth;
inferiority of speech;
low self-esteem;
inability to adapt to social life;
difficulty in choosing a future profession.

Diagnostics

The first signs of the appearance of the cleft palate in the fetus can be determined during an ultrasound scan at about the fifteenth week of pregnancy, but it is impossible to accurately diagnose and determine the degree of the integrity of the palate before the baby is born.

In our time, the attitude towards such a disease has changed significantly. A few decades ago, doctors strongly insisted on terminating a pregnancy, but now, on the contrary, they tell parents in what ways they can get rid of such an ailment.

Treatment

The treatment of the cleft palate is carried out only by those specialists who have observed the child from the moment of birth. The age recommended for corrective action should not be less than six months, but often much more. In any case, the preparation of a treatment plan is carried out for each child individually. Completion of the treatment period, which includes full recovery sky, is about the age of six or seven years.

The main task of the operations is aimed at restoring the integrity of the soft and hard palate - all this is feasible with the help of uranoplasty. Before starting such a treatment method, it is necessary to draw up detailed plan passing surgical intervention, which for each little patient will be strictly individual. The latest technologies for operations and high level qualification of doctors makes it possible to completely restore the integrity of the palate in 95% of cases.

Starting from the age of three, a child can undergo plastic surgery aimed at eliminating defects, as well as undertake additional cosmetic surgeries. Subsequent surgical interventions should be carried out no earlier than one year after the previous one.

An important component of the treatment of the cleft palate is postoperative rehabilitation. In the first few days after medical intervention, the patient must observe bed rest, it is allowed to feed him only liquid or puree food. It is important to perform proper oral care, to avoid infection and to disinfect. After a two-week period after the operation, the patient must begin to develop the operated palate with the help of special exercises prescribed by a speech therapist. In addition, the child will need to undergo regular check-ups with pediatric dentist and an otolaryngologist.

With proper, and most importantly, timely treatment and subsequent rehabilitation, it is guaranteed full recovery a child who will be no different from his peers and in the future will be able to become a successful person.

Prevention

Prophylactic agents to prevent this disease the expectant mother must:

completely abandon alcohol, nicotine and drugs;
eat a balanced diet a large number of vitamins, minerals, calcium and iron;
abandon strong physical exertion;
refrain from exposure stressful situations, unpleasant communication, harmful conditions labor;
relax and spend a lot of time fresh air, best in sanatoriums or resorts;
avoid all kinds of injuries not only to the abdomen, but also to other internal organs.

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Diseases with similar symptoms:

Children's cerebral paralysis(cerebral palsy) is a general medical term that is used to refer to a group movement disorders progressing in infants due to traumatization of various areas of the brain in the perinatal period. The first symptoms of cerebral palsy can sometimes be detected after the birth of a child. But usually the signs of the disease appear in infants in infancy(up to 1 year).

For many centuries, children born with developmental anomalies evoked ambiguous feelings among fellow tribesmen and parents. The most unpleasant were the defects that gave a resemblance to animals. The communicating nasal and oral cavities distorted speech - it resembled an animal grunt.

During the Middle Ages, when people did not know why genetic diseases and believed in demons and werewolves, the disease was called "wolf mouth". Otherwise related to this modern medicine. For maxillofacial surgeons, this is just a defect that is successfully corrected, leaving almost no visible marks.

Description and characteristics of the cleft palate and cleft lip

Found in colloquial speech the names "cleft palate" and "cleft lip" are congenital pathologies, they develop in the fetus during fetal development and have the same etiology. They appear due to the non-closure of the upper palate, which is formed from two paired palatine bones.

The length of the gap can be different. The most insignificant and easily correctable cleft of the soft palate in children in the part where the palatine uvula is formed from it. Outwardly, such a flaw is completely invisible, although it requires surgical correction so that the child can speak normally. A completely different picture is observed with complete non-closure of the hard and soft palate on one or both sides. A gap is formed in the mouth, which prevents the normal nutrition of the child. There is a gross defect on the face upper lip- "hare lip".

If the opening is one-sided, in children it passes through one of the halves of the lip, away from the midline, and communicates with the nasal cavity. With bilateral non-closure, the upper lip is divided into three independent parts, and both nostrils are combined with the mouth. Such defects lead to the fact that babies experience great nutritional difficulties. They cannot suckle on their own and can only be fed artificially - through a nasal tube.

Reasons for the defect

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There are no exact reasons for the formation of a wolf's mouth. Like other anomalies in the development of the fetus, the roots of the problem lie in a defect in one of the X chromosomes, which carries the gene responsible for the formation of the upper palate.

What caused this mutation is still not known. Empirically, risk factors have been identified that significantly increase the likelihood of having a baby with such a problem in apparently healthy parents.

In the first place are genetic diseases, the carrier of which is the mother or father. It is statistically determined that the probability of having a child with a "cleft palate" or " cleft lip» in a couple where one of the spouses had such a defect or it was present in one of the distant ancestors, 7 times higher. On average, according to various sources, one out of 800-2500 newborns is born with a "cleft lip". This common birth defect occurs in 0.8-0.025% of cases.

Not only direct inheritance is the cause of the flaw. As part of the syndrome, that is, a complex of individual symptoms of a violation of the structure of organs and tissues, the "cleft palate" can manifest itself in diseases:

Van der Wood syndrome;
Doyce-Dits syndrome;
Robin's syndrome;
Stickler syndrome.

The second most important factor influencing the intrauterine development of the fetus is the environmental impact on the mother during pregnancy. These are commonly referred to as:

fetal hypoxia (lack of oxygen) early dates pregnancy;
exposure to poisons and pesticides;
contact with compounds of lead, fluorine, chlorine, sodium;
reception during childbearing antihypertensive drugs that lower blood pressure;
use of anticonvulsants;
abuse of alcohol and tobacco;
unbalanced nutrition and dystrophy.

Direct evidence that one of these factors entails the birth of a child with a cleft palate, no. It is traditionally believed that the risk of a newborn with a developmental defect in women who experienced severe stress during the first 2 months of pregnancy is significantly higher than in those who lived in comfortable conditions. It is during these periods that the facial skeleton of the embryo is formed.

Classification

There are four variants of defect formation:

the defect affects only the soft palate;
cleft of the soft and partial cleft of the hard palate;
unilateral complete non-closure of the soft and hard palate;
bilateral cleft of the soft and hard palate.

To understand the difference between these types of "cleft palate", it is necessary to know the mechanism of the formation of the palate in the embryo. Hard palate - the bone base is formed from paired lateral processes of the upper jaw, located horizontally and extending from the alveolar processes in the direction of the "tongue" of the soft palate. middle part bone base consists of unpaired bone facial department skull, called the "vomer".

At normal development these three elements intertwine and coalesce. There is no gap between them. In case of improper formation of the embryo, the fusion of these bones does not occur on one or both sides throughout - then the gap opens outward, splitting the baby's upper lip. Formed cosmetic defect"hare lip". The above classification reflects the nature and degree of involvement in the process of only soft tissues or both soft and bone structures.

The degree of non-closure affects not only the appearance of the newborn. It is also reflected in the choice of the method of care, feeding and subsequent surgical treatment. most complex shape is a bilateral full splicing. It unites the nasopharynx into a single cavity. This entails the danger of food entering the Airways baby and death from asphyxia. He cannot suckle on his own - his lips do not tightly wrap around the mother's nipple. Newborns are immediately transferred to artificial feeding through a nasal probe and contain on it before the operation.

The danger of pathology

The danger of the "cleft palate" and the closely related "cleft lip" manifests itself in many ways. In infancy, it carries a danger for:

respiratory organs;
the possibility of breast sucking;
chewing food;
speech development;
formation of communication skills.

Breath. Communication between the cavities of the nose and mouth leads to the fact that the inhaled air enters the lungs not only through the nose, where it has time to warm up and moisten, but also through a gap in the oral cavity. The consequence of this is the development of bronchitis or pneumonia. In addition, the inhaled air can partially exit the lungs. Normally, its reverse movement through the nose is blocked by contraction of the soft palate. If it is missing or deformed, free air circulation occurs. The necessary pressure in the lungs is not created - as a result, hypoxia may develop. The face turns blue.

Sucking. A birth defect prevents reflex sucking. Milk entering the mouth is poured through the opening into the nasal sinuses, flowing through the Eustachian canals into the middle ear. Develops very rapidly in milk pathogenic microflora therefore, the development of sinusitis and otitis media is possible. In addition, the child simply does not receive nutrition, which leads to weight loss.

Chewing. If the "cleft palate" has not been corrected surgically before teething begins in an infant, there are immediately problems with chewing food. If the gap reaches the alveolar processes, there is an incorrect bite formation. The hard part is not chewed completely. This creates a load on the esophagus, stomach, intestines.

The development of speech. The formation of articulate sounds occurs with the participation of the soft palate. If it does not fully participate in articulation, speech becomes illegible. It is difficult to understand what the child is trying to say. With deep defects, when the cleft is complete, a rhinolalia develops, characterized by:

nasality;
uncharacteristic timbre of voice;
significant distortion of spoken sounds.

Development of communication skills. Man is a social being.

If the child is not surrounded by peers, his mental development slows down. Children who are very different appearance or the manner of conversation, find it difficult to find a common language in the team. They become shy, withdrawn into themselves. Significantly reduced self-esteem.

Diagnostics

Modern methods examinations of pregnant women reveal the formation of a "cleft palate" in the fetus at 14-16 weeks of pregnancy. If the "cleft palate" is not a symptom of more serious genetic diseases, there is no talk of terminating the pregnancy.

It is possible to more accurately determine the nature and extent of the defect only after the birth of the baby. Infants are immediately prescribed a respiratory examination, anomalies in the development of the skull are detected, which may be associated with the incorrect formation of the upper palate. Examine the organs of hearing and smell.

If we are talking about the birth of a second child by spouses who have a baby with a "cleft lip", it is necessary to establish the dependence of the appearance of pathology on the hereditary status of the parents. That is, to identify which of them is the carrier of the defective gene and what is the probability of it re-manifestation during pregnancy.

Treatment and correction of the defect

For the treatment of "cleft palate" and "hare lip" apply surgical methods, which, if necessary, combine with the supervision of therapists, neurologists, orthodontists, otolaryngologists, physiotherapists, speech therapists.

The choice of technique and nature of plastic surgery depends on the type and extent of the defect. Usually, the treatment is multi-stage, as it is associated with the layer-by-layer restoration of the integrity of bone and soft tissues, the elimination of cosmetic consequences. surgical intervention.

After the complete elimination of the defect and the return of the child to a full life, conservative treatment from specialized doctors, aimed at restoring body functions in full. According to various surgeons, optimum time for correction, the age of the child after 6 months is considered. If the baby is weak or unwell, reconstructive surgery can be performed at an older age.

Preparing for the operation

There is no special preparation for the operation to restore the palate defect. The main criterion is to achieve a certain size of the maxillofacial bones, when it will be convenient for the surgeon to perform manipulations, as well as physical health baby. The difficulty lies in maintaining the viability of the child before it can be operated on.

The first problem is feeding. Babies cannot suckle on their own. For feeding, probes inserted through the nose, special spoons worn on bottles, breast pads for the mother or glued to the upper palate of the baby during feeding, nipples with holes oriented downwards so that the streams of milk do not flow into nasal cavity. It is recommended to feed such a child in a strictly upright position.

The second problem is the protection of the nasopharynx from cold and dry air. The children's room is equipped with a humidifier and an ozonizer. They try to protect the baby from drafts as much as possible. During walks, such children must wear a gauze mask on their faces.

Types of surgery

There are three types of operations aimed at correcting a defect:

veloplasty;
uranoplasty;
cheiloplasty.

Veloplasty is the restoration of the integrity of the tissues of the soft palate in cases where bone structures are not involved in the process. May be the first stage of the operation preceding uranoplasty. Uranoplasty is the restoration of the integrity of the bone base of the hard palate. Usually, operations are carried out in several stages, the period of time can reach from 2 - 3 months to several years. It depends on the rate of bone growth. Cheiloplasty - restoration of the integrity of the upper "hare" lip.

Postoperative care

Operations are carried out under general anesthesia. After the operation, strict bed rest is indicated. Nutrition in the early days is carried out either through a nasal probe, or from a spoon in an upright position. Mandatory care of the oral cavity with the use of antiseptic solutions and preparations. After the stitches are removed, the rehabilitation and recovery phase begins. At this time, the child is taught to master the newly formed sky.

At the same time, the child is observed by an otolaryngologist and an orthodontist. Sick children are prone to ENT diseases, they often develop malocclusion due to a defect in the alveolar processes of the upper jaw.

Contraindications and possible complications

The main contraindication to the operation immediately after birth is the age of the child. Before reaching the age of 6 months, the operation can be performed only for health reasons - the complete inability to eat independently. Complications after surgery are mainly infectious and inflammatory in nature and are treated conservatively with antibiotics. Scars and scars formed as a result of cheiloplasty are usually removed at an older age through cosmetic surgery.

Forecast

In more than two centuries that have passed since the first operation to eliminate the "cleft palate", dozens of techniques have been developed and tested. Currently, in 98–99% of cases, a full restoration of tissue integrity is achieved. Stages recovery operations calculated in such a way that by 5 - 7 years, that is, by school age, the child has no visible traces of a birth defect. Children who have successfully passed the stage of postoperative rehabilitation are removed from the disability register.

How do you understand the treatment birth defect development of the palate can only be surgical. Naturally, there are quite certain age indications for this operation. As a standard, such indications should be determined strictly individually, in direct proportion to the diagnosis made by the doctor.

Note that plastic surgery of the soft as well as hard palate with a diagnosis of complete cleft palate can be performed at different age periods. For example, the soft palate is most often operated on in the time period from birth to one year. But let's say a cleft of the entire hard palate is usually operated on at the age of five, six years or even older.

Despite many different points of view on the issues of age indications for such operations, most practicing surgeons believe that such operations should be performed at preschool age and no later. It should be noted that they try to carry out early plastic surgery only when the child needs simultaneous orthodontic treatment. In any case, a dental surgeon, as well as a pediatrician and, accordingly, an anesthesiologist will prepare a child for such operations.

When plastic surgery of the palate, it is important for physicians to surgically completely eliminate the existing anatomical disorders that occur during a cleft palate. This means that the purpose of such an operation will be:

The need to close the existing cleft palate literally throughout its entire length.
Sufficiently lengthen the deformed soft palate.
Sufficiently narrow the slightly enlarged middle part of the pharynx.

As a rule, they try to perform palatoplasty using local tissues, using slightly displaced skin flaps (muco-periosteal) borrowed from the palatine plates or from the tissues of the soft palate. Radical palate plasty (named after Limberg) usually consists of five separate stages .

Primary refreshment of the edges of the existing cleft. When cutting out and specific exfoliation of individual skin flaps directly within the deformed hard palate.

At the same time, they try to make incisions on both sides of the existing cleft along almost the entire alveolar process.

Secondary release of those neurovascular bundles that come out of rather large palatine openings. The procedure is performed by resection of the so-called posterior inner edges of the same large palatine openings. In this case, physicians cut off part of the nasal mucosa from the posterior edges of the hard palate. After that, the obtained tissues are moved slightly backwards (which is called retrotransposition). This procedure is necessary for some lengthening of the previously deformed soft palate.

At the third stage, the so-called interlamellar (in other words, interlaminar) osteotomy is performed. This is a process in which the hook of the pterygoid process, simultaneously with a small section of the internal pterygoid type of the plate, as well as with the muscles of the soft palate itself attached to it, is carefully separated with a chisel from the existing pterygoid process of the leading bone. The separated area is then moved a little closer to the midline.

Such a procedure allows, without specialized dissection of the muscles of the soft palate itself, to somewhat weaken the transverse tension of those. And this means it allows you to close the cleft while remaining within the same soft palate.

The fourth stage is the narrowing of the middle sections of the deformed pharynx (or mesopharyngoconstriction). The process in which only the mucous membrane is dissected, the incisions continue to be made along both (on both sides) pterygo-mandibular folds.

After that, surgeons carefully stratify the muscles of certain lateral parts of the pharynx with a blunt instrument, moving them to the midline. As a result, the wounds are plugged with special iodine-shaped tampons directly in the so-called peripharyngeal space.

At the fifth stage, before the direct suturing of the wound (before staphylorrhaphy), the previously refreshed edges of the existing cleft should be dissected naturally throughout all sections of the soft palate.

Further, the soft palate is usually sewn up strictly in three layers. Where the first layer is the nasal exclusively mucous membrane. Where the second layer is directly the muscles, but the third layer is already the oral mucosa of the corrected soft palate. As a result, on the hard palate, previously exfoliated skin flaps are sufficiently approached and completely stitched together.

Of course, certain clinics are ready to use a somewhat simplified method of treating cleft palate, when the necessary neurovascular bundles are trying to release and pull out of the so-called pterygo-palatine canal. Although it is believed that simplified techniques are more prone to postoperative complications.

The most frequent of these complications after plastic surgery can be considered the divergence of the edges of the existing wound directly on the border with a section of the hard and the same soft palate. It is believed that this may be the result of some technical errors obtained during the operation itself (say, poor, insufficient removal of the necessary vascular bundles, insufficiently correctly performed interlaminar osteotomy, etc.).

Statistics says that in isolated cases, as a complication of such an operation, marginal or partial necrosis of certain mucoperiosteal flaps can be observed. Usually this can occur due to extensive tissue trauma or due to excessive compression of the tissues by the postoperative dressing. Naturally, children who have undergone such an operation need specialized postoperative care.

With such care, a special protective plate is usually put on the child's upper jaw, which is made from several dense layers of gauze and impregnated with celluloid solutions in acetone. In addition, after the operation, in order to create maximum rest in the wound for at least ten days, children are prescribed a complete silence mode. Naturally, every day after such an operation, children are given the most thorough toilet of the wound with irrigation of the entire oral cavity with a special warm solution of potassium permanganate (potassium permanganate).

This type of irrigation is repeated at least four or even five times a day, almost always after meals. A week after the operation, they usually try to make the first dressing of the wound, during which the stitches are usually removed. Subsequent dressings are carried out every two days.

- congenital deformity, which is a splitting of hard and soft palate in which there is communication between the oral and nasal cavities. Children born with a similar defect, from the moment of birth, experience difficulties with independent breathing and nutrition; lagging behind in physical development, gain weight poorly, often get sick, and at an older age suffer from speech disorders (rhinolalia). Cleft palate (cleft palate) correction is performed surgically using reconstructive interventions (uranoplasty, velopharyngoplasty) followed by orthopedic, speech therapy, physiotherapy rehabilitation.

The defect in the palate leads to the free exit through the nose of the inhaled air, as well as the entry of food and liquid into the nose. Fluid can enter through a cleft palate into eustachian tubes and sinuses, which contributes to the development of otitis media and sinusitis in such patients. With the cleft palate, there is a deformity of the bite and teeth that disrupt the process of chewing food.

Treatment of the cleft palate

Today, congenital defects in the development of the palate are successfully eliminated with the help of surgical intervention, during which the integrity of the alveolar process, the upper lip is restored and the plastic of the upper palate is performed. For successful treatment cleft palate requires the combined efforts of many medical disciplines: pediatrics, maxillofacial surgery, orthodontics, therapy, speech therapy, otolaryngology, neurology. Before the operation on the plastic palate for infants, the use of special obturators is prescribed to facilitate sucking and feeding. Performing plastic surgery hard palate early childhood difficult due to small sizes of the oral cavity, therefore, only veloplasty is possible - stitching the soft palate, recommended from 8 months of age.

Principles of treatment of patients with cleft palate

Operations to eliminate congenital maxillofacial defects are usually carried out in stages. The number of interventions can vary from 2-3 to 5-7 or even more. The age of the cleft palate correction is determined by specialists who observe the child from birth, according to individual indications, but not earlier than 3-6 months (usually more late dates). End of treatment including recovery period must be completed by the age of 6-7 years.

The age from 3 to 7 years is favorable for additional cosmetic operations to improve the appearance of the child so that after full rehabilitation he could attend general education educational institution because mental and mental development children with cleft palate does not differ from those in healthy children. After the defect of the palate is corrected and the full course of rehabilitation is completed, the children are deregistered due to disability.

The treatment of maxillofacial defects is carried out by profiled clinics, which have all the necessary specialists: a pediatrician and a micropediatrician, a surgeon, an orthodontist, a speech therapist teacher, a psychologist and Social worker. Modern plastic medicine is designed not only to help the child get rid of an external defect, but also to overcome the consequences of mental trauma from the feeling of inferiority for further full adaptation in society.

Correction of the cleft palate by uranoplasty

The task of restoring the correct anatomical structure of the soft and hard palate, as well as the middle parts of the pharynx, is solved by uranoplasty. The classic version of uranoplasty in the cleft palate, which solves these problems, is the operation according to the Limberg method. Today, Limberg uranoplasty is the main method for treating a congenital palate defect. When a cleft palate is combined with a cleft lip, cheiloplasty is also performed - an operation to correct the upper lip.

Before uranoplasty, an individual planning of the operation is carried out, a plastic material is selected to eliminate the cleft palate defect. Modern methods of uranoplasty and qualifications plastic surgeons provide restoration of a full-fledged anatomical structure of the palate in 92-98% of patients.

Radical correction of soft and hard palate defects involves solving a complex set of tasks: restoring the anatomically correct continuity of each layer of the soft and hard palate and their sizes; elimination of the vicious attachment of the palatopharyngeal muscles, their anatomically correct connection; exclusion of damage to the nerves that provide contraction of these muscles during surgery; performing a stable fixation of the restored anatomical structures, forms and functions of the sky.

Radical uranoplasty is preferable for children aged 3-6 years. At the age of 3-5 years, patients with non-through cleft palate are operated on; from 5 to 6 years - with through one- and two-sided clefts. The implementation of radical uranoplasty is not recommended in young children, because it can cause a delay in the development of the upper jaw. The implementation of sparing methods of uranoplasty is possible until the child reaches the age of 2 years.

Postoperative care includes bed rest within 2-3 days, taking only pureed food, abundant alkaline drink. Careful attention is paid to the care oral cavity: before and after meals, the mouth is irrigated with a weak solution of potassium permanganate. It is recommended to inflate several times a day air balloons. From the 14th day, it is necessary to conduct a special set of exercises and finger massage of the soft palate.

In order to prevent postoperative infection, antibiotics are prescribed for 5-7 days, for relief pain syndrome- painkillers. On the face after uranoplasty remains postoperative scar. Discharge from the hospital is carried out on the 21-28th day after the operation.

In the future, patients will have a long and painstaking work to restore full-fledged palatopharyngeal closure and palate mobility with the help of physiotherapeutic treatment methods.