Congenital cleft lip. Fetal cleft lip: causes of formation, ultrasound diagnosis, treatment. What does a cleft lip look like in a person?

Home|Facial malformations (cleft lip and palate)|Cleft lip (cleft lip)

Cleft lip is the most common congenital malformation of a child's face. Occurs in one baby out of 1000 births. Often called a “cleft lip”, the facial defect is formed in the first months of the fetus’s life and is already detected by ultrasound at the 16th week of pregnancy. It manifests itself as a dissection of the upper lip deep from a small fissure to a deep groove on one or both sides. If you consult a doctor in a timely manner, the anomaly can be successfully corrected. Our Clinic offers you qualified medical care from an oral and maxillofacial surgeon.

Symptoms of a cleft lip

A cleft lip is visualized during an external examination of a newborn. The presence of a genetic pathology is indicated by a characteristic deformity with unilateral or bilateral clefting in the lower/upper lip area. If you ignore the importance of surgical treatment of the disease, in the future the child may develop low self-esteem due to an unattractive appearance.

In infants, cleft lip and cleft palate interfere with normal sucking and swallowing processes. Deep and large cleft lips may result in the baby having to be fed through a nasal tube. Subsequently, due to malocclusion and tooth deformation, the processes of chewing food are disrupted.

Usually, a cleft lip leads to dental pathologies. The patient’s mouth may be missing some teeth, and their growth angles are also not always correct. There is a tendency to form caries. To eliminate dental symptoms, it is necessary to carry out competent orthodontic treatment and bite correction. In some cases, implantation of missing teeth and transplantation of excess teeth are required.

Children with a cleft lip have difficulty making sounds. Then they talk about rhinolalia - a disorder of speech function, manifested by problematic pronunciation of consonants, unclear pronunciation of words, and pronounced nasal sounds.

If you notice similar symptoms, consult a doctor immediately. It is easier to prevent a disease than to deal with the consequences.

Why is a child born with a cleft lip?

At the end of the first month of pregnancy, the baby's mouth forms from two separate halves that grow next to each other.

Around the sixth to eighth week, they fuse together to form the upper jaw. Next, the seam goes back and forth to seal the lips with the tongue.

By the tenth week of pregnancy, the mouth is fully formed and the nose has acquired its familiar structure and location.

A cleft lip is a congenital defect in which a child's upper lip is completely formed and has a hole. A cleft palate is a similar congenital anomaly in which the palate of the unborn child is not fully formed, but has a hole.

Some children with a cleft lip have only a small indentation in their upper lip. Others have a full open opening that extends through the upper jaw to the bottom of the nose. The abnormality may appear on one or both sides of the child's mouth.

This birth defect is called an oral cleft, or cleft lip. In children, the causes of its occurrence are still unknown.

Defects and the conditions for their development vary in severity and degree with variations:

• Cleft lip (lip defect).
• Cleft palate (defect of the roof of the mouth).
• Cleft lip and palate (both defects).
• Microform of a cleft (crack or scar).
• Unilateral cleft (one side of the lip and palate).
• Bilateral cleft (both sides of the lip and palate).

Cleft lip and cleft palate: causes

The causes of cleft lip, cleft palate and other facial abnormalities are not well understood, but they are directly related to changes in the child's genes.

It is believed that 25% of cases are due to heredity, up to 15% are chromosomal abnormalities and 60% are external causes of the birth of children with cleft lip. The tendency to become deformed may be inherited from one or both parents.

The potential for developing the disease increases when it occurs among close members of the same family.

Other factors that can affect the genes that cause the split include viruses, certain medications, diet, and environmental toxins.

Recent studies have identified smoking and drinking alcohol during pregnancy as risk factors for the development of cleft lip and palate, as well as other birth defects.

In addition, having diabetes significantly increases the risk of having a baby with a cleft lip or without a palate. Drug use and intoxication of the body can also cause these birth defects. Cleft lip and palate can occur along with other congenital anomalies.

This can lead to a number of difficulties in everyday life. Babies are often born with a cleft lip or palate if they have a family member with the condition or a history of other birth defects.

Genetics and heredity

To this day, the true causes of cleft palate and lip development are unknown, but doctors believe that the defects arise due to genetic and environmental factors. Genetics may play a role in the development of a condition such as cleft lip.

The causes may combine several factors. If one or both parents had this deviation, this significantly increases the manifestation of the anomaly in the child.

The lifestyle you lead during pregnancy may also increase your baby's chance of developing an abnormality.

So, why does a disease such as cleft lip develop? Photos, causes and treatment methods will help you learn better about this pathology.

• Exposure to phenytoin or drug use during pregnancy increases the risk of developing the abnormality by 10 times or more.
• Smoking during pregnancy increases the chance of developing a defect by 2 times.
• Use of alcohol, anti-seizure medications, or retinolic acid has been linked to birth defects that include cleft lip and palate.
• During pregnancy, a deficiency of vitamins, and especially folic acid, can also cause the development of craniofacial anomalies.

There are many factors that cause cleft lip in children. The reasons and photos of this disease make it clear the seriousness of the situation. Cleft palate can develop as an isolated birth defect or as part of a larger genetic syndrome that can lead to more severe defects.

Environment

During pregnancy, what a mother takes, eats and drinks is critical to the development of her unborn child. Vitamins and nutrients enter the growing body through the mother's blood.

But between a woman and her unborn baby there is a strong protective shell called the placenta. It does not allow some toxic substances to pass through and reliably protects the baby in the womb.

While the placenta is really good at filtering out toxins, other dangerous chemicals can pass through this barrier and enter the fetal blood stream.

Source: https://1001salad.com/pochemu-rebenok-rozhdaetsja-s-zajachej-guboj/

Diagnosis of cleft lip

You can understand that a child has developed a cleft lip through an ultrasound scan at 14-16 weeks of pregnancy. However, the photo obtained as a result of ultrasound diagnostics does not always make it possible to make a correct preliminary diagnosis.

After the baby is born, there are no problems with diagnosis. The defect is immediately noticeable. To exclude the presence of concomitant congenital defects, additional diagnostic measures are usually carried out (vision and hearing tests, step-by-step assessment of the level of development).

The best doctors for the treatment of cleft lip

8.7 4 reviews Plastic surgeon First category doctor Ivan Alekseevich Maisky Experience 14 years Medical center ON CLINIC on Novy Arbat Moscow, st. Bolshaya Molchanovka, 32, building 1 9.6 7 reviews Plastic surgeon Maxillofacial surgeon Ophthalmic surgeon Doctor of the highest category Professor Davydov Dmitry Viktorovich Experience 29 years Doctor of Medical Sciences Clinical Hospital on Yauza, st. Volochaevskaya, 15 Moscow, st. Volochaevskaya, 15, building 1 8.6 Dentist Dentist-surgeon Dentist-implantologist Maxillofacial surgeon Artem Dzhivanovich Enokyan Experience 10 years Euromedical Clinic Moscow, Sirenevy Boulevard, 32a 8.6 2 reviews Plastic surgeon Maxillofacial surgeon Doctor of the highest category Blokhin Kirill Sergeevich Experience 11 years Clinical Hospital on Yauza, st. Volochaevskaya, 15 Moscow, st. Volochaevskaya, 15, building 1

How dangerous is a cleft lip?

In the absence of timely and competent treatment, the disease “cleft lip” leads to improper formation of the maxillofacial system, namely to:

• serious aesthetic defect in appearance;
• inability to chew and swallow food normally;
• inability to speak normally.

Risk group

The risk of having a baby with a cleft lip is high if the expectant mother:

• lives in an area with unfavorable environmental conditions;
• works in hazardous production;
• suffers from viral infections in the first trimester of pregnancy;
• smokes, abuses alcohol;
• uses drugs;
• takes antibiotics during pregnancy;
• belongs to the category of old-timers.

There is also a high risk of having children with a cleft lip in families where one of the parents (or both) has this disease.

Cleft lip in children: what it is, what it looks like, causes, treatment, surgery

It is difficult to cope with the emotions of hearing during an ultrasound of the first or second trimester that the long-awaited baby may be born with a cleft lip and other disorders.

Usually it is during these studies that the doctor finds signs of pathology.

Before you panic or get upset, it is worth reminding yourself that cleft lip in children can be treated with modern surgical methods, and the defect itself does not lead to severe developmental disorders.

Characteristic

Cleft lip or cheiloschisis is a congenital pathology of the fetus that occurs during the formation of the maxillofacial elements. A gap appears in the child’s upper lip, through which the oral cavity is partially visible. It can damage not only the lip, but also lead into the nasal cavity.

The active process of formation of the maxillofacial system occurs from 4 to the end of 11 weeks. It is at this time that the middle nasal fusion occurs with the right and left maxillary processes.

The appearance and location of the gap depends on which process with which the fusion will be disrupted.

The violation occurs with a frequency of 1 in 2,500. According to some reports, it occurs more often in boys. In rare cases, the defect is accompanied by a cleft palate - a cleft in the middle part of the palate.

Classification

In most cases, the gap forms on one side of the upper lip, mainly on the left. According to statistics, deformation of the right lip is 2 times less common than the left. Sometimes pathology forms on both sides or the lower lip. Bilateral and unilateral clefts can be complete, i.e. lead from lip to nose, or incomplete - limited only to the lip.

One-sided can be hidden - the pathology concerns only muscle tissue and does not affect the skin and mucous membranes. Bilateral can be symmetrical or asymmetrical. In the latter case, the defect is more pronounced on one side.

Symptoms and diagnosis

Signs of pathology are detected during an ultrasound performed in the first or second trimester . Accurate description and confirmation of diagnosis, however, cannot be made before the baby is born.

When newborns are born, attention is immediately drawn to a unilateral or bilateral gap on the upper or lower lip. The cleft lip sometimes reaches the baby's nose. If this defect is detected, an ENT specialist is examined to clarify the presence of pathology in the oral and nasal cavities.

It is sometimes believed that signs of a cleft lip detected during an ultrasound are grounds for artificial termination of pregnancy. This issue is decided by a medical commission only in the presence of other developmental defects that threaten the child’s life.

Complications

A deformity affecting only the lip leads to problems associated with feeding, speech development, tooth growth and hearing.

A child up to one year old eats mainly milk and liquid food. The gap in the lip causes food to sometimes enter the nasal cavity. It is quite difficult to make sure that all the food gets into your mouth. In case of severe pathology, a special feeding tube is used for feeding.

Pathology leads to improper formation and growth of teeth. So, it can lead to the absence of some teeth or, conversely, the appearance of extra ones.

In some cases, teeth grow at the wrong angle, which leads to malocclusion and, as a consequence, incomplete chewing of food and deterioration in its processing in the gastrointestinal tract.

Irregular tooth growth also contributes to the development of tooth decay.

In many cases, a cleft lip leads to disturbances in the formation of sounds. The voice becomes nasal, speech becomes unclear. It is difficult for a child to pronounce consonant sounds accurately and clearly.

Increased susceptibility to colds. There is a high risk of complications in the form of otitis media, middle ear effusion and, as a consequence, hearing impairment.

The problem of adaptation is one of the most important. A grown-up child feels inferior because he is different from others and because they laugh at him. Closedness and self-doubt develop. Mental tension, susceptibility to depression and stress are often characteristic.

Treatment

Correction of a cleft lip is carried out only by surgical intervention. Treatment tactics are determined depending on whether the cleft lip is an isolated pathology or is accompanied by other anatomical disorders: clefts of the soft and hard palate, nasal deformities. Most often, one or more plastic surgeries are performed.

Surgical intervention is prescribed for a child who is born at term and has no contraindications, for example, heart defects, respiratory defects, jaundice, or birth injuries. Usually the operation is performed when the baby reaches 3-6 months.

If there are indications, it can be done earlier. Theoretically, before the age of one month, the operation could have a positive effect on the baby’s lips, nose and overall development, as well as relieve psychological stress from the parents.

But the lips at this age are still too small, and the child himself is prone to blood loss.

The operation is aimed at restoring the integrity of the lips, eliminating anatomical disorders of the palate and nose and normal development of the maxillofacial system.

It is expected that all stages of surgical treatment should be completed before 3 years. It is during this period that the formation and development of speech occurs.

After all stages of the surgical intervention, treatment is carried out aimed at eliminating the scar that arose after the operation, correcting the bite and correcting speech therapy disorders. Typically, complete treatment is completed by the age of 6 – the time when baby teeth begin to change to permanent ones.

However, in cases where the cleft affects the alveolar process, surgery can be performed at the age of 7-8 years. Correction of nasal deformity is corrected at the age of 16-18 years.

Modern surgery provides 3 types of operations for the treatment of cleft lip:

• Cheiloplasty;
• Rhinocheiloplasty;
• Rhinocheilognatoplasty.

Cheiloplasty

This type of surgical intervention is indicated if the deformity is only on the lip and does not affect the cartilaginous and bone elements. In this case, one of three methods is used:

• For minor violations - the linear method;
• For a deep cleft, use the method of forming a quadrangular flap;
• For clefts extending into the nasal cavity, the triangular flap method is used.

Cheiloplasty is often the first stage of a cycle of operations.

Rhinocheiloplasty

This surgical intervention is indicated for complete cleft lip with deformation of the cartilage tissue of the nose and oral muscles. During the operation, the cartilage is installed and fixed in the correct position, then the lip tissue is sutured.

At the end of the operation, a tampon is inserted into the nose to prevent food from entering the nasal cavity and narrowing the passages. After 2-3 days, a tube is installed instead of a tampon, aimed at maintaining the correct position of the nose.

It may remain in the nose until it is completely healed.

In case of significant violations, repeated surgery is indicated.

Rhinocheilognatoplasty

Aimed at restoring the anatomical integrity of the lips, forming the muscles around the mouth, eliminating nasal deformities, and disorders of the alveolar process. This is a complex plastic surgery, followed by a long rehabilitation period.

Rehabilitation period

After the operation is completed, the child will remain in the hospital for some time. Doctors will monitor his condition and continue pain medication. Feeding during this period is carried out through a tube and using soft nipples. A bandage will be placed on your face to prevent the stitches from coming apart. The stitches themselves are removed on the fifth day.

Treatment must be continued after discharge from the hospital. Clinic specialists will prescribe procedures aimed at accelerating the healing of damaged tissues and, if necessary, continue pain relief. Older children may need to see a speech therapist and dental treatment. A consultation with an otolaryngologist is indicated.

At home, parents are recommended to do lip exercises and speech development with their children.

There is no need to be afraid that a child was born with a cleft lip. Modern surgical methods make it possible to correct deformities, eliminate scars, restore the shape of the nose, and correct the bite. Timely measures taken will help avoid the influence of pathology on the child’s mental state.

Source: https://LechenieDetej.ru/zuby/zayachya-guba.html

Prevention

To minimize the risk of having a child with a cleft lip and cleft palate, expectant parents should:

• to refuse from bad habits;
• plan your pregnancy in advance;
• get tested for STIs and TORCH;
• consult a geneticist if one of your relatives has this pathology;
• avoid unnecessary use of medications;
• eliminate stress;
• plan pregnancy at a young age.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Cleft lip and cleft palate: photos before and after surgery, causes of occurrence

With the birth of a child, great joy appears in the family, but sometimes children are born with certain defects.

In some groups of children, certain types of deformations of the mouth and face as a whole may be found, some of which are cleft palate and cleft lip. A peculiarity of these defects is that the formation process takes place in the first few months of pregnancy, when the child is in the mother’s womb.

Major defects in children at birth

The formation of such defects is facilitated by incorrectly connected areas of the body, which is caused by a lack of tissue in some areas.

A cleft lip is a cleft formed on both sides of the upper lip, which is the result of a physiological abnormality. In appearance, this is a narrow hole, or a kind of gap in the skin above the upper lip.

But there are also cases where the cleft reached the nose, and also affected the upper gum and the bone of the upper jaw.

But the cleft palate is a kind of expansion that affects the area of ​​the palate. Sometimes in newborns with such a deviation, the cleft palate even involves the soft/hard palate.

Of the common signs of these two defects, we note that they can affect one or both sides of the mouth.

Due to the fact that these organs develop separately, a child may have one or even two of these deformities.

Who can have a cleft palate and cleft lip?

If we talk about a cleft lip, which can be a separate deformity, or go in combination with a cleft palate, it should be noted that this disorder in tissue development is found in every 700th child every year.

In the USA, this type of deviation is the most popular, and in the list of defects these two are given fourth place. Children of Native American, Latin American and Asian origin are most susceptible to such deformation.

Also, this deformation is often found in boys - diagnostics have shown that boys are twice as susceptible to one of these deviations, and we are talking specifically about the cleft lip.

At the same time, girls are much more often diagnosed with a cleft palate (cleft palate), and the likelihood of developing this defect is twice as high in them as in boys.

factors causing cleft lip and cleft palate

At the moment, none of the scientists can say for sure why children develop this kind of deformation. for this reason they cannot make recommendations to minimize the risk of such defects in infants.

Some believe that these defects are primarily associated with the influence of genetic and natural factors.

so, if the parents of a newborn, as well as relatives, have such a deformity, then there is a high probability that it will be passed on to the child.

These defects can appear in a child even if the mother had to take certain medications during pregnancy. among them there are those that can easily cause a child to develop a cleft lip or palate.

Among the most popular “catalysts” for the formation of these defects, we note:

• acne products containing accutane.
• drugs of the anticonvulsant class.
• methotrexate. Doctors often prescribe this drug to patients whose list of diseases includes arthritis, psoriasis, or diagnosed cancer.

In addition to all this, the best conditions for the intrauterine development of a cleft lip or cleft palate may be the influence of chemicals or viruses on the fetus. in other cases, such deformities are associated with the development of diseases that have a different etiology.

How are cleft palate and cleft lip diagnosed?

Even the very knowledge that there are physiological defects in the formation of a cleft palate or lip simplifies the diagnostic process. in some cases, the presence of defects can be diagnosed by undergoing a perinatal ultrasound examination .

if it does not give a positive result, then after the birth of the child it is imperative to conduct a physical examination of the nasal cavity, palate and mouth to confirm the absence of conditions for the formation of such defects. in some cases, this diagnosis can be established during an examination, which is carried out to identify other developmental abnormalities.

What difficulties are associated with the appearance of cleft lip and cleft palate in children?

If a child has these deformities, this will limit him in performing standard actions that are necessary to maintain life.

difficulty eating

If a child is diagnosed with a cleft lip or cleft palate, then during feeding fluid can enter the nasal cavity, and only from there into the mouth. Today, scientists and specialists are actively working to solve this problem and for such children special nipples and bottles for feeding children are offered, thanks to which the child can feed without problems, taking food directly into the esophagus.

To simplify feeding of children with a cleft palate, it will be necessary to install an artificial palate, due to which the flow of food into the esophagus will be simplified and will not cause any inconvenience. This will remain the case until the attending physician authorizes surgery.

ear infections and hearing loss

If a child has a cleft palate, there is a high probability that in addition to this defect he will have an ear infection. this risk is quite high due to the fact that such children have a tendency to develop and accumulate fluid inside the middle ear. This condition requires urgent and expensive treatment, otherwise there is a risk of hearing loss in the child.

In order to avoid this, such children are advised to buy special tubes that are placed on the eardrum, thus creating conditions for removing accumulated fluid. In addition, children with such defects and risks must be examined every year by the necessary doctors to evaluate their hearing.

speech problems

If a child is diagnosed with a cleft palate or cleft lip, then the likelihood that he will have problems with speech also increases.

Due to their peculiarities in the body, children can make sounds through their nose, as a result of which their speech may not always be understandable to others. but, fortunately, not all children have this.

There are cases when, thanks to a surgical operation, it was possible to restore the ability to speak normally to a child with a defect.

if the child has visible problems with speech and its development, then you will need to contact a speech therapist. This specialist doctor will work separately with the child, drawing up a list of exercises necessary to correct the deficiency so that speech is restored to the required level.

problems with teeth

One of the problems that can also affect children who have been diagnosed with a cleft palate or lip is caries.

Sometimes these children have extra, displaced or crooked teeth, which means they need to visit an orthodontist or pediatric dentist. In addition, there are cases where children with such diagnoses were found to have an alveolar ridge defect. The alveoli are the part of the upper gums made of bone that acts as a base for the teeth.

If a child is diagnosed with a defect associated with the alveoli, this can have the following unpleasant consequences:

• a defect that is associated with the location of permanent teeth, which can be expressed in displacement, rotation or protrusion.
• the appearance of interference with the full development of permanent teeth.
• the emergence of difficulties for the full formation of the ridge.

In order to combat such manifestations, medicine has several methods of maxillofacial surgery, thanks to which it is possible to remove all these problems with 100% efficiency in one operation.

who treats children with cleft lip and cleft palate?

Considering that these types of deformities affect areas that are dealt with by several different specialists, most often, to effectively combat this, you will have to involve a whole council of doctors.

and usually such a team consists of the following doctors:

• plastic surgeon. This is a professional who performs surgical operations on the roof of the mouth or lip.
• otolaryngologist. A doctor who treats hearing problems and who can determine the best treatment for ear problems.
• maxillofacial surgeon . this doctor deals with various manipulations to move the upper jaw, which are necessary to improve and normal functioning, as well as remove cosmetic defects and cleft gums.
• orthodontist _ A doctor who specializes in moving and straightening teeth.
• dentist. A doctor whose specialty is oral and dental care.
• prostodon. a doctor who creates artificial teeth and certain dental appliances that help restore normal speech and appearance. If necessary, these devices also make eating easier.
• speech therapist. a doctor who knows how to improve speech quality.
• speech pathology specialist. a doctor who studies pathologies associated with food intake.
• log. This specialist studies the causes of communication disorders that are associated with hearing loss or impairment.
• psychologist/social worker. a person who provides planned assistance and gives advice on overcoming problems associated with the adaptive period.
• genetics specialist. Both parents and adults are interested in advice from this doctor, since they can find out to what extent there is a high probability that they will have a child with the same defect.
• Therapist. a person who studies the general condition of the child based on the findings of all the above doctors.

Treatment of a child requires the preparation of a specific program, which involves the joint actions of each of the specialists and taking into account all the needs of the little patient.

Usually, already during infancy, specialists are selected for the child and a number of measures are carried out to remove the found deformations.

but this process is quite long, and usually ends when the patient reaches early adulthood.

how to treat cleft palate and cleft lip?

To completely remove the deformity, specialists need to perform 1-2 plastic surgeries. The final decision will be made after studying the condition of the cleft. The first surgical intervention is performed when the child is three months old.

The treatment of cleft palate has its own complexity, since to get rid of this defect it will be necessary to perform many operations and only after the patient turns 18 will he be able to regain his normal appearance. The first time the palate is corrected is when the child is 6 or 12 months old.

after the first operation, usually not only an improvement in the condition is noted, but also a decrease in the risk of fluid getting into the middle ear. Among other advantages, we also note the creation of excellent conditions for the formation of facial bones and teeth in normal proportions, shapes and sizes.

conclusion.

Cleft palate and cleft lip are quite serious diseases that can bring many difficulties into a person’s life from infancy.

Such children need the help of doctors from the very first day of birth. To our relief, today’s medicine has a considerable number of methods that can return such children to normal life.

The disadvantages include the fact that the process takes a lot of time and requires a huge number of operations. But if you follow the recommendations of specialists and carry out all the prescribed procedures, in most cases the treatment of the disease will not be so difficult and will yield good results!

Source: https://iplastica.ru/kosmetologia/na-lice/zayachya-guba-i-volchya-past.html

When can cleft surgery be performed?

Forms of cleft palate: A - Cleft uvula of the soft palate; B - Cleft soft palate; B - Cleft of the soft and partially hard palate; D - Complete lateral cleft of the soft and hard palate; D - Complete bilateral cleft of the hard and soft palate

D.Yu.Komelyagin: Different clinics adhere to different rules and different timing of the operation. We operate on cleft lip at the age of four months (more precisely, from four to six months) depending on the situation. If the child is hypotrophic, low weight, with low hemoglobin, then it is better to postpone the operation. Should I operate on a cleft before four months? Such an operation is painstaking work; it is important that the baby’s tissues with which the surgeon will work are already mature. In addition, the lungs and heart must mature so that the baby can safely endure anesthesia and the postoperative period. There's no point in rushing. Unless, of course, nothing threatens the child’s life.

Often, facial clefts are signs of one or another syndrome with associated complications (Stickler syndrome, Lowes-Dietz syndrome, Hardikar syndrome, Treacher-Collins syndrome, etc.), including Pierre Robin syndrome, characterized by underdevelopment of the lower jaw and recessed tongue. A child with this syndrome simply cannot breathe normally or breathes only in a certain position (on his side, on his stomach), because the tissues are displaced and block the airways.

Of course, in such cases, early operations are justified. This is what is called “operations for vital reasons” (D.Yu. Komelyagin and the team of the 1st surgical department have a patent for the invention of a compression-distraction device that makes it possible to successfully treat children with Pierre Robin syndrome - Ed.).

— What should parents of a child born with a cleft pay attention to?

- For all. Conduct a full examination. And after that, build a treatment plan together with specialists. Let's say, if he has a heart defect, of course, first of all, you need to deal with the defect, and then treat the cleft.

But if there are no other, more important factors, we recommend surgery for a cleft lip at the age of four months, and a cleft palate at the age of one and a half years. It is more difficult to treat an alveolar cleft. Previously, we proposed to operate on her at twelve years old, now we start at eight. For treatment, bone grafting is performed, that is, the patient’s own bone is used (say, from the lower jaw, tibia) or artificial bone (bone graft).

An important point in the treatment of alveolar cleft is orthodontic preparation. That is, first the orthodontist achieves the correct position of the upper jaw fragments relative to each other and relative to the lower jaw, and then the surgeons begin the correction.

If the operation is successful, patients then return for follow-up visits every six months. The surgeon and orthodontist monitor the formation of scars, the upper jaw, and whether there is any deformation of the nose. Sometimes you have to do surgical correction again. But it is important to make these decisions together with your orthodontist. If the growth of the upper jaw is not complete, surgery can be harmful.

In addition to the maxillofacial surgeon, you may need help from: neurologist, otorhinolaryngologist, orthodontist, dentist, speech therapist, audiologist, phonopedist, psychologist

Why does a cleft lip occur, how to eliminate the disease

Summary of the article:

Pregnancy is one of the most important periods in the life of a woman and her baby. However, modern medicine is not able to keep track of all the processes occurring in the stomach of the expectant mother.

And sometimes after giving birth it turns out that the baby’s condition requires immediate medical intervention. One such health disorder is a cleft lip.

The causes, treatment and prevention are described in detail in this article.

Types of pathology

A cleft lip is a congenital pathology characterized by a non-fused upper part of the mouth. The cleft may be partial or deep, affecting the palate and nose. Doctors determine the presence of the disease immediately after the baby is born. However, there are cases when the pathology is mild and takes the form of a small pit on the lip.

Typically, cleft lip occurs on the left side of the face. Very often the cleft extends from the lip to the nose; it can be so deep that the alveolar process of the jaw is visible. As a rule, the disease is divided into the following types:

• The first type - the defect is localized on one or both sides of the lip;
• The second type is the so-called through cleft, when part of the lip tissue is completely missing.

A defect in the form of a cleft lip is difficult to eliminate. However, this does not mean that it is impossible to get rid of such a defect. To date, surgeons have been able to perform successful operations in the most difficult situations. However, it is important to remember that such medical intervention should be carried out no later than one year after the birth of the child.

Causes of cleft lip

The main reason that explains the presence of a cleft lip in a newborn is a genetic mutation . In addition, the development of a facial defect can be triggered by factors such as:

1. The presence of infection in a woman in early pregnancy;
2. Adverse habits of the expectant mother (tobacco products, alcoholic drinks, drugs);
3. Inappropriate use of medications;
4. Hereditary predisposition to cleft lip (there is a high risk that this pathology will be passed on to the future generation);
5. The presence of frequent stress during pregnancy;
6. Diseases of the cardiovascular system;
7. Diabetes;
8. Abdominal injuries;
9. Anemia;
10. Overheating or freezing;
11. Neglect of healthy eating;
12. Obesity of the expectant mother;
13. Severe toxicosis;
14. The age of the woman giving birth is over 35 years.

The presence of the above factors in the early stages of pregnancy is especially dangerous. Since during this period the baby’s body is formed, and any harmful influence can lead to deformation of the body. This includes cleft lip.

What danger does the disease pose?

A defect in the form of a cleft is a rather dangerous condition that can lead to the following consequences:

• Since a baby up to one year of age eats only liquid food, this may create some difficulties when feeding. Food can easily get into the nose, and you will have to work hard to feed the baby. In some cases, a feeding tube is used;
• Sometimes, for some reason, it is not possible to perform an operation when a child’s teeth begin to erupt. This is fraught with new consequences - the addition or absence of some units;
• In the future, such a defect may affect the baby’s bite. After all, the angle of teeth growth changes slightly. Chewing, and subsequently digestion, noticeably deteriorates;
• As spoken sounds enter the nose, the child's speech and voice become less intelligible and nasal;
• Do not forget that even a small facial defect can aggravate a child’s communication with his peers, which will negatively affect his self-esteem;
• In addition, a cleft lip can cause hearing impairment;
• Children with this pathology often experience ear inflammation.

These reasons are enough to understand why a child with this pathology needs surgical intervention.

How is this pathology eliminated?

A cleft lip can only be corrected through surgery. First of all, the surgeon assesses the child’s condition and facial defect, then sets the timing and number of operations. As a rule, cleft repair is carried out through the following operations:

1. Rhinocheilognatoplasty;
2. Rhinocheiloplasty;
3. Cheiloplasty.

What are the listed types of surgical interventions? So:

1. Rhinocheilognatoplasty. By performing this operation, you can completely and easily restore the integrity of the lips, avoid underdevelopment of the jaw, correct deformation of the cartilaginous tissues of the nose and restore full functionality to the facial muscular system;
2. Rhinocheiloplasty. This method of treatment is used in particularly difficult situations when deformation of the nose and bones of the facial part of the skull has occurred. The operation is long and complex;
3. Cheiloplasty. This type of treatment is used if the cleft is shallow. It promotes complete restoration of lip function and returns it to a healthy appearance. Surgical intervention is allowed from the first months of life, but provided that the child has no problems with weight gain, a healthy central nervous system, heart and blood vessels.

Important preventive measures

It is quite possible to avoid such consequences as a cleft lip. It is enough to follow some tips:

• Before conception, it is advisable to visit a doctor and conduct an examination for the presence of infectious diseases;
• During pregnancy, it is extremely important to monitor your diet. Any harmful foods should be consumed in limited quantities. The diet should be rich in vitamins;
• Monitor your body temperature; the body should not become overcooled or overheated;
• Any medication should be taken under the strict supervision of the attending physician. And some drugs are completely prohibited during pregnancy, for example, antibiotics;
• During the period of gestation, it is necessary to forget about any bad habits. Avoid contact with people who smoke, avoid smoky rooms;
• Intoxication with toxic substances increases the risk of developing the disease. Avoid the smell of paint, varnish, gasoline, etc.

Pregnancy is the most exciting and special period in a woman’s life. Therefore, many mothers worry that they may provoke the development of a pathology such as cleft lip; the causes are very diverse, but if you follow the above tips, the baby will definitely be born healthy.

about unfused lip

In this video you will learn about the causes of the disease:

Source: https://medic-23.ru/bolezni/520-zayachya-guba-prichiny-vozniknoveniya.html

“The children did not laugh, they took care of her “teeth on her nose”!

“I saw my sixth daughter for the first time a month after her birth,” recalls Marianna Simonova, a mother of seven adopted daughters from Novosibirsk. “In the photograph in the Federal Database. She was there... scary. They photographed her sideways, unsuccessfully. But something told me: “Mine. If I don’t take it, the system will destroy her.”

A few months later I was already flying from my Novosibirsk to meet her in Vladivostok. My husband said at home: “The eyes are beautiful, we’ll fix everything else.” So I already had my husband’s support. She flew in, picked her up, and sniffed her. All. This was enough for me to make a decision. I'm picking it up.

Yes, she had a bilateral cleft lip and palate. At that time, I had already read it, asked around, and consulted with surgeons. My husband and I decided that we will fix it. The only thing I was afraid of was the reaction of my other daughters. How will they accept it? Won't they laugh? She was the youngest at that time.

I then left her at the institution, supposedly they were expecting a quota for an operation for her. But I soon realized that time was passing - no one was taking care of it there. And she took it home.

At first we just needed to feed her. The weight was too low, the hemoglobin was low, the operation could not be performed in this condition. How to feed her? The pacifier is sucked by pressing it against the roof of the mouth with the tongue. And she has a gap in the sky - there is nothing to press against. Then she somehow managed to wrap her tongue around the nipple and pull from it. She had to be fed every 2-3 hours both day and night.

Meat purees (hemolobin must be raised) were given from a spoon. You put the spoon down and everything falls out, there’s nothing to hold it down with. You clean your nose and you see right through everything, almost to the brain. You give the liquid and you understand - you need to be extremely careful, under no circumstances should you choke on it. My friends in the same situation had food pouring out of their ears. We didn't have that, really.

But in the end, by the age of one and a half years, she was ready for surgery. Several hours of surgery, several days in intensive care without my mother - all this is behind me. And the brilliant result is obvious. No complications. Before the operation, I was advised by an excellent maxillofacial surgeon, our Novosibirsk resident, Mikhail Vasilyevich Kolybelkin. He even helped me choose a name for my daughter. According to her passport, her daughter’s name is Victoria, Vika. “She can’t pronounce it yet, give her a short name.” This is how we got Iya, Iyushka (from Greek “violet”). That’s what we have – a beautiful violet, a delicate flower! This name suits her so well!

And the older children, by the way, never laughed at her; on the contrary, they protected her as best they could, especially before the operation, did not let her fall, and were afraid for her “teeth on her nose” (that’s what they called her defect).

Not scary? No, I was only afraid for her, how she would endure everything. And it was even worse to leave her in the system. Children cannot be left without a family. Especially like this. Without surgery, attention, love, they very quickly become heavy, with severe developmental delays. But this is just a surgical problem. If a child is in the family, everything can be fixed!”

Materials used in preparing this article:​

1st surgical department of St. Vladimir Children's City Clinical Hospital: https://cmfsurgery.ru

Institute of Congenital Diseases of the Maxillofacial Region, Professor G.V. Gonchakova: https://www.vasha-nadezhda.ru/care

website https://www.operabelno.ru/metody-xirurgicheskoj-korrekcii-volchej-pasti-u-detej/

Medical and clinical genetics for dentists: a textbook for universities / Ed. O.O. Yanushevich., - 2009. - 400 p.

Memo prepared by the “He Needs You” Foundation. You can download the memo.

If you need medical help or advice, you can submit an application for remote consultation and hospitalization in specialized hospitals

Reasons for the formation of pathology

The formation of a cleft can be caused by one harmful factor affecting the body of the expectant mother, or several reasons at once. The most common ones are:

• internal factors in the development of cleft lip pathology: hereditary, parental age exceeding 40 years, disorders in the formation of germ cells;
• external influences: unfavorable ecology, radiation, chemical intoxication with alcohol, smoking, drugs, medicines;
• abnormal course of pregnancy, lack of vitamins;
• infectious diseases: rubella, herpes, etc.

Various processes during a woman’s pregnancy can lead to the birth of a child with a “cleft lip,” increasing the likelihood of developing fetal malformations. This is a high body temperature resulting in overheating of the fetus due to illness, exposure to the sun or visiting a bathhouse. Increasing the degree of permeability of the placenta, through which medications enter, having a negative effect on the fetus. The cause of congenital cleft of the upper lip is often uterine tumors, previous abortions, predisposition to miscarriages, and severe toxicosis.

Causes of pathology

A cleft lip or cleft palate is formed at the genetic level. There is a mutation in the TBX22 gene, which is associated with facial anomalies. Such a mutation can be provoked by: prolonged and severe toxicosis, stress, prolonged and uncontrolled use of antibacterial drugs, exposure to radioactive or chemical substances, taking drugs and alcoholic beverages, as well as smoking during pregnancy, when all organs and systems are formed.

The listed factors have a particularly negative effect in the first trimester of gestation. Another risk factor is late pregnancy – after 40 years. Heredity plays an important role. Such a defect can be detected using ultrasound examination in the last trimester of gestation. If the family already has children with such a malformation of the jaw, parents should undergo genetic testing from specialists in the future when planning other children.

Cheiloschisis and palatoschisis are congenital developmental anomalies. In many cases, doctors are unable to determine the exact cause of their development. Also, according to experts, such a pathology can be formed either under the influence of one of the provoking factors or several.

Common causes of anomaly development

The main reasons for the formation of clefts include:

• influence of endogenous factors;
• exposure to adverse environmental conditions;
• radioactive influence;
• ingestion of toxic or chemical substances into the body of a pregnant woman;
• acute deficiency of vitamin substances during the formation and formation of organs and systems;
• maintaining an unhealthy lifestyle during pregnancy;
• use of certain medications;
• severe infectious diseases;
• external conditions;
• hereditary factor;
• Also, such a defect can be formed under the influence of smoking, drinking alcoholic beverages, and narcotic substances.

Influence of endogenous factors

Endogenous factors influence the development of pathology from the inside. Endogenous provoking factors include: genetic predisposition, age of mother and father, biological inferiority of germ cells.

This anomaly often appears in those children whose parents also have a similar defect. According to statistics, the risk of such oral anomalies is about 4%. If the defect is present in the father and mother, the probability of its occurrence in the child is 9%. Genetic pathologies appear under the influence of endogenous and exogenous conditions. The result is a gene mutation. Mutagens include chemicals and microorganisms that parasitize at the cellular level.

The age category of the parents is an important factor. Of particular importance is the age of the mother - above 40 years.

Inferiority of germ cells is their inability to create cellular structures that have a complete set of chromosomes. Abnormalities can be caused by defective reproductive cells of the father and mother equally. The main reasons for such inferiority include: overripeness of the egg. This is more common among smoking parents. Abuse of alcoholic beverages and the presence of unfavorable environmental conditions also affect this.

Negative effects of environmental conditions

Under the influence of exogenous factors, embryonic development is also disrupted. Negative conditions include: living in an unfavorable ecological environment, electromagnetic and radiation radiation. Women who live or work in areas of environmental pollution are included in the risk category for having children with developmental anomalies. You can be exposed to electromagnetic radiation at work and at home, constantly in contact with equipment and household appliances.

One of the key negative factors is ionizing radiation. Penetrating into a woman’s body, such substances are able to accumulate there and remain for a long period of time.

Chemical poisoning

Some inorganic chemical compounds, penetrating into the body, can cause defects in the development of children. Such compounds are called teratogenic poisons. They are contained in some cosmetics, household chemicals and products used in agriculture. Among all substances, one of the most common and dangerous is lead. It is able to enter the body along with food. Mercury, cadmium and arsenic can also cause an anomaly.

Other teratogenic poisons include:

• poisons used in the agricultural industry (pesticides, fungicides, herbicides);
• mineral fertilizers (nitrates);
• food additives (dyes and preservatives);
• substances in cosmetics (retinoids, sodium lauryl sulfate);
• household chemicals (chlorine, ammonia, phosphates).

Acute deficiency of vitamins

If there is a lack of vitamin substances in the body, the risk of having a child with developmental abnormalities increases. Particularly important is the full amount of vitamins in the first months of pregnancy, when the baby begins to form. A great danger is the lack of folic acid, vitamins A, E, C, B12.

Poor lifestyle and infections

Many experts associate such pathologies with the fact that a woman abuses alcohol during gestation and continues to smoke and use drugs.

If a woman suffers any infections during pregnancy, the risk of defects in the child increases. At the same time, both viral and bacterial infections are dangerous. The most dangerous diseases that cause such consequences include: measles, rubella, cytomegalovirus infection, Coxsackie virus, herpes, smallpox.

Taking medications

After using certain medications, the body also receives a teratogenic effect. The amount of negative impact is directly determined by the degree of penetration of the active substances of drugs through the placenta. High-risk drugs:

• psychotropic;
• medications against epilepsy;
• cytostatics;
• antibacterial drugs;
• remedies designed to combat depression.

Exogenous conditions

The following factors can provoke the development of pathologies in the facial region: neoplasms in the uterus, attempts by the mother to terminate the pregnancy, abortions, blows to the stomach, careless falls from a height, heat exposure, constant overheating in the sun, frequent visits to the steam room.

Another reason may be fetal hypoxia, diseases of the cardiovascular system, diseases of the hematopoietic system, and intense toxicosis. All these factors negatively affect the child's health.

Causes

The occurrence of pathology is based on hereditary predisposition. The anomaly is associated with a mutation in the TBX22 gene. Sometimes the formation of a defect may be associated with malfunctions of the genetic system caused by toxicosis, psycho-emotional stress, antibiotic therapy, infectious diseases, smoking, taking drugs and alcohol. It is believed that the impact of negative factors on the fetus in the first trimester of pregnancy is especially dangerous. Sometimes gene mutations that provoke the onset of the disease are caused by late childbirth. When distributing negative agents according to the intensity of their impact, they can be arranged in the following sequence:

23%chemical;

6% traumatic;

5% biological;

2% physical and all others.

Manifestations of a cleft lip defect

The defect in the form of a cleft is usually localized on the upper lip on one, less often two sides, sometimes accompanied by a cleft palate and cleft of the alveolar process of the jaw. In addition to external manifestations, the defect is characterized by symptoms of impaired dentition, sucking, swallowing and sound pronunciation. Bilateral anomaly is less common, often in combination with other pathologies of the maxillofacial apparatus. Often, a cleft lip is accompanied by a cleft palate defect, in which the gap extends to the upper palate.

According to the degree of severity of the defect and the location of the “cleft lip” in newborn children, there are:

• one-sided: full (with splitting up to the nostril); incomplete (with partial preservation of tissue); hidden (with muscle splitting while maintaining the mucous membrane and skin);
• bilateral: symmetrical (equally full or partial on both sides); asymmetrical (with complete cleavage on one side and incomplete or hidden on the other).

Causes of cleft lip in newborns

A cleft lip is a congenital malformation of the tissues of the nasal cavity and upper jaw (when these tissues do not fuse together completely). Externally, the defect looks like a specific cleft of the upper lip.

The pathology is relatively rare, in approximately 0.04% of cases, and is more often diagnosed in boys. Often, against the background of a cleft lip, a newborn also has another defect, which is a cleft in the palate (cleft palate).

The prerequisites for the development of the disease can be observed even in the prenatal period using ultrasound . Correction of the defect in children is carried out only surgically. We will talk about the causes of cleft lip in this article.

How is limb brachydactyly inherited in a child? Find out about this from our article.

Characteristics of the pathology

Cleft lip in a child - photo:

A cleft lip is usually called a congenital defect of the bones of the maxillofacial system , manifested in the form of a cleft in the upper lip. The cleft can have different sizes, most often through it you can see the oral cavity.

In some cases, the depth of the cleft is quite significant; it can reach the nasal cavity.

The defect can be unilateral (the cleft appears on the right or left side), or bilateral (appears on both sides at once), in most cases there is a cleft that occurs in the middle of the upper lip.

Reasons for the development of the defect

Why are people born with a cleft lip? The formation of the maxillofacial system is influenced by many factors. The development of the defect can be caused by such unfavorable reasons as:

1. Genetic predisposition. If one of the child’s parents suffered from this defect, the probability of its occurrence in the fetus is about 7%.
2. Adverse chemical effects on the body of a pregnant woman at the beginning of pregnancy. Such influences include smoking, drinking alcohol and drugs, taking medications and dietary supplements, unfavorable environmental conditions, and eating food contaminated with chemicals.
3. Viral and bacterial diseases, as well as STDs.
4. Adverse physical effects on the body of the expectant mother, for example, injuries, hypothermia and overheating of the body, exposure to radiation.
5. Oncological diseases (in particular, a tumor developing in the uterine area).
6. Multiple and late pregnancy (over 40 years).
7. Stress and emotional distress.
8. Obesity.
9. Severe toxicosis in the 1st trimester.
10. Poor nutrition during pregnancy, insufficient intake of vitamins and minerals.
11. Diabetes mellitus of the expectant mother.
12. Anemia and diseases of the cardiovascular system.
13. Complicated pregnancy, accompanied by uterine bleeding, threat of miscarriage.

Read about methods for diagnosing Down syndrome in a child here.

Differences from cleft palate

Cleft lip is often accompanied by other malformations of the maxillofacial apparatus. The most common cases are when, along with a cleft lip, a child also has a cleft palate - a more serious problem that provokes serious problems with breathing, swallowing, and speech.

The differences between these two ailments lie in the location of the defect.

Thus, with a cleft lip, the pathological process involves the soft tissues of the maxillofacial system, and in some cases, the bone tissue of the upper jaw.

The cleft palate is a cleft located in the area between the nasal cavity and the palate .

Symptoms and clinical manifestations

The pathology has a pronounced clinical picture, symptoms that can be seen with the naked eye. So, outwardly the pathology manifests itself in the form of:

1. Cleft , which affects the upper, and in rare cases, lower lip.
2. The size of the defect may vary. In some cases, only the lip area is affected; in more serious cases, the cleft reaches the nasal cavity and even enters it.
3. The upper jaw can often be seen through the incision in the upper lip.
4. Depending on the form of the pathology, the child has one or two furrows .

How dangerous is the disease?

The defect, in addition to aesthetic problems, is accompanied by such phenomena as:

1. Difficulty swallowing.
2. Dental disorders . If the problem is not eliminated before the baby's first teeth begin to emerge, this may lead to the absence of some teeth, or, conversely, to the appearance of extra ones.

Over time, the child’s bite becomes disturbed, and this is fraught with problems such as impaired digestion of food (since the child cannot chew it well), tooth sensitivity, and a tendency to form caries.

3. Speech impairment . The child cannot pronounce certain sounds correctly, and his voice becomes nasal.
4. Hearing impairment, possible otitis media.
5. Difficulties in adaptation . The child experiences psychological problems related to his appearance.

Treatment and correction

The defect can only be eliminated surgically. It is advisable to carry out the operation before the child reaches six months of age (or until the baby begins to teethe).

Various types of surgical operations are used; the choice of one or the other depends on the severity of the pathology, its type, and the presence or absence of other defects.

Indications and contraindications

Surgical intervention is not possible if:

• the child is small for his age;
• there are diseases of the heart and circulatory system;
• there are breathing problems;
• problems are noted in the functioning of vital organs (gastrointestinal tract, endocrine, nervous system);
• in the presence of anemia, jaundice of newborns;
• The child was severely injured during childbirth.

In all other cases, the small patient is prescribed elective surgery .

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Types of correction methods

Depending on the severity of the defect, one of the types of surgical intervention is prescribed:

Rehabilitation period and care

After the operation, the child needs a long rehabilitation period, which is carried out in 3 stages:

The importance of timely treatment

A child diagnosed with a cleft lip should be shown to a specialist as early as possible in order to find out the degree of complexity of the case, outline a treatment plan and increase the likelihood of successfully eliminating the problem. A competent diagnosis of the disease reveals not only a noticeable externally cosmetic defect, but also a number of other disorders. It is necessary to prevent their development and negative effect on the child’s health until the defect is corrected through surgery, which is possible no earlier than 4-6 months of age.

Among the dangerous consequences of not providing timely medical care to children with congenital complete or incomplete cleft lip:

• feeding disorders, when the child is able to swallow only liquid food or receive it through a tube directly into the stomach;
• improper formation of teeth, lack of teeth, growth at an angle;
• problems with voice and speech (nasality, unclear pronunciation of consonants);
• hearing impairment;
• tendency to otitis media, colds.
• psychological difficulties of adaptation in a children's group due to differences in appearance.

Cleft palate is a common congenital developmental anomaly. It is caused by a delay in the fusion of the bones of the right and left upper jaw, which manifests itself as a complete or partial absence of the septum between the nasal and oral cavities. Such a developmental defect leads to very serious consequences, since the proper supply of air to the body is disrupted, namely its purification and warming, the child experiences difficulties with nutrition, and subsequently with speech, in addition, hearing suffers.

However, the cleft palate is not associated with developmental defects of the nervous system, and children who have it are neither mentally nor physically retarded. Previously, however, children with a cleft palate rarely lived to adulthood, as they died from colds - cold and polluted air easily penetrated the respiratory tract, and in addition, food often got there. Currently, cleft palate is being successfully treated, in particular, the elimination of cleft palate in Israel allows us to completely solve this problem. At the same time, it is noted that prices for treatment in Israel are much more affordable than in other countries.

Cleft lip and cleft palate: causes, diagnosis and treatment, photos before and after surgery

Newborn babies are not always born without defects. In a certain group of children, types of deformities of the face and mouth area such as cleft lip and cleft palate may be found. Their peculiarity is that the process of their formation occurs in the first months of pregnancy, when the child is still in the mother’s womb.

The formation of such deformations is facilitated by improper connection of certain parts of the body, caused by an insufficient amount of tissue in a particular area.

A cleft lip appears as a cleft formed on both sides of the upper lip, resulting from a physiological abnormality. In appearance, it resembles a narrow hole or gap in the skin of the upper lip. There are cases when the cleft reaches the nasal area and also affects the upper jaw bone and upper gum.

The cleft palate is also a kind of expansion that affects the palate area. In some newborns, the cleft palate may involve the hard or soft palate.

A common feature characteristic of each of the considered defects is that they can affect one or both sides of the mouth at once.

Because the lips and palate develop separately, a child may have one or both of these deformities.

Who gets cleft palate and cleft lip?

Considering the cleft lip, which can appear alone or in combination with a cleft palate , it should be noted that such a deformity is diagnosed in every seven hundredth child every year.

In the USA, this deformation is one of the most common; it is ranked 4th in the list of such defects. Children of Asian, Hispanic, or Native American descent are most susceptible to them.

More often than others, these deformities affect boys , in whom they are diagnosed 2 times more often than in girls. In this case, this refers to a cleft lip. At the same time, girls are much more likely to have a cleft palate or cleft palate, and there are 50% more such cases than in boys.

What are the causes of cleft lip and cleft palate?

To date , scientists cannot say what reasons cause the appearance of such deformations . Therefore, they cannot provide advice on how to avoid these defects.

According to some experts, such defects are primarily associated with the combined influence of genetic and environmental factors.

Therefore, if the parents of a newborn, his relatives or brothers already have such a deformity, then there is a high probability that it will be passed on to the child.

Also, such
defects can occur as a result of the mother's use of medications during pregnancy.
Among the medications there are those that can cause the appearance of a cleft palate or lip. The list of the most common should include:

• anticolvunsants;
• acne treatments containing Accutane;
• methotrexate. This drug is often prescribed by doctors for patients diagnosed with cancer, arthritis and psoriasis.

Also, exposure to viruses or chemicals on the fetus can create favorable conditions for the development of a cleft lip or cleft palate . In all other cases, such deformations are usually associated with the development of diseases that have a different etiology.

How is cleft palate and cleft lip diagnosed?

The very fact that physiological defects are noted during the development of a cleft palate or lip In some cases, the fact of their presence can be determined using a prenatal ultrasound examination.

If the prenatal ultrasound examination does not give positive results, then after the birth of the newborn, a physical examination of the mouth, nose and palate is required to obtain confirmation that there are no conditions for the development of such defects.

In some cases, such a diagnosis can be made during an examination carried out to identify other developmental disorders.

What problems are associated with the appearance of cleft palate and cleft lip?

If a child has such deformities, this seriously limits him in performing the usual actions necessary to maintain life.

Difficulty eating

If a child has one of these deformities, then during a meal food and liquid may begin to move into the nasal cavity , and from there enter the mouth.

Today, this problem is being actively solved and special bottles and nipples for infant feeding are offered for such newborns, thanks to which it is possible to feed them in such a way that food moves down to the esophagus.

To make it easier to feed children with a cleft palate , they will need to have an artificial palate installed, which will help facilitate the process of food entering the esophagus. They will have to be fed in this way until the attending physician decides to perform the necessary surgical operation.

Ear infections and hearing loss

If a child has a cleft palate, there is a high chance that he will be diagnosed with an ear infection . This risk is high due to the fact that such children have a tendency to form and accumulate fluid in the middle ear. This condition requires appropriate treatment, otherwise there is a risk of hearing loss in the child.

To avoid this, for such children it is recommended to use special tubes that are installed on the eardrum, thereby creating conditions for the removal of fluid. In addition, children with these risks should be examined annually by a doctor to confirm good hearing.

Speech problems

Having deformities such as a cleft lip or cleft palate in a child increases the likelihood that it will be difficult for him to master speech .

Due to the characteristics of the body, such children can make nasal sounds, and this can often prevent others from understanding their speech. Fortunately, this does not happen to all children.

There are cases where, through surgery, it was possible to restore the ability to normal speech to a child with similar defects.

If a child has clearly visible difficulties in mastering speech, then he will need to work with a speech therapist. This specialist will work separately with the child, creating exercises for him so that he can restore his speech to a normal level.

Dental problems

One of the problems that can affect children diagnosed with cleft palate and cleft lip is tooth decay.

Sometimes they may have extra, crooked or misaligned teeth , which usually requires the help of a specialist dentist or orthodontist.

In addition, there are cases where alveolar ridge defects were discovered in children with similar deformities. The alveoli are the bony part of the upper gums that act as the basis for the teeth.

If a child has an alveolar defect, this is fraught with the following troubles:

• A defect associated with the location of permanent teeth, which can be expressed in their displacement, protrusion or rotation;
• Interfering with the normal development of permanent teeth;
• Creating difficulties for the normal formation of the alveolar ridge.

To combat such manifestations, modern medicine offers methods of maxillofacial surgery that can effectively eliminate the above problems.

Who treats children with cleft palate and lip?

Considering that such deformation affects areas that are under the jurisdiction of various specialists , most often it is necessary to involve a whole team of doctors to combat these defects. And, as a rule, such a team includes the following doctors:

• Plastic surgeon. A specialist who performs lip or palate surgery;
• Otolaryngologist. A doctor whose specialization is the fight against diseases affecting hearing, who is able to select the most effective method for treating problems of this kind;
• Maxillofacial surgeon. This doctor is responsible for carrying out manipulations to move part of the upper jaw, designed to achieve normal functioning, as well as eliminate cosmetic defects and cleft gums;
• Orthodontist. A doctor who specializes in straightening and moving teeth;
• Dentist. A doctor who specializes in dental and oral health care;
• Prostodont. A doctor who produces artificial teeth and special dental devices that help restore the appearance and normal functioning of the speech apparatus. If necessary, these devices help make eating easier;
• Speech pathology specialist. A doctor who studies pathologies related to eating and speech;
• Speech therapist. A specialist who knows methods to improve speech quality;
• log. This physician's expertise includes the study of communication disorders associated with hearing loss or impairment.
• Attending doctor. A specialist who studies the general condition of the child;
• Social worker or psychologist. Provides planned assistance to the family and gives advice on overcoming any problems associated with adaptation;
• Specialist in the field of genetics. Both parents and adult patients are interested in the advice of this doctor, from which they can find out how high the likelihood of having children with similar defects is.

Treatment of a child involves drawing up a special program , involving the joint participation of each specialist and taking into account the individual needs of the patient.

Most often, already in infancy, specialists prescribe and carry out the first measures to get rid of detected deformities.

However, this process is quite lengthy and most often ends when the patient reaches early adulthood.

How is a cleft palate or lip treated?

To completely remove the deformity, specialists have to perform one or two surgical operations. The final decision is made after studying the condition of the defect. The first time surgery is performed when the child reaches three months of age.

Treatment of cleft palate is characterized by its complexity, since to eliminate such a defect it is necessary to carry out a large number of operations and therefore, most often, only after reaching 18 years of age can the patient return to a normal appearance. The first time an intervention aimed at correcting the palate is performed when the patient is 6 months or 1 year old.

After the first operation, there is not only an improvement in the functioning of the palate, but also a decrease in the risk that fluid will enter the middle ear. Other positive effects include the creation of conditions for the proper formation of teeth and facial bones.

Conclusion

Cleft lip and cleft palate are quite serious diseases that can complicate the life of any person even in early infancy. Therefore, from birth such children require the attention of doctors. Fortunately, today medicine offers many methods to return such children to a normal life.

Unfortunately, this process is quite lengthy and often requires numerous operations. However, by adhering to the recommendations of specialists and carrying out the entire range of procedures prescribed by a group of treating doctors, in most cases the prognosis for curing this disease is favorable.

• Vera Anatolyevna Rodionova
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Forms of pathology, diagnosis of cleft palate abroad

Non-closure of the palate can manifest itself in several ways:

1. non-closure of only the soft palate;
2. cleft palate and partial cleft of the hard palate;
3. unilateral non-fusion of the soft and hard palate;
4. bilateral cleft of the soft and hard palate.

This anomaly can occur in isolation, but it is often diagnosed in combination with a cleft lip (cleft lip) or other malformations of the facial bones.

Diagnosis of cleft palate in Israel mainly occurs during the mother’s pregnancy; the defect is detected during prenatal screening in the early (10-12 weeks) or late (last trimester) stages of pregnancy, since the period of formation of the facial skeleton is from 2 to 7 weeks of pregnancy. In some cases, the position of the fetus does not allow the cleft palate to be detected before the birth of the child, then the diagnosis is made either immediately after birth or in the first days of the child’s life.

Correction of the cleft palate using uranoplasty

Currently, anomalies in the structure of the palate are successfully corrected through surgery. Traditionally, such treatment is carried out in stages, the number of operations ranges from two to seven. Treatment is carried out no earlier than 3 months of the child’s life (except for severe cases). One type of surgical correction of a defect is uranoplasty. During its implementation, the specialist restores the correct anatomical structure of the soft and hard palate and the middle sections of the oropharynx.

The traditional version of uranoplasty, which solves problems associated with feeding and breathing, is the Limberg operation. Before treatment, the doctor selects a plastic material to eliminate the defect. Thanks to modern surgical techniques and qualified specialists, it is possible to completely restore the structure of the palate in more than 95% of patients.

Complex treatment of cleft palate: removal of cleft palate abroad

Elimination of cleft palate or cleft palate is only one of the stages of treatment abroad. The operation to remove the cleft palate is called uranoplasty. Radical uranoplasty is performed at the age of 3 to 5 years; lighter versions of this operation can be performed at an earlier age, according to indications. Until this time, parents of a child with a congenital defect of the hard palate are taught to use obturators, orthopedic devices that block the communication between the mouth and nose.

Uranoplasty is performed in various variants, depending on the shape of the defect. For complete bilateral defects, implants are used to replace the missing section of bone. Such manipulations will be performed in leading plastic surgery centers abroad.

Further treatment involves a set of procedures aimed at restoring the function of swallowing, speech, speech therapy correction, and restoring hearing if this function has been affected. As a rule, non-drug rehabilitation methods are used: finger massage of the palate, physiotherapy, etc.

Elimination of cleft palate in Israeli clinics is carried out using the latest techniques, both surgical and therapeutic, and in more than 95% of cases, complete success is achieved by the age of 6-7, when the child begins school. Compliance with treatment deadlines and timely seeking help ensure the best result.

Treatment [edit | edit code ]

The first surgical operation of a cleft soft palate was performed two centuries ago [ when?

] in France, a dentist. Today's medicine has several methods of plastic surgery to correct maxillofacial defects. The most effective are cheiloplasty - correction of the upper lip and uranoplasty - correction of the palate. Surgical operations are usually performed in several stages - it depends on the degree of pathology. In some cases, in order to achieve a better result, 2-3 interventions are performed, in others - 5-7 or more.

Experts disagree on the age at which uranoplasty and cheiloplasty should be performed: some doctors prefer to perform the operation at 3-6 months, others at a later date.

Right-sided cleft lip and palate before treatment. Age 5 months.

Right-sided cleft lip and palate after treatment. Age 10 months.

Right-sided cleft lip and palate after treatment. Age 8 years.

The days waiting for your baby are filled with pleasant chores: choosing a crib and stroller, decorating the nursery, buying toys. Young parents are prepared for the fact that the baby will have sniffles and colic, insomnia and whims when teeth are being cut. However, few of them understand that a child can be born with special needs, and a message from a doctor can be overwhelming, negating all the joy from the birth of a baby.

One such feature is cleft lip or cleft lip . According to medical literature, such a pathology occurs in one newborn out of a thousand. Typically, the integrity of the tissue is restored with the help of a relatively simple plastic surgery, and by the time they grow up, only a barely noticeable scar remains.

In this article we will tell TecRussia.ru readers about how and why this problem appears, at what stage of pregnancy it can be detected by ultrasound, and what to do if you really want to have a second child, but the first one was born with a pathology.

How dangerous is this disease?

A cleft lip is a congenital defect, a disruption in the prenatal period of the normal development of the nasal cavity and upper jaw. Its characteristic form is a deformation of the upper, or, less commonly, lower lip on the child’s face: it is split and consists of two (for a unilateral defect) or three (for a bilateral defect) fragments. The length and depth of the rupture may vary. Sometimes through it you can see the mucous membrane of the upper jaw.

• Sucking in such children is difficult. With a pronounced defect in the tissue of the upper lip or with a combination of cleft lip and cleft palate (cleft palate), feeding is possible only through a nasal tube.
• Due to disruption of the normal processes of formation of bone and cartilaginous structures of the upper jaw and the walls of the nasal cavity, the child may develop dental anomalies. This manifests itself in different ways: their absence in the dentition, the appearance of additional teeth, malocclusion, and rapid caries.
• In the future, defects in the dentition and soft tissues of the lips often lead to speech disorders: difficulties with the pronunciation of consonants, vagueness, and nasality.
• Naturally, with all these features, patients who have not undergone correction suffer from low self-esteem and impaired social adaptation.
• In addition, a cleft lip may be just one of a large number of anomalies in the development of the maxillofacial structure, accompanied by problems with internal organs, etc.

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Why are children born with cleft lip?

This phenomenon is based on a genetic disorder - a mutation in the TBX-22 gene. At the same time, a person’s mental and physical health does not suffer; the problem manifests itself only in the form of physiological disorders. A defective gene can be inherited, but not with 100% probability (if blood relatives have the pathology, the risk of its occurrence in a child increases by only 7%). Much more often, the cause of a mutation and, accordingly, the appearance of a cleft lip in a newborn is a confluence of several factors and unfavorable circumstances affecting the mother:

• taking alcohol, drugs, smoking;
• influence of harmful production conditions;
• infectious diseases during pregnancy;
• severe toxicosis in early pregnancy;
• obesity;
• lack of folic acid;
• stress factors;
• injuries or surgical operations in the abdominal area;
• age over 35 years.

The main problem is that the formation of the structures of the fetal maxillofacial system occurs before 8 weeks of intrauterine development. For most of this period, a woman may not even be aware of her pregnancy and therefore she has no reason to limit the intake of medications, alcohol, or refuse medical examinations or other procedures potentially dangerous to the fetus.

Types of pathology

The medical classification of cleft lip varieties is based on what the cleft looks like, where it is located, how deep and extended:

• Single or double sided. With a unilateral location, the defect forms on the side of the middle of the lip. In bilateral cases, a cushion of soft tissue forms between the two clefts.
• Complete and incomplete. Complete cleft starts from the upper line of the lips and goes up to the nose; in case of incomplete cleft there is only a small depression.
• Depth and length. The cleft can pass not only through the soft tissues of the face, but also affect the cartilaginous and bone structures of the upper jaw and nasal cavity.

Diagnosis of cleft lip and its effect on pregnancy

This pathology of the development of the maxillofacial system is clearly detected by ultrasound. The accuracy of the determination largely depends on the class of the device used and the qualifications of the doctor, but usually it is possible to examine defects in the structure of the soft tissues of the face and the bone structures of the facial skull from the 4th month of pregnancy. However, a diagnosis cannot be made based on ultrasound data alone - this can only be done by a neonatologist or pediatrician who examines the child after birth.

Of course, parents, both during carrying a problematic pregnancy and when planning a second child, if the first one was born with a cleft lip, have natural questions for doctors. Let's consider both of these cases:

• Detection of changes in the structure of the maxillofacial system in the fetus by ultrasound. The presence of a cleft lip in itself is not an indication for termination of pregnancy. If no other problems are identified in the fetus, the child will most likely be born physically and mentally healthy. If signs of certain other congenital syndromes are detected that can lead to disability or death at an early age, the doctor may recommend that the woman terminate the pregnancy.
• Planning a second pregnancy if your first child has a cleft lip. It all depends on the causes of the pathology. The defective gene may be present in one or both parents, or the mutation occurs in the germ cell for the first time. In the first case, there is a certain increased likelihood that the spouses can pass on their altered genetic material to the next child. If the mutation appeared spontaneously, the born child will have a defective gene, and all other children of this couple may be completely healthy. You can find out more accurately what the probability of having a second child with a pathology is through a medical genetic consultation.

Treatment of cleft lip

The only way to eliminate such a defect is plastic surgery. As a rule, it is performed on a child no earlier than 3-6 months after birth, as planned, in the absence of contraindications (birth injuries, physiological jaundice, malformations of vital organs, infections).

It is possible to start treatment earlier, but this requires compelling reasons. Usually, immediately after birth, only those babies are operated on whose cleft lip has a significant depth and extent and makes the process of normal feeding impossible. Advantages of early surgical correction:

• conditions for further development of facial tissues (lips and nose) are improved;
• psychological discomfort and tension in parents is reduced.

And its main disadvantages:

• the lips are too small, which complicates the surgeon’s work and makes it difficult to obtain an ideal aesthetic result;
• the risk of blood loss and complications due to the weak functioning of many body systems;

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Some doctors consider it possible and even preferable to carry out treatment at a later date - after the child reaches 1-2 years of age. In the most difficult cases (usually when the defect is combined with a cleft palate - cleft palate), several sequential surgical interventions may be required, the final stages of which often occur in adolescence (14-16 years).

How are cleft lip removal operations performed?

After the defect is diagnosed, the small patient is examined by a plastic surgeon, who decides on the general feasibility and all the details of the correction. Main types of operations:

• Cheiloplasty is technically the simplest option, since medical manipulations affect only the soft tissues of the lip, and therefore can be performed even in the first days of a child’s life. It is effective only if the splitting is small in extent and there is no disruption in the structure of the cartilaginous and bone elements of the nasal cavity and jaw.
• Rhinocheiloplasty is performed in cases where, in addition to closing a soft tissue defect, it is necessary to correct the position of the nasal cartilage and orbicularis oris muscle. After surgery, a gauze pad is left in the nasal cavity to protect the sutures from mucus and food particles. After removing the tampon, a plastic tube can be inserted into the nose, which will hold its cartilage in the correct position until complete healing (about 3 months).
• Rhinocheilognatoplasty is performed for defects of the alveolar process of the upper jaw, its underdevelopment, significant deformations of the nose, as well as to restore the correct position of the orbicularis oris muscle. In the same way as in the case of rhinocheiloplasty, in the postoperative period tampons, various plastic tubes and spacers can be used for a sufficiently long period to hold bones and cartilaginous structures in the correct position.

Surgical correction allows in 85-90% of cases to completely restore the correct shape of the upper jaw, nose and muscular frame of the mouth. The results are assessed no earlier than one year after the operation. At that time, a decision may be made to carry out additional procedures.

A postoperative scar remains at the site of the sutured defect. The surgeon will make every effort to make it minimally noticeable, but its final thickness and appearance will largely depend on the individual characteristics of the body. In addition, sometimes, due to the presence of a scar, the lip is slightly pulled up. These consequences can be corrected to some extent with the help of plastic surgery or cosmetic procedures, but, as a rule, only after the patient reaches adulthood.

Orthodontic treatment and work with a speech therapist

• During the formation of a cleft lip, the normal structure of the upper jaw is often disrupted, which affects, among other things, the formation of the dentition and bite. Usually, wearing braces or plates is enough to correct them.
• The need for speech therapy classes appears in cases where it is not possible to complete surgical and orthodontic treatment before 3 years of age. Sessions with a speech therapist should begin as early as possible in order to be completed before the age of 6, when the child will join the school community.

As you can see, the fact that a child was born with a cleft lip is not a problem if the correction is carried out in a timely manner. A child with such a feature may well become a full-fledged member of society, give joy to his parents and live in harmony with himself.

Modern science has still not been able to fully understand all the processes occurring in the womb. Even if all tests and examinations show normal fetal development, features that require medical attention may be discovered after birth. One of them is cleft lip, which occurs during the formation of the nasal processes. This is one of those congenital pathologies that are easily eliminated. If a child develops a cleft lip or its combination with a cleft palate, plastic surgery is required.

Methods for correcting cleft lip

In the absence of contraindications, this defect, called by the medical term “cheiloschisis,” is corrected by plastic surgery. Cheiloplasty involves restoring the anatomically correct shape of the mouth, continuity of the orbicularis muscle and correction of the nose. The degree of complexity of the case determines the scope of preventive and surgical measures, the duration of treatment and rehabilitation.

Patients with a double cleft lip are given a pressure elastic bandage immediately after birth to prevent excessive protrusion of the upper jaw. In difficult cases, treatment is carried out in several stages:

• primary surgery – at 4-6 months;
• repeated (in case of protrusion of the premaxillary bone by 10 mm or more) – after 2.5-3 months;
• lengthening of the skin of the septum, bringing the wings of the nose closer together at the base - at 4-6 years;
• final correction of the nose - at 16-18 years of age (after the growth of the facial bones has completed).

Classification

In most cases, the cleft is located on the upper lip on the left, less often on the right side of the midline. Sometimes the defect occurs on both sides. In mild cases, the cleft affects only the external soft tissue. In severe forms of the defect, the bones of the palate and the upper jaw may be deformed. In some cases, deformation of the nose occurs. "Hare's lip" can be:

• one-sided and two-sided;
• isolated;
• full;
• partial;
• with a defect on one lip;
• light form;
• severe form.

Where can I get free help for my child?

Knowing how important it is for your baby to receive timely treatment and how much cleft lip surgery costs in a specialized medical center, do not waste time and the opportunity to receive free, qualified help. Surgeons of our Clinic: Professor Bessonov Sergey Nikolaevich and Eremeyshvili Levan Avtandilovich provide consultation and surgical treatment of patients with maxillofacial pathology. Thanks to the support of the “Beautiful Children in a Beautiful World” foundation and Rusfond, medical care within the framework of the “Towards Life” project is free.

To take advantage of our offer, collect a package of necessary documentation from the list and send it to [email protected] for registration. After checking your documents, you will be sent a call for treatment. To confirm the need for surgical treatment, it is worth sending a portrait photograph of the child by mail and then undergo a consultation with Doctor of Medical Sciences S.N. Bessonov or L.A. Eremeyshvili, other specialists and get answers to all your questions by calling tel. or by filling out the site's contact form.

You can make an appointment with a specialist by phone: 8 on weekdays from 9.00 to 19.00 Moscow time Or through the form on the website Sign up for a free consultation

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Treatment

Once an anomaly is diagnosed, its treatment is only possible with surgery. To eliminate the disease, the use of certain plastic surgery methods is indicated, allowing for complete facial reconstruction. Depending on the type of anomaly, primary cheiloplasty, rhinocheiloplasty, or rhinocheilognatoplasty can be performed.

In 90% of cases, through plastic surgery methods, it is possible to completely eliminate the defect and adapt the baby to normal life in a social environment.

Complications

Surgeries performed on newborns with cleft lip are not characterized by complications. However, possible postoperative consequences include:

• hemorrhage on the skin - lasts 3-4 weeks and goes away on its own;
• swelling in the operation area – increases by the fourth day and goes away on its own after 3–4 months;
• bleeding from the wound - in this case it is necessary to open the wound and cauterize the blood vessels;
• hematoma is a very rare complication, the prevention of which is to stop the bleeding;
• necrosis of the wound edges.