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A congenital pathology of the lip, in which soft tissues do not grow together, is colloquially called “cleft lip”. This name is given because in hares the upper lip consists of two halves that are not fused together.
The nature of the defect is the same as that of the “cleft palate”. But in the case of the latter, not only soft tissues do not fuse, but also the bones of the palate. In half of the cases, facial tissues are not affected, and there is no cosmetic defect. In this case, it will only be a “wolf mouth”.
The cleft palate and lips are scientifically called cheiloschisis. This congenital pathology occurs in the womb, usually in the first trimester of pregnancy. Under the influence of harmful factors, the development of the lip, palate and alveolar process is disrupted.
Children with a cleft lip can have not only external defects, but also a serious deformation of the skull bones. Because of this, there are difficulties with nutrition, speech. But pathology causes only physical problems – the intellect and psyche of such babies are in perfect order.
Cleft lip without cleft palate is a milder pathology, since only soft tissues are affected and the bones are not deformed.
What is cleft lip
Cleft palate and lips appear in the baby in the first months of development. It is then that the jaw and face are formed. Normally, by the 11th week, the bones of the palate in the fetus grow together, and then the soft palate is formed. In the 2nd to 3rd month, the upper lip is also formed, when the processes of the upper jaw and the median nasal process are finally fused.
The first months of pregnancy are the most important for the formation of the correct anatomy of the child. If during this period negative factors from the outside influence the embryo, a failure in the formation of bones and soft tissues may occur, and a cleft lip occurs. Genetic factors also play a role.
Causes of cleft lip in children
The cleft lip develops under the influence of “internal” and “external” causes. A hereditary factor, inferiority of germ cells, early abortions can affect the development of the fetus.
No less dangerous infections that a woman suffers in early pregnancy.
Chemicals, radiation, mother’s consumption of drugs, alcohol or smoking adversely affect intrauterine development. Poor nutrition, beriberi, cold and heat, abdominal trauma, fetal hypoxia also affect the formation of the fetus.
The causes of pathology are still being studied. The main ones are listed above, but in rare cases, a cleft lip develops after birth. After injuries, infections, removal of tumors, the palate and lips can be damaged.
Symptoms of cleft lip in children
A baby’s cleft lip is usually detected even before birth, on an ultrasound scan after 12 weeks of pregnancy. Unfortunately, even with this early detection, nothing can be done before the baby is born.
After birth, the baby shows deformed lips, nose, and possibly a cleft palate. The form and degree of pathology are of varying severity – crevices are possible even on both sides. But unilateral cleft palate and lips are more common.
An infant with such a defect takes the breast poorly, often chokes, and breathes shallowly. It is prone to infections of the nasopharynx and ear due to frequent reflux of food through the cleft in this area.
Treatment of cleft lip in children
It is important to understand that a cleft lip is often not only a cosmetic problem. She will have to be treated anyway, and at a very early age. Otherwise, the child will not be able to suck, swallow food correctly, sometimes feeding through a tube is even required.
Without treatment of the defect, the bite is formed incorrectly, speech is disturbed. The splitting of the palate disrupts the timbre of the voice, children do not pronounce sounds well and speak “through the nose”. Even a cleft only in the soft tissues will interfere with the production of speech. Frequent inflammation in the nasal cavity and ears due to reflux of food leads to hearing loss.
After the diagnosis is made, a decision is made on a surgical operation – there are no other ways to help the child. The age at which the baby will be operated on is determined by the doctor. If the defect is too dangerous, the first operation is possible in the first month of life. Usually it is postponed until 5 – 6 months.
Treatment consists of several stages, so one surgical intervention will not work. Even before the age of 3, the baby will have to go through 2 to 6 operations. But as a result, only a barely noticeable scar and possibly a slight asymmetry of the lips will remain. All other problems will be behind.
Diagnostics
The first diagnosis of a cleft lip is carried out even inside the womb using ultrasound. After the birth of such a child, the doctor examines the severity of the pathology. It determines how much the defect prevents the baby from eating, whether there are any respiratory disorders.
They resort to the help of other specialists: an otolaryngologist, a dentist, an infectious disease specialist. Further, general blood and urine tests, blood biochemistry, x-rays of the maxillofacial region are prescribed. The reaction of the baby to sounds and smells is checked – this is how hearing and smell, facial expressions are evaluated.
Modern treatments
To eliminate the defect of the cleft lip, plastic surgery is used. Doctors of various profiles will be involved in multi-stage treatment. Before surgery, the child often wears an obturator – a device that serves as a barrier between the nasal and oral cavities. This prevents the reflux of food, helps to breathe and talk normally.
With a small defect, isolated cheiloplasty is used – the skin, fiber, muscle and mucous layers of the lips are sewn together. If the nose is affected, rhinocheiloplasty is performed, correcting the cartilages of the nose. Rhinognatocheiloplasty forms the muscular frame of the mouth area.
Cleavage of the palate is eliminated by uranoplasty. Unlike previous operations, it is carried out quite late – by 3 or even 5 years. Early intervention can damage jaw growth.
Additional reconstructive surgeries are needed to remove scars, improve speech and aesthetics.
In addition to surgical treatment, the child needs the help of a speech therapist, since it is more difficult for such children to pronounce sounds correctly than for others. The otolaryngologist makes sure that the baby’s hearing is not affected, and the breathing is full. If the teeth do not grow properly, the orthodontist installs braces.
Constant oxygen starvation due to shallow breathing, poor weight gain and frequent infections can lead to sickly appearance, stunted growth.
The help of a psychologist will be equally important, because due to their characteristics, children with a cleft lip experience difficulties in adapting. Despite the fact that the mind of such children is in perfect order, they can still lag behind in development. Due to psychological problems, unwillingness to study due to bullying by peers, there are problems in learning. Difficulties in pronunciation of words can also interfere with a fulfilling life. Therefore, it is better to complete all stages of treatment before school age.
Prevention of cleft lip in children at home
It is quite difficult to avoid such a problem. If such a pathology was observed in the family, you can consult a geneticist to find out the likelihood of having a baby with a cleft lip.
It is important to take special care of yourself in the first weeks of pregnancy – avoid infections, injuries, eat well. As a preventive measure, pregnant women take folic acid.
It is necessary to detect the problem as early as possible, even in the womb. Since cleft palate and lip can cause additional complications during childbirth, the doctor should be aware. During childbirth, the risk of amniotic fluid entering the baby’s respiratory tract increases.
After the birth of a child with a cleft lip, it is necessary to conduct a complete diagnosis, consult with specialists and assess the severity of the pathology. If doctors insist on an early operation, then the baby really needs it.
The first months and years of the life of such a child will be difficult, feeding is difficult and parents need to be prepared for this. But do not forget that after all stages of treatment, the child will be completely healthy and the problem will be left behind.
Popular questions and answers
The pediatrician remains the main doctor for a child with a cleft lip – he prescribes additional examinations, refers to narrow specialists. Learn more about this pathology pediatrician Daria Schukina.