Defects of the face and palate

Defects in the face and palate are very common and occur in a variety of forms, ranging from small fissures in the lip to complete unilateral or bilateral clefts in the lip, alveolar process and palate. A one-sided cleavage of the lip itself is called a hare lip, and when it coexists with a cleft palate, we speak of a wolf’s mouth.

Face and palate defects – description

Defects of the face and palate are an increasingly common problem not only for the patient, but also for the family and society. They are often associated with disability and even life-threatening conditions. Developmental disorders can take many forms, ranging from small fissures in the lip to a complete cleft lip or palate. These defects, in addition to being deformed, make it difficult to feed infants because they cannot suckle properly, and the danger of respiratory tract catarrhage. These children need to be fed the withdrawn food with a small spoon. Treatment of this type of disease is long and complicated, the most important is thorough imaging diagnostics (including computed tomography, intraoral dental and occlusal images or pantomographic images).

Surgical treatment of cleft lip, nose loss and anterior part of the palate is initiated before the child is three months old, provided, of course, that his physical development is normal. Restoration of the palate defect is performed before the child is 12 months old, before he even starts talking.

In addition to surgical treatment, learning to speak and care for the proper development of teeth and bite is very important.

Cleft defects

Facial cleft defects result from the discontinuity of soft tissues or bones. The most common disorders of this type are:

  1. cleft lip
  2. cleft alveolar process,
  3. cleft palate,
  4. cleft nose / jaw / eyelids / orbital walls (clefts rarely seen).

The causes of cleft defects are various, including:

  1. genetic predisposition,
  2. race (facial and palate defects are more common in African-Americans and Indians),
  3. ionizing radiation,
  4. environment pollution,
  5. excessive alcohol consumption,
  6. taking certain medications by pregnant women /

It is worth mentioning that the defects of the face and palate are the second most common birth defects in children, right after the heart defects. Usually these disorders occur on their own, although they may be a component of other syndromes.

Diagnostics

Imaging tests play a significant role in face and palate defects. They are important both at the diagnostic stage and during treatment (monitoring the progress of treatment). The choice of the examination method is an individual matter, it should be adjusted both to the patient’s age and the purpose of the examination, these may include: imaging examination performed in terms of the planned surgery; prenatal imaging tests to show any cleft gaps; imaging tests as a control after repair procedures and before planning the next stages of treatment.

During prenatal examinations, an ultrasound scan is used. At the moment, a three-dimensional 3D and 4D examination is available, which accurately illustrates the child’s facial features, which makes it highly effective in diagnosing facial defects. Another examination that allows for accurate imaging of the facial part of the fetal skull is magnetic resonance imaging.

In addition, the following X-ray examinations are used in the diagnosis of cleft defects:

  1. occlusal photo (showing a cleft palate);
  2. dental photo (showing the cleft fissure of the dental process);
  3. cephalometric image (useful in planning orthodontic treatment);
  4. pantomographic picture (allowing to comprehensively assess dental abnormalities).

Before the first operation is performed, the baby is most often fed with a tube and then through a bottle with a nipple. There are patients who require a special insert imitating the palate. This procedure is to facilitate feeding. After the reconstruction is performed, sometimes help is needed:

  1. psychologist,
  2. plastic surgeon (face surgical correction),
  3. speech therapists or phoniatrists (the child should learn to speak; children with cleft palate have difficulty pronouncing consonants correctly);
  4. an audiologist (the child may be hard of hearing);
  5. dentist or orthodontist (with a cleft there are frequent malocclusions; a “cross bite” may develop – the upper teeth position themselves behind the lower teeth).

Face and palate defects and Down syndrome

Down syndrome (chromosome 21 trisomy) is the most common genetic disorder that occurs with varying frequency. Down syndrome in the head and neck area is characterized by:

  1. microcephaly,
  2. short head,
  3. underdevelopment of the sphenoid and frontal sinuses,
  4. underdevelopment of the middle tier of the facial part of the skull,
  5. myopia and squint,
  6. a small nose with its broad back,
  7. excessive development of the mandible,
  8. hypertelorism,
  9. spacing of the eyelid gaps similar to people of Mongolian origin.

In addition, defects in the heart, hearing and digestive system are often observed in children with Down syndrome. They are to some extent mentally impaired (mild to moderate). They are characterized by a slight increase.

Face and palate defects and Turner syndrome

Turner syndrome is a group of symptoms caused by the lack of one of the X chromosomes in the body. It is considered the most common chromosomal aberration in humans. The incidence of this syndrome is 1 in 40-50 thousand. live births of female newborns. In people with Turner syndrome, short stature and underdevelopment of gonads and poorly marked female features are visible. There may be infertility.

In turn, in the area of ​​the head and neck, the following is observed:

  1. poorly developed mandible,
  2. low hairline,
  3. angular wrinkle,
  4. low set ears,
  5. webbed neck,
  6. hypertelorism (increasing the distance above the norm between two even organs),
  7. gothic palate,
  8. retrognation.

In addition to the above-mentioned symptoms, patients may also experience shortening of the metacarpal bones and valgus of the elbows and knees. Heart defects are not uncommon.

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