Wolf’s Mouth

Wolf’s Mouth
Cleft palate is a congenital pathology, which consists in splitting the hard and soft areas of the palate, resulting in a violation of breathing, speech, difficulty eating.

The content of the article:
Features of the structure and development of the sky
Manifestations of the cleft palate
Treatment of cleft palate
Principles of treatment of cleft palate
Correction of the cleft palate by uranoplasty
Wolf’s Mouth
This pathology occurs due to the late fusion of the outgrowths of the upper jaw and the coulter. This defect occurs in 0.1% of children. There is a complete and incomplete cleavage of the sky. In the first case, there is a splitting of soft and hard parts of the sky, and in the second — there is only a hole in the sky.

Cleft palate is one of the most common mutations. In some cases, it may be accompanied by a split tongue. The cause of this anomaly is a deformity of the TBX22 gene. However, it is possible to identify other factors that influence the formation of this defect. First of all, it is a mutagenic effect on the fetus, which can come from the environment or the body of a pregnant woman. In particular, smoking, drug or alcohol use by a woman during pregnancy has a very negative effect on the development of the embryo.

In addition to these factors, this pathology can provoke diseases of the endocrine system, metabolic disorders, folic acid deficiency in the body.

The risk of a defect increases significantly in the presence of infectious diseases, including STDs, toxicosis, mental or physical injuries of a pregnant woman. It is important to note that the laying of the structure of the maxillofacial apparatus is performed in the first trimester of pregnancy – at this time the embryo is very vulnerable. Negative factors in the first 13 weeks of pregnancy most strongly affect the health of the embryo. If there is this disease in the relatives of one of the parents, the risk of its occurrence in the baby increases 7 times compared to other children. If one of the parents has this developmental anomaly, then the risk of its occurrence in the child increases by 10%, and if both — by 50%. According to statistics, smoking from 1 to 10 cigarettes a day increases the risk of developing cleft palate by 30 times, and the whole pack by 70%.

The appearance of this anomaly is also influenced by environmental ecology and occupational hazards. The risk of developing not only cleft palate, but also other pathologies increases if a woman’s first pregnancy took place after 35 years. The cause of the development of pathology can also be obesity, taking drugs prohibited during pregnancy. It becomes clear that the occurrence of this anomaly is influenced by many factors — and only in 5% of cases, gene deformations are to blame.

Features of the structure and development of the sky
The upper palate acts as a barrier separating the nasal cavity from the oral cavity. In the course of evolution, the sky began to form in organisms whose habitat was land. It consists of 2 parts: hard and soft palate. The front part of the oral cavity is occupied by the hard palate, consisting of bone tissue, as well as palatine processes of the upper jaw, horizontal plates of the palate bones. Immediately behind it is the soft palate, consisting of muscle tissue, aponeurosis and glands. With the help of muscles, the soft palate can change its position during uttering sounds or eating. Palate tissues prevent fluid and food from entering the upper respiratory tract. In the middle of the posterior edge there is a soft palate tongue.

At the 8th week of fetal development, the upper jaw begins to form, consisting of 2 bones fused together. Initially, the formation of palatine processes, consisting of the inner surface of the jaw, occurs. As they develop, they fuse with each other and with the nasal septum, thus forming a hard palate.

Due to the presence of gene defects at the time of the development of the maxillofacial system, the palate and upper lip do not fuse. You can learn about the development of this pathology in a child only in the last weeks of pregnancy during ultrasound.

People with this defect are constantly ill, as the air entering their lungs does not heat up and is not humidified. They may have various changes in the maxillofacial skeleton and hearing aid. Splitting of the upper lip and palate may be an independent disease or accompanied by the presence of other anomalies.

Manifestations of the cleft palate
Symptoms of cleft palate manifest themselves immediately after the birth of a child. First of all, it is the presence of a cosmetic flaw. With this pathology, the sucking process becomes impossible. In the presence of a cleft palate, food and water enter the nose. Due to the fact that air enters the oral cavity immediately, such children often suffer from inflammatory diseases. Due to the fact that food and liquid constantly enter the sinuses of the nose and the auditory tubes, patients may experience hearing loss over time. Cleft palate can be accompanied by anomalies of growth and development of teeth, malocclusion, which makes eating even more difficult. Due to the development of the articulatory apparatus, the patient’s speech worsens. As a rule, such children do not have mental development disorders, but it is difficult for them to adapt in society due to a cosmetic defect and incorrect speech. They are very often lagging behind their peers in physical development. This is due to the difficulty of the feeding process.

Treatment of cleft palate
Cleft palate has been treated surgically for many years. The essence of the method is to close the cleavage of the lip, as well as the alveolar process and perform surgery on the upper palate. To perform this operation, a surgeon with extensive experience in the maxillofacial department is required, since the oral cavity in children is small, this makes it difficult to perform surgical correction. In this case, veloplasty is most often recommended, during which the soft palate is stitched. This procedure can be carried out from 8 months. The age for the operation is determined based on the severity of the disease.

After the first operation, the result will be visible. The child will be able to breathe normally and eat. During the next procedure, a cosmetic defect is eliminated, so that the child’s self-esteem becomes higher. After the operation, it is very important that the patient is treated by other specialists, including an otolaryngologist, neurologist, pediatrician, speech therapist. This is necessary in order to restore some lost functions and prevent the occurrence of complications.

Principles of treatment of cleft palate
As a rule, defects in the maxillofacial region are eliminated step by step. The number of operations required to achieve the result can reach 2-3, and in some cases 5-7. The age at which surgical treatment will be carried out is determined by medical workers who have been watching the child since his birth. Usually, operations are not performed if the patient is under 3-6 months old. In any case, the treatment process and the rehabilitation period should be completed by 6-7 years. The age from 3 to 7 years is better suited for additional cosmetic procedures that improve the appearance of the child. This is necessary so that the patient can freely attend school or other educational institutions, since the mental development of children with cleft palate fully corresponds to their age. After the child passes all the stages of treatment and rehabilitation, he is removed from the disability register.

Specialized medical institutions are engaged in surgical correction of the cleft palate and similar anomalies. As a rule, in addition to the surgeon, they have all the specialists necessary for further treatment: speech therapists, dentists, psychologists, social workers. Thanks to modern medicine, the patient will not only be able to eliminate a cosmetic flaw, but also get rid of mental trauma, increase self-esteem, adapt normally in society.

Correction of the cleft palate by uranoplasty
Uranoplasty is a plastic surgery, the purpose of which is to eliminate cleavage in the palate. During surgery, the doctor restores the integrity of the middle pharynx and palatine tissues by closing the cleavage with a flap taken from the nearest areas. After properly performed uranoplasty, the child’s speech develops fully, he can eat normally.

Like any other surgical procedure, uranoplasty has its own contraindications. Among them are the following:

pneumonia;
anemia;
the presence of hypoplasia of the lungs;
spinal hernia;
severe diseases of the cardiovascular system;
injuries sustained during childbirth;
intrauterine hypotrophy;
colds;
severe lung diseases;
prematurity;
respiratory disorders, manifested in attacks of suffocation;
the presence of any serious malformations.
There are 2 types of uranoplasty. With the right method, a positive result is achieved in 92-98% of patients. When choosing a type of uranoplasty, it is important to take into account the individual degree of tissue cleavage, since based on these data, the site is selected from which tissue material will be taken for the treatment of the defect in the future. Most often, the lateral parts of the sky are used for these purposes. During the operation, they are stitched along the middle line.

Uranoplasty happens:

gentle: to eliminate the defect of the cleft palate in children at an early age, surgeons use gentle methods of correction. For example, in this case, uranoplasty is carried out in 2 stages. Of these, the first is done to restore soft palatine tissues without resection of the ring of the palatine opening. And the second is to normalize the conditions for the development of speech and eating. Operations that are performed at an early age have many advantages. For example, after them, the child’s jaw develops normally and does not deform in the future, the maladaptation period decreases. Before the surgical correction, the child wears a “floating” obturator, which makes it easier to eat, breathe, and promotes the development of normal speech. 2 weeks before the operation, the obturator is removed;
radical. It is carried out for children whose age has reached 3-6 years. During the procedure, the surgeon closes a large area of the nasopharynx. This is the shortest way to eliminate the defect of the nasopharynx and normalize its functions. The method of uranoplasty proposed by A. A. Limberg is the most common. The technique of this operation was developed in 1927. The essence of the intervention is to give the palate integrity through the use of muco-periosteal flaps and soft palatine tissues. Some stages of this operation are used during gentle uranoplasty. This procedure is not performed for children at an early age. This type of uranoplasty is divided into several stages:
muco-periosteal flaps are taken from palatine tissues;
neurovascular bundles are released;
an interplate osteotomy is performed;
the middle section of the pharynx narrows;
seams are applied layer by layer to the area of the sky;
the palatine surface is treated with an antiseptic;
the palatal plate is superimposed.
After the operation, patients are recommended to stay in bed for 2-3 days, drink plenty, and eat exclusively soft food. In order to avoid the appearance of infections, antibiotics are prescribed for 5-7 days, painkillers are prescribed to eliminate pain. A scar remains on the face after the procedure. Patients are discharged from the hospital on 21-28 days after surgery. After that, patients should do special exercises to normalize the function of palate-pharyngeal closure and palate mobility.

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