A cleft lip is a congenital defect in the development of the bones of the facial skull, when there is a gap in the child’s upper lip through which the oral cavity can be clearly visible; the cleft can also lead into the nasal cavity. Such a defect can be observed on one or both sides or above the place where the middle of the lip should be. Often, a cleft lip, or, as they say, a cleft of the upper lip, is combined with a cleft palate - a “cleft palate”, but in every fifth case it is combined with more severe developmental defects.

Cleft lip can occur due to a large number of reasons. In some cases, this is a gene defect that can be inherited, but often these are damaging factors that affected the fetus during the formation of its face. The pathology is not life-threatening, but leads to disturbances in nutrition, speech, and hearing. It is the cause of frequent ear infections, abnormal growth and dental caries.

The disease occurs with different frequencies in different regions: at best, it is 1 baby out of 2500, but sometimes 2 children out of 1000. Boys are more often affected. Treatment is only surgery, which is performed when the child is 3-6 months old. After surgery to eliminate a cleft lip, rehabilitation measures are carried out: classes with a speech therapist, dentist, pediatrician. They should be completely completed by the age of 6 years of age, so as not to complicate the child’s adaptation to society.

Why does a cleft lip occur, what dangers does it pose, and what conditions are needed for the operation, read on.

Where does cleft lip come from?

You will be able to better understand how facial defects are formed if you consider how a multicellular embryo is formed from 1 maternal and 1 paternal cell, and how it acquires a face.

So, after the fusion of the egg and the male cell, one cell is formed, which begins to divide into 2, then 4 and then cells, all of them identical. At the beginning of division, the cells become smaller and smaller, but after time the volume of the embryo begins to grow. Over time, as the cell mass grows, the following significant event occurs: the cells from which the body of a developing person is built become different. They form 3 layers:

• internal - endoderm, from the cells of which the intestines, liver, lungs, pancreas are subsequently formed;
• external - ectoderm, giving rise to skin, nails, hair, nervous system and sensory organs;
• middle - mesoderm, from which muscles, bones, blood vessels, heart, genitals and kidneys develop.

At 2 weeks of life, a depression forms between the developing brain and the area from which the heart will be formed - the primary mouth. It connects to a cavity within the endodermis called the primitive gut. This is how the digestive canal is formed.

At week 4, longitudinal impressions appear on one and the other side of the primary mouth - gill arches. There are 4 of them on each side, and they deepen so that structures similar to mounds are obtained. The anterior ends of the I and II gill arches bifurcate, forming several processes resembling petals. From the first gill arch, which gives rise to the entire face, there are 5 of them:

• 1 nasofrontal process;
• 2 maxillary;
• 2 mandibular.

Between the nasofrontal and maxillary processes there is a gap where the eye sockets will later be. In the space between the maxillary and mandibular processes, the mouth will form, and when they join in the lateral sections, the cheeks are formed. The anterior third of the auricle will also form from 1 gill arch.

The frontal and maxillary “petals” move towards each other first, then the cheeks, upper and lower jaws are formed: the skin, mucous membranes, salivary glands, and tooth enamel are formed from the ectoderm; from the mesoderm - bones and muscles of the face, internal parts of the teeth. If fusion of the processes does not occur, which can happen in any one or several places, the face changes. The severity of this change varies from a small cleft in the upper lip to a completely disfigured face.

Starting from the 4th to the end of the 8th week of intrauterine development, these processes should unite, but their complete fusion occurs until the 11th week inclusive. It turns out that in the period from the second to the 11th week, the embryo is extremely sensitive to damaging factors that can affect it through the mother. And the sooner the harmful circumstance takes effect, the more severe the vice will be. But a damaging factor leads to the formation of a defect only if it acts until the formation of the face is completed. The period from 3 to 6 weeks is considered the most dangerous for the face, and it is at this time that the expectant mother usually does not know about her pregnancy, continuing to lead a normal lifestyle with smoking, taking alcohol or taking the usual medications.

Causes of cleft lip

The reasons for which cleft lip occurs are varied, as a result of which they are divided into groups:

1. Genetic background. The main gene that causes this disease is believed to be called TBX-22. Many other genes can also do this: MMP3, BMP4, VAX1, pTCH1 and others. If one parent has a cleft lip, there is only a 7% chance that they will pass the condition on to their child.
2. Harmful chemical effects on the maternal body in the first trimester (accounting for 22.8% of cases). This:
   • smoking;
   • alcohol;
   • addiction;
   • taking medications: anticonvulsants, blood pressure-lowering medications, hormonal medications, medications containing sodium, salicylates, insulin;
   • exposure to pesticides, lead, mercury vapor, insecticides, organophosphorus substances, harmful environmental factors, epoxides, arsenic, benzenes;
   • ingestion of additives: tetrazine, sodium cyclomate, aromatic hydrocarbons.
3. Harmful biological effects on the body of the developing fetus in the first 11 weeks of its formation (this factor accounts for 5% of the causes):
   • viral diseases: ARVI (especially if the temperature rises), herpes, rubella, cytomegalovirus infection, mumps, chickenpox;
   • diseases caused by certain protozoan microorganisms, for example, toxolasmosis or malaria;
   • infections that a woman “acquired” through sexual contact: chlamydia, gonorrhea, syphilis.
4. Physical effects on a pregnant woman (2% of reasons):
   • injuries (especially a blow to the lower third of the abdomen),
   • freezing,
   • radiation impacts,
   • vibration in the workplace where a pregnant woman works,
   • overheating in production (hot shop, laundry), in a bathhouse, sauna,
   • tumors of the uterus (mainly fibroids), which prevent the fetus from developing normally,
   • multiple pregnancy,
   • adhesions or “threads” that are formed from fruit membranes.
5. Stress factors, due to which the level of adrenaline in the blood increases, and this has a teratogenic (disfiguring) effect on the fetus: quarrels, fear, overwork.
6. If this pregnancy occurred after 40 years, especially if before that the woman did not lead the most “righteous” lifestyle.
7. Insufficient or unbalanced nutrition of a pregnant woman, when the diet lacks proteins, folic acid, zinc, manganese, copper or, conversely, a lot of vitamin A.
8. Maternal obesity.
9. Anemia (low amount of hemoglobin) in the mother, for which she did not receive treatment.
10. Diseases of the cardiovascular system in the mother.
11. Severe toxicosis.
12. Threat of miscarriage or uterine bleeding during pregnancy.
13. Diabetes mellitus.

Maxillofacial surgeons have conducted numerous studies that have proven that cleft lip is only 10-15% hereditary. The remaining 80-85% is due to the fact that the impact on the fetus occurred from several sides at once, and, perhaps, it was genetically predisposed to the development of this particular facial defect.

This defect does not always occur in isolation: in some cases, a cleft lip is only one of multiple defects that form in a child during the prenatal period. This:

• Van der Woude syndrome, the cause of which is a special change in the IRF4 gene. This is the most common disease that causes cleft lip and cleft palate. It is characterized by the appearance of cracks in the lip, palate, together with the development of pits on one or both lips;
• Loeys-Dietz syndrome, in which the child not only has a cleft lip, but also damage to the palate, a bifurcated uvula, a large distance between the eyes, and an aortic aneurysm;
• Stickler syndrome, which causes cleft lip and palate, as well as myopia and joint pain;
• Hardikar syndrome, in which there is a combination of cleft palate, cleft lip with intestinal obstruction, and hydronephrosis of the kidney.

How dangerous is the disease?

If a child is born with only a cleft lip, but the hard palate remains intact, this leads to the following disorders:

• under the age of one year, when the child eats only liquid food, it is difficult for him to suck and swallow; food can enter the nasal cavity, and this requires special tricks when feeding, sometimes even placing a probe - a tube that will lead from the nose to the stomach;
• if it is not possible to perform surgery when teeth begin to form, this may lead to the absence of necessary teeth or the appearance of additional units;
• teeth begin to grow at incorrect angles - the bite is disturbed. This affects both the chewing of food and, accordingly, its digestion worsens, and caries often occurs;
• the process of sound formation is disrupted: the sound wave, entering the nasal cavity, makes the voice nasal and speech unclear, with problems in pronouncing consonants;
• hearing problems arise;
• often there are otitis media;
• a cleft lip, even mildly expressed, is a significant cosmetic defect, which will make it difficult for a child to adapt to children’s society

That is why a cleft lip, even if it is not very pronounced, must be operated on. And this needs to be done before one year, in order to have time to undergo the necessary rehabilitation measures before the development of speech and before the child’s socialization begins.

Classification of the disease

A cleft lip can be:

View	Subspecies	What does it mean
Unilateral cleft lip	Full	The cleft runs from the lip to the nose
	Incomplete	The cleft affects only the lip
	Hidden	Only the muscles are split, and the mucous membrane and skin above them are not changed
Bilateral cleft lip	Full	The defect goes from the lip to the nose
	Incomplete	The defect is located only within the lip mucosa
	Symmetrical	The defect is the same on both sides
	Asymmetrical	The cleft is larger on one side and smaller on the other.

A cleft lip can be on one upper lip, one lower lip, or both.

The classification is used when choosing a method of surgical correction.

Symptoms

Signs of this disease are visible immediately after the birth of the child. This:

• defect in the upper (usually) or lower lip;
• it can either take the form of a small gap in the red part of the lip, or manifest itself as a significant divergence of the lip tissue from the lip to the nostrils, or even even extending into the nasal cavity;
• may be on one or both sides (in the second case, the lip consists of three fragments);
• through this gap in the lip the mucous membrane of the upper jaw is often visible.

Diagnostics

The diagnosis of “cleft lip” in children is made after birth - based on external examination alone. At the same time, an examination is carried out by an ENT doctor to find out whether there is a defect in the nasal cavity, on the hard or soft palate.

A cleft lip is usually visible on an ultrasound performed at 14 to 16 weeks or later, but the first routine ultrasound is usually performed earlier, between 12 and 14 weeks. In addition, no one, even the best sonologist examining the fetus using ultrasound, can guarantee that the child has developed a cleft lip. This diagnosis before birth can only be made by a council of doctors, and usually this is discussed when this developmental defect prompts a woman to decide on an abortion. According to the legislation of the Russian Federation, abortion of a fetus that is older than 12 weeks is possible only if, in addition to the cleft lip, there are other developmental defects that threaten the life of the fetus.

Anatomy of the affected area

Let's take a brief look at what tissues are affected by a cleft lip. This will make it clearer the amount of work that the surgeon has to perform.

The lip is a complex musculocutaneous formation. The outer layer consists of three parts:

• skin, which contains mucous and sweat glands;
• the skin passes into the intermediate part, which has a slightly different structure and is rich in blood vessels (therefore has a red color);
• the intermediate part passes into the mucous membrane, which is in direct contact with the teeth.

Beneath the mucocutaneous outer layer is a loose layer of connective tissue, and below that is the orbicularis oris muscle and several other muscles. Below the lip are the gums, the mucous membrane that covers the bone of the upper and lower jaw.

The lower jaw is a solid bone. It consists of a body on which there are cells for teeth, and processes that connect to the skull. The upper jaw is more complex: it not only has cells for teeth, this bone continues higher and forms the entrance to the nasal cavity, as well as the maxillary sinus.

Treatment

Cleft lip before and after surgery

Only surgery can eliminate a cleft lip. It is recommended to perform it before one year, and better – from 3 to 6 months after birth. If this is not possible, it can be performed later - the main thing is that all treatment of the little patient, including further post-operative rehabilitation measures (classes with a speech therapist, wearing orthodontic devices) is completed by the age of 6 years.

Surgeons Musgrave and Willelmessen, who improved surgical interventions for the correction of cleft lip back in 1969, introduced the “rule of 10”, under which surgery is possible:

1. the child must be at least 10 weeks old;
2. The baby's weight should not be less than 10 pounds (4.5 kg);
3. hemoglobin in his blood should not be less than 10 g/dl (that is, at least 100 g/l).

In our country, surgeries to eliminate cleft lip are usually performed at 6 months or later. Conditions such as: sufficient weight gain of the child, absence of pathology of the intestines, nervous and cardiovascular systems are added here.

Preoperative period

Before the operation begins, the child needs to receive nutrition. How to feed a newborn with such a defect depends on the type and degree of the defect.

So, if the cleft is incomplete and one-sided, it will be possible to feed both by breast (optimally) and from a bottle, while holding the child not in a lying position, but half-sitting or upright (“soldier”).

If the defects are deep, but the hard palate is not affected, you will have to give up breastfeeding in favor of special nipples (they are produced, for example, by NUK and Avent), which are placed on a bottle into which formula or breast milk is poured. This pacifier should be pushed as far into the baby's mouth as possible, to the root of his tongue. If the baby is unable to suck because of the small hole in this nipple, it can be widened using a thick needle that has previously been disinfected by fire.

If the cleft lip is combined with a cleft palate, then feeding can only be done through a tube. It is installed in the nose in a children's hospital or maternity hospital, after which the mother must learn how to use it correctly.

It is recommended to feed the child with breast milk as much as possible, at least in the preoperative period, unless he has enzyme deficiency or other contraindications. Only human milk contains the necessary substances for the development of immunity, digestion and other processes occurring in the child’s body.

Operation

One of three types of surgery can be performed to correct a cleft lip.

Cheiloplasty

This intervention is performed when the cleft is only in the lip. One of three techniques for performing this operation can be used. Its choice depends on the shape of the labial cleft:

1. Triangular flap method. In this case, a triangle is created from the tissues of the damaged lip, which is installed so as to lengthen the lip tissues and make them symmetrical. As a result of this intervention, a transverse scar is formed between the mouth and nose.
2. Method with the formation of a quadrangular flap. It is used when the cleft is severe.
3. Linear method. It is suitable for correcting small defects of the lip, as it does not make up for significant tissue deficiencies.

If the lip is cleft on both sides, then cheiloplasty is performed either as the first stage of the operation, after which the nasal defect is corrected in the second stage, or rhinocheiloplasty is used immediately.

This is what the cleft lip looked like before and after cheiloplasty:

Rhinocheiloplasty

This intervention involves the correction of a complete cleft lip, when the nasal cartilage and oral muscles have been damaged. In this case, the nasal cartilage is freed from the skin and subcutaneous tissue, they are placed in the correct position and fixed. After this, the tissues of the upper lip are stitched together. After a while, if the defect was significant, a repeat operation may be necessary.

The operation ends with the installation of a tampon into the nasal passage. This cotton-gauze device will prevent food from entering the nose, as well as narrowing the nasal passages. On days 2-3, the tampon is removed and a polyvinyl chloride (PVC) tube is installed instead, the purpose of which is to prevent narrowing of the nose and deformation of its wings.

Rhinocheilognatoplasty

This intervention is used to recreate the correct position of the lip, nasal cartilage and hard palate. The intervention is complex and traumatic. After it, tampons and various PVC and plastic retainers may remain in the mouth for some time.

Postoperative rehabilitation

It is carried out in three stages:

1. In the hospital - immediately after the operation. Here they provide pain relief, prevention of suppuration of injured tissues, feeding and correction of water-salt balance. A special device is placed on the child’s face to prevent the seams from coming apart when the lips move. A splint can be placed on the baby's arms for 3 weeks, which will prevent him from scratching and damaging the stitches.
2. With the help of clinic specialists. This stage begins immediately after discharge, when the mother must come with the child to the local therapist at her place of residence, and he will write down which specialists will need to be visited and how often, which physiotherapeutic procedures to attend and which pills to take.
   At the outpatient stage:
   • Work with a speech therapist - if the consequences of surgical intervention on speech cannot be eliminated before 3 years. Then a speech therapist should be involved in the development of the child’s speech, and these classes must be completed before the age of 6, when the child will join the school community.
   • Treatment by an orthodontist to correct the bite. It consists of wearing various braces, mouth guards or plates. The method depends on the specific situation and financial capabilities of the family.
   • Treatment by an audiologist if the child has hearing problems.
3. At home, when classes with the child are carried out with less intensity, ENT specialists, an orthodontist, a dental therapist, and a speech therapist are periodically visited.

Until the violations of speech formation, bite, and respiratory and digestive systems are completely eliminated, the child is assigned a disability.

If the postoperative scar turns out to be unsightly, it can be corrected using a laser beam. Additional corrective interventions may also be performed subsequently to correct smile irregularities.

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 looks like a cleft, formed on both sides of the upper lip, resulting from a physiological deviation. 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.

General a sign 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?

Looking at a cleft lip that may appear alone or in combination with cleft palate, it should be noted that such a deformity is diagnosed in every seven hundred 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. Moreover, in this case we mean a cleft lip. At the same time, girls are much more likely to have a cleft palate or cleft palate, and such cases are 50% more common 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 similar defects may arise as a result maternal 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:

Also create favorable conditions for the development of cleft lip or cleft palate may expose the fetus to viruses or chemicals. 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 with the development of a cleft palate or lip physiological defects are noted, this significantly simplifies the process of diagnosing them. 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 get into 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 it was easier to feed children with cleft palates, they will need to install an artificial palate, with which they can 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, which 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

The presence of deformities such as cleft lip and 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 extra, crooked or displaced teeth may be found, 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 serve 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:

Treatment of a child provides for the preparation of a special program, which involves 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 difficult because to eliminate such a defect a large number of operations have to be performed and therefore, most often, only after reaching 18 years of age can the patient return to a normal appearance. The first 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 creating conditions for the proper formation of teeth and facial bones.

Conclusion

They 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.

Cleft palate and cleft lip

Unfortunately, this process is quite long and often requires multiple 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.

– a congenital defect formed by the tissues of the nasal cavity and upper jaw that have not fused during the prenatal period and is characterized by a cleft lip. A cleft lip is manifested by external deformity, problems in nutrition and speech development, but the general psychosomatic development of the child usually does not suffer from this. Along with a cleft lip, newborns with maxillofacial defects often have a cleft palate - cleft palate. The fact of the presence of such defects in the fetus can be established in utero using ultrasound. Treatment of cleft lip is carried out surgically - through cheiloplasty; for combined defects – rhinocheiloplasty, rhinocheilognatoplasty.

General information

Cleft lip (cheiloschisis) is a developmental defect of the maxillofacial region, which is a cleft lip. 0.04% of babies are born with a cleft lip, most of whom are boys. The formation of cleft lips and palates occurs before the 8th week of pregnancy, when the maxillofacial organs are formed. Facial clefts are rarely isolated defects; in every fifth case they represent one of the components of severe congenital syndromes. Correction of facial clefts, restoration of impaired functions and rehabilitation of patients with such congenital pathology are carried out by specialists in the field of maxillofacial surgery, dentistry, speech therapy, and pediatrics.

Causes of cleft lip development

The formation of a cleft lip, as well as a cleft palate, is determined at the genetic level. Mutations in the TBX22 gene that cause cleft lip can be provoked by toxicosis, stress, antibiotic abuse, radiation or infectious exposure, drug use, alcohol use, or smoking by the expectant mother. The effect of these factors is especially dangerous in the first 2 months of pregnancy. Another risk factor for developing a cleft lip is late (after 35-40 years) childbirth. A certain role in the formation of the defect is assigned to the gynecological and general somatic pathology of the pregnant woman.

On the scale of influence on the formation of a cleft lip, unfavorable factors are arranged in the following sequence: chemical (22.8%), mental (9%), mechanical injuries (6%), biological (5%), physical (2%), etc. The birth of a child with a cleft lip can be determined by ultrasound examination of the fetus in the late stages of pregnancy. Parents who already have a child with a cleft lip are advised to undergo genetic counseling before planning their next pregnancy.

Classification of cheiloschisis (cleft lip)

Typically, a cleft forms on the upper lip, on one side of its midline. Less commonly, the defect appears on both sides or on the lower lip. Unilateral lip cleft is most often formed on the left. With a bilateral defect, the presence of a protruding intermaxillary process of the maxilla is often noted.

There are incomplete and full forms of cleft lip. Partial clefting is usually unilateral and appears as an indentation on the lip. It is formed as a result of non-fusion of the middle nasal and one of the maxillary processes. A complete cleft lip is characterized by a deep crack (chip) extending from the lip to the nose on one or both sides. This is caused by non-fusion of the nasal process with the left and right maxillary. The depth and extent of the defect may vary. In mild cases, the splitting affects only the soft tissue of the lip; in severe cases, the defect is associated with the palatine bone and the bone of the upper jaw.

A cleft lip can occur in isolation, but is more often accompanied by other anatomical defects in the development of the upper jaw: clefts of the hard or soft palate, nasal deformities, etc. Establishing the form of the defect, its severity, and its combination with other maxillofacial pathologies allows us to determine the tactics for managing patients with cleft lip and the choice of methods for correcting congenital defects.

Manifestations of cleft lip

Cleft lip is determined by external examination of the child immediately after birth. The presence of a cleft lip is indicated by a characteristic facial deformity with a one- or two-sided cleft in the upper or lower lip. If a cleft lip is not corrected, it can cause a decrease in personal self-esteem in a child. Infants with cleft lip have difficulty sucking and swallowing. If the cleft lip is deep and large, feeding through a nasal tube may be necessary. In the future, due to deformation of the teeth and bite, the processes of chewing food are disrupted.

In 70% of cases, additional interventions may be required to correct residual deformities of the lip and nose at an older age. The achievement of functional and aesthetic results after cheiloplasty is judged one year after plastic surgery. In some cases, it is possible to develop cicatricial deformation of the lip from the mucous membrane, which may require plastic surgery of the oral vestibule.

Cleft lip in newborns is a congenital pathology that is a cleft lip. It is formed due to non-fusion of the tissues of the upper jaw and nasal cavity. This disease is considered rare, as only about 0.04% of children are born with it. Pathology causes not only aesthetic, but also physical discomfort. Due to the defect, it is difficult for children to eat, talk, and smile fully. But still, first of all, this pathology is a cosmetic defect, but it can be eliminated through surgery.

Reasons

Many people are concerned about the question of why children are born with this pathology. After all, if you exclude the reasons that lead to the formation of the defect, then it will not develop in the child. The following factors lead to the appearance of a cleft lip in a newborn:

• childbirth after 40 years. Late births are dangerous precisely because children are often born with certain pathologies;
• illnesses of a viral nature that the mother suffered in the first three months of pregnancy;
• genetic factor. Many scientists are confident that cleft lip is the result of a mutation that occurred at the gene level;
• complications during pregnancy. This group includes STDs, chronic illnesses already present in the mother’s body, and so on. Many scientists consider this reason to be one of the main ones;
• hereditary factor. It is not uncommon for children with a cleft lip to be born into families in which several members already had this pathology. This is also one of the main reasons that most often leads to the formation of pathology;
• unfavorable environment;
• smoking and alcohol consumption.

Species

In medicine, the following types of cleft lip in newborns are distinguished:

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

Symptoms

There are quite a few reasons for the occurrence of pathology. As a result of the influence of certain factors, a defect is formed in the eighth week of intrauterine development. It is during this period that children begin to develop their maxillofacial organs.

In infants, the processes of swallowing and sucking are disrupted. The child cannot eat properly. If the defect reaches a large size, then feeding is done through a nasogastric tube.

The following symptoms are also observed:

• incorrect pronunciation of sounds;
• delayed speech development;
• psychological discomfort;
• ear infections. Typically, they can develop like this if there is a cleft palate. In the case of just such a defect, the ear canals may be in the wrong position. Because of this, the level of exudate in the canal increases, and the likelihood of pathogenic microorganisms entering increases several times;
• violation of tooth formation. Teeth may not begin to grow at all or may erupt in the wrong position.

All these unpleasant symptoms can only be eliminated through plastic surgery. No conservative methods will help in this case.

Diagnostics

The presence of this defect in the fetus can be determined in the third trimester of pregnancy through. This is the most informative technique. The presence of a cleft lip is not an indication for termination of pregnancy.

Treatment

The pathology can be eliminated only with the help of surgical treatment methods. The number of operations, their volume, and duration can only be determined by a surgeon after a thorough assessment of the defect and the patient’s condition.

Treatment of cleft lip is carried out through the following operations:

• cheiloplasty;
• rhinocheiloplasty;
• Rhinocheilognatoplasty.

Cheiloplasty– a surgical operation that allows you to completely restore the aesthetic and functional usefulness of a lip that has been split. This treatment method can be used at 3–6 months of age. But if a severe defect is observed, then the operation can be performed as early as 1 month of the baby’s life. There are certain conditions:

• the child should not have anemia, diseases of the central nervous system, cardiovascular and endocrine systems;
• For surgical treatment at this age, the baby must gain enough weight.

Rhinocheiloplasty is a surgical treatment method that is indicated for severe forms of pathology, the presence of deformities of the nose and facial skeleton. This operation is complex and lengthy.

Rhinocheilognatoplasty– an operation that makes it possible to completely restore the lips, eliminate underdevelopment of the jaw, and defects in the cartilage tissue of the nose. Successful surgical intervention allows the formation of a full-fledged muscle frame.

Contraindications

Surgical treatment (plastic surgery) cannot be performed if:

• birth injuries;
• ailments of an infectious nature;
• defects of various vital organs.

Such surgical procedures are quite complex, so they should only be performed by a highly qualified surgeon.

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Spinal amyotrophy Werdnig-Hoffmann is a genetic pathology of the nervous system, which manifests muscle weakness throughout the body. This disease impairs a person’s ability to sit, move independently, and care for themselves. In the modern world there is no effective therapy that would give a positive result.

Adenoiditis is an inflammation that occurs in the area of ​​the pharyngeal tonsil. The process of inflammation is infectious and allergic in nature, while adenoiditis, the symptoms of which in its course occurs by analogy with the inflammatory process that occurs with a sore throat, with a long course and undertreatment can provoke the occurrence and subsequent development of heart defects, kidney diseases, digestive organs and other pathologies .

An adenoma formed on the thyroid gland is a benign neoplasm with clear edges and a fibrous capsule. Such a tumor is not fused with the surrounding tissues, is small in size, and is absolutely painless. The danger of an adenoma on the thyroid gland lies in its possible degeneration into a malignant neoplasm, therefore, if the tumor grows rapidly, its immediate removal is indicated. The operation consists of excision of the tumor along with the capsule, followed by sending it for histological examination to confirm or refute the presence of cancer cells in the adenoma.

An aortic aneurysm is a characteristic sac-like dilatation that occurs in a blood vessel (mostly an artery, but in more rare cases a vein). An aortic aneurysm, the symptoms of which, as a rule, have scant symptoms or no symptoms at all, occurs due to thinning and overstretching of the vessel walls. In addition, it can be formed as a result of the influence of a number of certain factors in the form of atherosclerosis, hypertension, late stages of syphilis, including vascular injuries, infectious effects and the presence of congenital defects concentrated in the area of ​​the vascular wall and others.

Cleft lip in children (cheiloschisis) is a congenital pathology of the structure of the nasal cavity and deformation of the upper jaw, externally manifested by a characteristic cleft located in the labial area. A cleft lip in children looks ugly in the photo; in addition, it prevents the child from eating and speaking normally, and also negatively affects the child’s psychological state. Along with a cleft lip, children are often simultaneously diagnosed with a cleft palate, a pathology manifested by a cleft palate. Diagnosis of cleft lip is possible even at the stage of intrauterine development; for this it will be enough to conduct a classic ultrasound examination after 8 weeks. Treatment involves exclusively surgical techniques and includes a combination of several tactics.

Causes of cleft lip:

Why are children born with cleft lip? The cause of the development of the defect originates at the gene level, a mutation occurs in TBX22. The birth of a child with a cleft lip is caused by the following reasons:

Severe toxicosis, especially in the third trimester
Stress during pregnancy
Taking antibiotics
Unfavorable ecological atmosphere
Alcohol, drugs, smoking
Late childbirth and diagnosis of problematic pregnancy

All of the above factors are especially dangerous in the first trimester.

Varieties:

Depending on the location of the defect, there are:

One-sided cleft
Bilateral cleft lip

There is a classification depending on the depth of the cleft:

Full form - a deep chip is formed from the nose to the lip, can be one- or two-sided
Incomplete form - formed due to non-fused nasal and jaw sections

A cleft lip can only affect soft tissue, in which case a mild form is diagnosed; in the vast majority of cases, the pathology affects bone tissue. In addition, it is important to note that cleft lip is often combined with other structural defects of bones and facial tissues.

Signs:

The symptoms of a cleft lip are specific; the diagnosis is made after an external examination of the newborn. A cleft appears on the child’s face on the upper, or less often, lower lip.

Important! Surgery to correct a cleft lip must be carried out as quickly as possible in order to normalize the process of eating, swallowing, etc.

Cleft lip in newborns is manifested by the following symptoms:

Difficulty sucking milk
Incorrect bite formation
Teeth growing at an incorrect angle, gaps between teeth, poor quality teeth
Slurred speech – rhinopalia

Diagnostics:

Diagnosis of cleft lip and cleft palate is not particularly difficult; it is carried out during a routine examination of a pregnant woman at a gestational age of 2 months or more. If a couple has already had a child with a cleft lip, it is recommended to consult a geneticist and undergo appropriate genetic tests to find out the likelihood of a recurrence of the pathology in the newborn.

Treatment of cleft lip in a child:

Treatment of a cleft lip involves surgery, and it usually takes place in several stages. Plastic surgery for cleft lip is performed on children who were born at 39-40 weeks and do not have any associated health problems.

Planned cheiloplasty is performed at the age of three to six months; unscheduled surgery is indicated earlier if there are reasons:

Insufficient weight gain
Pathological abnormalities in the gastrointestinal tract and heart function
Neurodevelopmental problems and endocrine disorders

Important! Before planning surgery to correct a cleft lip in a newborn, it is necessary to weigh the pros and cons, since there is a high probability of massive blood loss.

Surgery for cleft lip:

The result of a successfully performed cheiloplasty is the restoration of the normal structure of the bone structure of the jaw, the elimination of all defects on the face. In addition, the surgeon sets himself the task of creating all the conditions so that the child develops normally as he grows up.

According to international protocols for the treatment of cleft lip, the last surgical interventions should be performed before the age of three years, it is during this period that speech formation occurs. Possible speech defects must be eliminated through consultations with a speech therapist.

Surgical techniques

Depending on what form of defect is diagnosed in the child, the surgeon, together with the pediatrician, decides on the type of operation: rhinocheilognatoplasty or rhinocheiloplasty.

Rhinocheiloplasty

The operation is indicated in the presence of defects in the structure of cartilage tissue, bones, as well as incorrect localization of muscle tissue in the mouth. Such an intervention is considered complex from a technical point of view, but in the vast majority of cases it eliminates the defect and guarantees the child’s normal functioning.

Rhinocheilognatoplasty

Rhinocheilognatoplasty allows you to solve the following problems:

Restores the anatomical structure of the lip
Removes defects in nasal cartilage
Allows you to create a normal muscle frame
Eliminates underdevelopment of the alveolar process
This operation is also classified as complex and requires highly qualified surgeons and skills.

Postoperative period

After completing the reconstructive work, the surgeon sutures the split tissue, and a tampon is placed in the area of ​​the nasal passage to maintain the integrity of the sutures, as well as protect them from natural mucus and food ingress.
After the tampon is removed, a special tube is inserted into the patient's nasal passage. This is necessary in order to prevent narrowing of the lumen, as well as to prevent the wings of the nose from forming incorrectly. The sutures are removed on the tenth day after surgery.

Forecast:

Today, more than 85% of successfully performed operations to correct the cleft lip defect make it possible to completely eliminate the defect and ensure normal adaptation of patients in society at a conscious age. The appearance of a postoperative scar can be improved with the help of minimally invasive cosmetic procedures that can be performed at an older age.
In 65% of cases, after the first operation, a secondary surgical intervention may be required to eliminate residual defects of the cleft lip of the procedure; it is also recommended to be performed at an older age. The success of the surgical procedure can be assessed within one year from the date of plastic surgery.

Remember that a cleft lip is not a death sentence; if you consult a doctor in a timely manner and the operation is carried out correctly, your child will be no different from his peers and will lead a normal life.