Cleft lip because of what. Is it possible to prevent the development of disease? Intrauterine development of the face

A hare lip or heilchisis refers to a congenital defect that is formed due to the non-growth of tissues, from which the upper jaw and the nasal cavity are obtained at the stage of intrauterine development, which leads to the formation of a characteristic lip cleft.

This defect leads to a change in appearance, hampers nutrition and the formation of speech, but does not affect the metal abilities of the baby in any way. To correct the situation can only be surgically.

Causes of Heilosis

Cleavage of the upper lip provokes mutation of the TBX-22 gene. Sometimes a defective gene is inherited, but this happens infrequently. The presence of relatives with this pathology increases the chances of having a baby with a cleft lip by only 7%. Much more often, adverse factors affecting the expectant mother and fetus during pregnancy become the cause of the disorder. These include:

• Smoking, use of alcohol and drugs;
• The influence of harmful substances in the environment, if women live in environmentally unfavorable territories or work in hazardous industries;
• Infectious diseases, especially viral, transferred in the first trimester of pregnancy;
• Obesity;
• Deficiency of folic acid and some other vitamins during the laying of fetal organs;
• Acceptance of some medicinal preparations;
• Severe stress;
• Injuries and surgical interventions in the abdomen;
• Age of mother over 35 years.

The main problem is that the maxillofacial structure of the embryo lays up to 8 weeks of intrauterine development. Many women at such a short time are not aware of the onset of pregnancy, so they do not change their lifestyle and can take medicine or drink alcohol.

Clinical picture

Manifestations of the disease can differ quite strongly in different patients, therefore several types of hare lip are distinguished:

• Single or double sided. In the first case, there is one crevice on the lip to the side of the center, and in the second - two slits with a cushion of soft tissue in the middle.
• Complete and incomplete. In the first version of the cleft lip, only a small depression is noticeable. With a complete cleft comes to the very nose.
• Depth and length. Often the cleft affects not only the soft tissues of the lips, but also the bone and cartilage structures of the jaw and even the nose.

The hare lip is found both in isolation and in combination with defects of the palate and nose. Therefore, before choosing the treatment tactics, doctors carefully examine the patient and determine the form of the defect, the degree of severity and the presence of other disorders.

To identify this pathology even during fetal development can be on ultrasound examination. The accuracy of diagnosis depends on the quality of the device and the qualifications of the doctor, but usually you can notice the splitting in the soft tissues of the face from the 4th month of pregnancy. But according to the results of such a study, the analysis is not set; the neonatologist does this after examining the newborn.

If an ultrasound reveals a violation of the structure of the maxillofacial system, the doctor may recommend a more detailed examination. If there are no other pathologies, you can safely carry the pregnancy further, since, most likely, the child will be born healthy somatically and mentally. The only problem is that surgical correction of the defect is required. If other defects are detected, after assessing their severity, doctors may even advise premature termination of pregnancy.

Actors Joachin Phoenix and Mikhail Boyarsky, Masha Malinovskaya and singer Karmit Bashar were born with a hare lip. There is an opinion that Pharaoh Tutankhamen had the same vice, but his subjects considered him a sign of the presence of supernatural forces.

Many parents of babies with this pathology are afraid to have a second child. In this situation, a consultation of genetics and clarification of the reason for the formation of a defect in an older child will be required. If one of the parents is the carrier of the defective gene, there is a risk that he will be passed on to the next child.

Cleft lip treatment

The only treatment for this congenital abnormality is timely plastic surgery. In the absence of contraindications, such as jaundice, birth injuries, infectious diseases and serious defects of other organs, it is carried out 3-6 months after birth. If necessary, you can operate earlier. This is usually done if the baby has a very strong splitting that interferes with feeding.

The main advantages of early surgery include:

• Improving conditions for the development of the lips and nose;
• Reducing stress from parents.

The main disadvantages:

• The lips are too small and this complicates the work of the surgeon, so there is a higher probability of getting an aesthetically non-ideal result;
• High risk of complications and blood loss due to the immaturity of the body systems of the baby.

Some doctors believe that it is better to move the operation to a later date - up to 1.5-2 years. If a cleft lip is combined with cleft palate, several operations may be required. In the most difficult situations, treatment can take up to 14-16 years.

The main types of surgery for cleft lip:

• Cheiloplasty - correction of the soft tissues of the lip. It helps to eliminate small splittings - a relatively simple operation.
• Rinohejloplasty - correction of soft tissues, cartilage of the nose and circular muscles of the mouth.
• Rinohaylognoplastika - correction of the company, the nose and the alveolar process of the upper jaw.

Plastic surgery in 85-90% allows you to fully restore the normal shape of the lips, nose and mouth. One year after the correction, they evaluate the result and draw conclusions about the need for additional treatment.

At the site of splitting, even after successfully performed operations, a small scar remains, and sometimes the lip rises up. Such a defect can be corrected with the help of plastic surgery after the patient has reached the age of majority. Cosmetology procedures sometimes help.

If necessary, patients undergo correction of the bite using plates or braces. If the treatment is delayed for about three years or more, it is necessary to practice with a speech therapist in order to work out the correct pronunciation. In most cases, before the child goes to school, doctors manage to completely correct his lip and the baby is no different from peers.

Prevention of vice

Unfortunately, it is impossible to completely prevent the birth of a child with such a defect, but it is possible to reduce the likelihood of any developmental disability. For this you need:

• Plan a pregnancy and give up bad habits before it occurs;
• To be examined for STDs and TORCH infections prior to the start of active planning and to make all the necessary vaccinations in advance;
• If there is such a pathology in the family or, if you are over 35, consult a geneticist;
• Take medication only as recommended by the doctor;
• Avoid stressful situations.

All this to some extent protect against possible trouble and certainly will not be superfluous for all planning couples.

Heilhosis   or cleft lip   - This is a congenital anomaly of the facial section, in which the upper lip is divided into two parts. A cleft lip may be limited only to the upper lip, but may also affect the upper palate, combined with other malformations.

Statistical data

Cleft lip is one of the most common congenital anomalies. With this defect, one out of every 1000 babies is born, which is about 0.04 percent of the total population of the planet. Most often, with a split lip boys are born. In most cases, the cleft is located on the left side of the upper lip. In the United States, the frequency of birth of children with a cleft lip varies with the state. In New York, 0.78 babies per 1000 babies are born with such a defect, 1.94 in Alabama, and 2.5 in New Mexico.

There is a definite relationship between race and the frequency of the spread of this pathology. Compared with the fair-skinned population, Asian people have cleft lip twice as often. For the Negroid race, the formation of a defect in 50 percent of newborns is characteristic.

According to the World Health Organization ( WHO) today there is a tendency to increase the number of children born with this anomaly. This fact is associated with environmental degradation and the emergence of a large number of factors affecting the occurrence of congenital anomalies. Thus, in the Republic of Belarus, where every 5 resident suffered from the Chernobyl accident, there is an annual increase in the number of children with a cleft lip by 0.25 times per 1000 newborns. Attempts to explain the reasons for the birth of people with a split lip were made in the times of ancient civilizations. Anomalies prescribed religious significance. In ancient Egypt, it was believed that people born with this defect were punished by gods. Representatives of other cultures associated the defect with a sign of the introduction into the person of representatives of evil forces. In Russia, children born with such a lip belonged to special people endowed with supernatural powers. It was believed that they could transform into animals.

The first who attempted surgical treatment of split lips, were the ancient Egyptians. During the excavations, mummies were found, on the remains of whose faces there were signs of overgrown cleft lip. The defect was sewn by Egyptian healers with the help of thin veins of animals.
  The Chinese first described the procedure for correcting this anomaly. The principle of the method was based on cutting a flat slit and its subsequent stitching in parts. In the middle of the 17th century, special plates were used for the reconstruction of the face.
  Interestingly explains the causes of the formation of the Ayurveda defect ( ancient science of healthy life, originated in ancient India). According to Ayurveda, hare lip belongs to the group of diseases Janma-val-pravritta ( diseases acquired in the mother's womb). Factors in the development of such pathologies are the abnormal behavior of women during pregnancy. It was believed that a woman can give birth to a child with a split lip, if she is having sex during pregnancy, commits sinful acts, often experiences anger and irritability.

The cleft lip is not a sentence, and its consequences are successfully corrected by modern surgery. Many people born with such a defect achieved success and well-being in their lives. One of the famous people who possessed this pathology was, for example, Glenn Turner, who today is considered the king of network marketing. From 1962 to 1967, Glenn Turner, having a starting capital of $ 5,000, earned 300 million. This man is devoted to a series of books under the general title “Glenn Turner - hare lip”, written by Soviet journalist Melor Georgievich Sturua.

Among modern celebrities, Joaquin Phoenix has a scar indicating the previous cleft lip surgery. There is also information that such stars as Mikhail Boyarsky, Andrei Makarevich, Andrei Mironov were born with a split lip.

Lip anatomy

  Lips are skin-muscular formations located on the front surfaces of the upper and lower jaws, around the entrance to the oral cavity. Allocate the upper and lower lips, which together form the mouth gap.

Lips are formed by several layers of different tissues.

The main tissue layers forming the lip are:

• skin layer;
• loose connective tissue layer;
• muscle layer;
• slime layer.

  Almost the entire skin layer of the lips is formed by a stratified squamous squamous epithelium. The term keratinizing means that it is inherent in the process of keratinization. Only at the outer edge of the lip, a non-keratinized epithelium is noted, due to which the skin is thinner. Through it translucent hypodermic vessels, giving the lip a pinkish color.

Loose connective tissue layer is moderately pronounced. It contains a large number of sebaceous glands, choroid plexuses and nerve fibers.

The muscular layer of the lip is represented predominantly by the circular muscle of the mouth. Part of its muscle fibers is circular, forming a rounded sphincter. With the reduction of these fibers, the lips are closed and pressed against the teeth. Another part of the fibers passes radially from the edge of the lips to the bones of the skull. As a result of their contraction, the lips move forward and the mouth opening opens. The muscle layer of the lips also includes a number of facial muscles.

Mimic muscles located in the thickness of the lips are:

• muscle lifting the upper lip;
• muscle lifting the upper lip and wing of the nose;
• muscle, raising the angle of the mouth;
• malar small and large muscles;
• cheek muscle;
• muscle, lowering the upper lip;
• muscle, lowering the corner of the mouth;
• subcutaneous muscle of the neck.

  As a result, contractions of the mimic muscles of the lips change their position, expressing various human feelings and emotions.

The mucous layer lining the entire inner surface of the lip, goes into the skin layer on the outer surface. The transition zone of one layer to another is called the lip border. It has a bright red color due to highly translucent blood vessels. When the mucous layer passes into the gums, a transverse mucous fold, called the bridle, is formed along the midline. A number of excretory ducts of the salivary glands of the upper lip come out on the surface of the mucous layer.

The structure and anatomy of the upper jaw

  The upper jaw is a steamy massive bone that participates in the formation of the orbits, nose and mouth. The front surface of the upper jaw is covered by the upper lip.

The anatomical structure in the upper jaw secrete the body and four bone processes. The body of the upper jaw is a hollow bone with a large pneumatic sinus. This sinus is called the maxillary or maxillary sinus. It has a connection with the nasal cavity through a wide opening.

The bony processes of the upper jaw are:

• the frontal process, which merges with the frontal bone and participates in the formation of the nasal cavity;
• palatal process, which is involved in the formation of a hard palate ( bone plate separating the oral cavity from the nasal cavity);
• the alveolar process, which is provided with dental cells for the attachment of eight teeth;
• zygomatic process, which is spliced ​​with the zygomatic bone.

Intrauterine development of the face

  Intrauterine facial development is a complex process of formation and fusion of bones and tissues, which starts at the end of the first month of embryonic development.
  On the fourth week, five hillocks begin to stand out from the embryo ( shoots), limiting the oral cavity.

The embryonic hillocks involved in intrauterine facial development are:

• frontal bump;
• paired maxillary tubercle;
• paired mandibular tubercle.

  Embryonic mounds gradually grow and merge with each other.

Maxillary and mandibular tubercles grow laterally ( to the sides) and connect on the sides. Thus, the lateral part of the upper jaw and lips, as well as the cheeks are formed. Next, there is a gradual convergence of the mandibular processes and their fusion, which gives the development of the lower lip and lower jaw.

The maxillary tubercles, unlike the mandibular, do not reach the median line. The resulting gap fills the nasal process of the frontal tubercle, which grows from top to bottom. It is wedged between the maxillary tubercles, forming the outer part of the nose, the middle part of the upper jaw and the middle of the upper lip.
  Thus, the processes of the maxillary tubercles and the nasal process of the frontal tubercle are involved in the formation of the upper jaw and upper lip.

As a result of the proliferation and convergence of embryonic hillocks, clefts are formed between their processes.

Embryonic clefts are:

• the midline crevice, which forms at the site of convergence of the maxillary or mandibular hillocks;
• transverse cleft, which is formed by the maxillary and mandibular mounds;
• oblique and lateral cleft lips, formed at the site of convergence of the nasal process of the frontal tubercle and processes of the maxillary tubercles.

  By the beginning of the eighth week of intrauterine development, the fusion of facial clefts with the formation of the main lines of the face.
  When, for any reason, there is no complete fusion of the processes of the embryonic hillocks, the crevices remain in the form of congenital anomalies. Thus, when the lateral cleft is not split, a cleft lip is formed, and when the transverse cleft is preserved, a macrostomy is observed ( pathologically large mouth).

Causes of defect formation

  A cleft lip defect is related to congenital anomalies of development, the exact causes of which in most cases remain unexplained. Experts note that the formation of a crevice on the lip can be due to one factor or a combination of several reasons.

The reasons for the formation of the defect are:

• endogenous factors;
• adverse environmental conditions;
• radiation effect;
• chemical intoxication of the fetus;
• lack of vitamins;
• wrong lifestyle of the mother;
• taking medications;
• infectious diseases of a pregnant woman;
• other external factors.

Endogenous factors

  Endogenous factors include internal causes of anomaly development.

Endogenous causes of cleft lip formation are:

• heredity;
• age of parents;
• biological inferiority of germ cells.

Heredity
  This pathology is often formed in children whose parents or other family members have a similar defect. According to statistics, if one of the parents was born with a split lip, the probability of having a child with the same pathology reaches 4 percent. If both parents had a cleft lip, the risk of developing a defect is 9 percent.

Hereditary pathologies result from exposure to internal and external factors, as a result of which various mutations occur at the genetic level. According to a discovery made in 1991, a hare lip develops due to a mutation of the TBX-22 gene.

The factors that can trigger the abnormality of this gene are called mutagens. By nature, mutagens can be physical, chemical or biological. The most significant physical mutagen is ionizing radiation. Chemical mutagens include chemicals that cause changes mainly in the structure of DNA ( molecule providing storage and transfer of genetic information). Biological mutagens include various microorganisms that enter the body and cause mutations.

Parents age
  Experts determine the parental age, which exceeds 40 years, as one of the reasons for the formation of a hare lip in a child. The most important is the age of the mother.

Biological inferiority of germ cells
  The inferiority of the germ cell is its inability to form a cell with a complete set of chromosomes, which is called a zygote and is formed as a result of the fusion of the male spermatozoon and the female egg. Both male and female defective sex cells can cause the formation of a split lip.

Causes of germ cell inferiority are:

• "Overripe" ( increase in the period from ovulation to the merger of the sperm with the egg);
• addiction to alcohol;
• unfavorable ecological situation.

Adverse environmental conditions

  In some cases, healthy at the genetic level, embryos, while in the womb, acquire this pathology under the influence of environmental factors.

Negative environmental factors include:

• unfavorable ecological situation;
• electromagnetic radiation;
• radiation.

Unfavorable environmental situation
  At increased risk of having a child with a cleft lip are women living or working in areas of environmental pollution.

Sources of pollution are:

• thermal power plants;
• metallurgical enterprises;
• chemical production;
• oil producing enterprises;
• agricultural organizations.

  In the process of these institutions, various chemical compounds are released into the atmosphere and soil ( sulfur oxides, ammonia, hydrogen sulfide, etc.). These substances, entering the woman's body, cause various violations of fetal development, including the cleft lip.

One of the sources of pollution, the value of which has grown recently, is motor transport. The exhaust gases of cars contain a large number of toxic compounds that have a negative impact on the development of the fetus.

Electromagnetic radiation
  Exposed to electromagnetic radiation, the expectant mother can both at work and in living conditions.

Sources of electromagnetic radiation are:

• personal computer, laptop, tablet;
• eBooks;
• cell phones;
• devices for copying documents;
• scanners and printers;
• devices for the destruction of documents;
• microwaves;
• refrigerators;
• tvs

Radiation

  Ionizing radiation is one of the key adverse environmental factors that trigger the development of a cleft lip. Entering the female body, radioactive substances can linger in it for a long time. The degree of danger to the embryo is determined by such factors as the time of the radionuclide ingress ( radioactive substance), duration of exposure and the ability of the substance to penetrate the placental barrier. Sources of radiation can be natural or artificial.

Natural radionuclides are divided into terrestrial and cosmic. A pregnant woman may be exposed to severe radiation exposure during the flight by plane. Earth radionuclides are located in the earth's crust, of which the most significant is radon. Prevent the penetration of this substance into the body using a special device radiometer.

Artificial radiation sources are used in energy production, the creation of nuclear weapons, the manufacture of certain consumer products. Staying close to these radiation factors, the expectant mother puts herself at risk of having a baby with a cleft lip.
  A large number of sources of radiation used in modern medicine.

Medical radiation sources include:

• x-ray machines;
• radiation therapy devices;
• equipment operating on the basis of radioisotopes.

Chemical intoxication of the fetus

  Penetration into the female body of some inorganic chemical compounds can cause the birth of a child with a cleft lip. Substances that can cause congenital malformations are called teratogenic poisons. Teratogenic poisons are part of some cosmetics, household chemicals, drugs used in agriculture. Lead is one of the most dangerous and widespread elements with a teratogenic effect. This substance can enter the body through the skin, respiratory tract, along with food. Mercury, arsenic, cadmium can also provoke the formation of a cleft lip.

Other teratogenic poisons are:

• agricultural poisons ( pesticides, fungicides, herbicides);
• mineral fertilizers ( nitrates, nitrogen);
• nutritional supplements ( cyclic acid, amaranth dye);
• cosmetic components ( retinoids, Accutane, sodium lauryl sulfate);
• household chemicals ( chlorine, ammonia, phosphates, xylene).

Lack of vitamins

  An insufficient amount of vitamins in the body of a pregnant woman can cause the birth of a child with a split lip. The most dangerous is a folic acid deficiency. This substance is necessary for the normal formation and development of the fetus. Folic acid is actively involved in such processes as cell division, tissue growth, doubling of nucleic acids. Also, in the process of carrying a fetus, a woman should receive such vitamins as A, E, C with food or as supplements. The need for such a vitamin as B6 increases by 30 percent. Women who adhere to a vegetarian diet can give birth to a child with a split lip due to a lack of vitamin B12. Expectant mothers living in the northern areas need to supplement their diet with vitamin D3.

Wrong way of life

  According to many experts, the probability of having a baby with a cleft lip increases if a woman consumes alcohol during pregnancy. The level of negative influence of alcohol is determined by its quantity. When used up to 30 milliliters of ethanol per day ( no more than 1 glass of dry winea) negative impact on the fetus is not carried out. If a pregnant woman consumes alcohol daily, which contains from 30 to 60 milliliters of ethyl alcohol, the chance of having a child with this defect is 12 percent.
Women who use tobacco and drugs during pregnancy are at risk of having a baby with a split lip.

Infectious diseases

  Infectious processes in the body of a pregnant woman increases the likelihood of hare lip formation in the fetus. Infections of both viral and bacterial nature are harmful. The effect of the virus can spread directly to the fetus, causing it to become infected. Also, viral infections can have a negative effect indirectly, causing hyperthermia in the mother ( high temperature). Infections caused by bacteria also provoke overheating of the fetus, which can cause cleft lip.

The diseases that can cause this anomaly are:

• cytomegaly;
• coxsackie virus;
• smallpox.

Medications

  Some drugs have a teratogenic effect. The level of adverse effects on the fetus depends on the degree of penetration of the drug through the placental barrier.

High risk drugs are:

• psychotropic drugs ( lithium);
• antiepileptic drugs ( valproic acid, phenytoin);
• cytostatic drugs ( methotrexate);
• antibiotics ( dactinomycin, exifin);
• antidepressants ( sertraline, fluoxetine).

  Medications with a significant degree of risk include anticonvulsants and neuroleptics, anti-diabetes drugs, and anti-inflammatory drugs.

External factors

  Physical factors such as uterine tumors, attempts to terminate the current pregnancy, and earlier abortions can cause the development of a child's cleft lip. Falling pregnant women from a height, bad landings, and blows to the lower abdomen can also affect the formation of a split lip in the fetus.
  One of the external circumstances that can cause this congenital developmental anomaly is heat exposure. Overheating of the woman in the sun, high temperature due to illness, visiting a steam room - all this increases the risk of having a baby with a cleft lip.

Hypoxia can cause a congenital labial cleft ( oxygen starvationa) fetus. Due to the insufficient amount of oxygen in the fetus, the metabolism is disturbed, which causes various pathologies in the formation of tissues. Diseases of the cardiovascular system, blood diseases, and strong toxicosis can cause hypoxia. In some cases, lack of oxygen provoke a predisposition to miscarriage, pathological processes in the uterus.

What does a hare lip look like?

Defect of the cleft lip looks like a unilateral or bilateral cleft of the upper lip. Also, the defect may affect the lower lip, which is extremely rare. The most common one-sided cleft, which is localized on the left side of the median line. Bilateral cleft lip is much rarer and, as a rule, is combined with other malformations of the maxillofacial apparatus.

Unilateral cleft lip

  Most often located on the left, but may be on the right. The defect has the form of a cleft, the length of which may vary. This may be a shallow defect that will not reach the wings of the nose. In this case, the upper lip looks like a little split. In this case, the upper jaw with teeth and the nasal cavity is not visible. However, as a rule, the cleft stretches from the edge of the upper lip to the wings of the nose, exposing the anterior jaw ( thereby giving the child a resemblance to a hare). Through this defect, both the nasal cavity and the intermaxillary process with teeth are visible.

Unilateral cleft lip can be hidden and open. An open defect is characterized by the absence of all layers of the upper lip. The cleft is in this case through, and through it the nasal cavity and the intermaxillary process is visible. With a hidden cleft of the upper lip, some of the tissue remains intact. In this case the bone basis is exposed to splitting ( jaw process) and the muscles of the lips, and the skin of the lips and their mucous remains intact. Visually, such a defect is not immediately recognized, since the skin and mucosa cover the cleft in the lip.

Bilateral cleft lip

  This type of anomaly can be symmetric and asymmetric. In the first case, clefts are localized on both sides of the midline of the upper lip. They can also be complete ( and reach the wings of the nose) and incomplete ( look like shallow grooves). Full bilateral cleavage of the upper jaw is characterized by a deep cleavage ( a crack that runs from the wings of the nose to the soft palate). The parts of the upper lip in this case are completely separated. In the asymmetric version of the cleft lip, on the one hand, the cleft may be complete, and on the other - incomplete.

In both cases, the bilateral maxillary process of the upper jaw protrudes slightly in the bilateral cleft lip. This type of cleft lip is almost always accompanied by a cleft in the upper sky. Thus, the anomaly affects not only the upper lip, but also other structures of the maxillofacial apparatus.

Other manifestations of cleft lip

Heylosis is not only a cosmetic defect, but also deep respiratory and speech disorders.

The main manifestations of cheilosis are:

• impaired sucking and swallowing;
• impaired dentition;
• chewing disorders;
• speech function disorders;
• other anomalies of the maxillofacial apparatus.

Impaired sucking and swallowing
  Most clearly manifested in deep, through defects, which are characterized by direct communication between the oral and nasal cavity. Due to the lack of tightness between these two cavities, the necessary pressure is not created in the oral cavity, which would provide the child with a sucking reflex. If the defect affects the muscles of the soft palate, the process of swallowing is also disturbed. In this case, a newborn with a cleft lip is transferred to artificial feeding through a probe. If this is a one-sided and shallow upper lip defect, then the sucking and swallowing reflex is preserved.

Dental impairment
  Due to the split of the upper jaw, when the cleft lip is disturbed, the growth of the teeth. Abnormalities in the dentition can be characterized by missing teeth, an abnormal growth angle, or the presence of additional teeth. The teeth of children born with a cleft lip are prone to caries and quickly deteriorate. Sometimes, even after the plastic repair of the defect, the bite is disturbed in such children, which further requires the intervention of an orthodontist.

Chewing disorders
  Chewing disorders are noted at a later age. They develop in several cases - if the plastic of the defect was not made, and also if the wrong bite was formed. The most common violation of the chewing process is due to improper bite and deformation of the teeth. Improper chewing also contributes to the weakness of the muscles of the pharynx and palate, which is observed in the bilateral cleft of the upper lip, together with the cleft of the upper palate.

Speech Disorders
  Due to the violation of the integrity of the upper jaw in children disrupts the process of formation of sounds. This is manifested in the development of rhinolalia. With this defect in sound pronunciation, the speech acquires a pronounced nasal hue, the sounds become fuzzy.

Other abnormalities of the maxillofacial apparatus
  Most often, the hare lip is combined with such an anomaly of development as a wolf's mouth. In this case, the slit cuts not only the lip, but also the upper sky. Disorders of sound pronunciation, breathing and nutrition in this case are expressed to the maximum. The defect affects not only bone structures, but also muscle aponeurosis ( tendon plates). The weakness and dysfunction of the muscular system of the oral cavity lead to serious problems in the nutrition of children. The greatest danger is a violation of swallowing. Also in children with multiple anomalies of the maxillofacial apparatus respiratory disorders are noted. Shallow breathing leads to the development of oxygen deficiency, as less oxygen enters the body. All this leads to a physical underdevelopment of children. It should be immediately noted that such an unfavorable outcome is observed in cases where they do not resort in time to surgical correction of the defect.

Similarly, cleft lip can be combined with abnormal development of the nose, face, and developmental defects of the internal organs. Cleft lip is also found in the structure of Patau syndrome. This is a chromosomal disease, which is characterized by the presence of an additional thirteenth chromosome. In this syndrome there are multiple abnormalities in the development of internal organs, for example, atrial septal defects and blood vessels. In children with Patau syndrome, in addition to malformations of internal organs, there are also multiple external abnormalities. For example, the narrowing of the palpebral fissure, deformation of the auricles, as well as the cleft of the upper lip ( cleft lip) and the upper palate ( cleft palate).

Surgical defect correction

At what age is it better to have surgery?

  The most favorable time for the surgical treatment of the cleft lip is determined by the surgeon. Factors such as the nature of the anomaly are taken into account ( location and severity of the defect), child's weight and other features of its development. The optimal time, in the absence of contraindications, is the period from 2 to 12 birthday and the interval between 6 and 8 months. Contraindications for the operation may be the patient's unsatisfactory weight, the presence of diseases of the cardiovascular system or problems with breathing, and other congenital defects. A number of experts believe that operations performed between 6 and 8 months of age are more appropriate. Surgical intervention in the first weeks after birth contributes to better development of the upper lip and nose. But patients at this age react severely to blood loss occurring during surgery. In addition, in such children, the upper lip is small in size, which makes surgery more difficult. When reaching 6 - 8 months, the condition of the child allows you to carry out all operations in full, while significantly reducing the risk of complications. The rate of development of bone tissue in the middle of the face stabilizes, which represents a favorable environment for the operation.

If the defect is expressed by bilateral cleft, the operation is impossible in the first weeks of birth and is postponed until the child reaches six months. If necessary, repeat operations are carried out in a few months.
  If the damage is deep, soft tissue repair is performed at an early age. Correction of bone and cartilaginous structures is assigned for a period of 4-6 years. The final surgical correction of the jaw and nose is best done after 16 years, when the growth of the facial bones stops.

Plastic technique defect

  In medical practice, there are a large number of cleft lip correction methods. To eliminate the defect, you can use only one technique or a combination of several techniques. Regardless of the type of plastics used, the goal of surgical intervention is to restore the anatomical integrity of the lip and to eliminate concomitant deformations. Surgical treatment should provide favorable conditions for the growth and development of all structures of the middle part of the face throughout the patient's childhood.

Preparation for surgery
Any kind of operation is preceded by a series of preparatory procedures. The surgeon explains to the parents the principle of the technique chosen, the type of anesthesia used, the possible risks and complications. Before the operation, the patient is assigned several examinations and tests in order to identify possible contraindications. Within 2 weeks before plastics, patients should not take drugs that contain acetylsalicylic acid and various anticoagulants. In some cases, surgical treatment involves some additional manipulations. This may be special dental tires or molded dental linings.

The number of operations and types of plastic in the treatment of cleft lip
  The optimal method of cutting plastic lips and the number of required operations are set by the surgeon. The physician takes note of the nature of the defect and the general condition of the patient.

The factors that the plastic surgeon takes into account are:

• type of cleft - may be full or partial;
• type of damage to the lip - meaning unilateral or bilateral cleft;
• the presence of concomitant defects on the face - the presence of a split palate or nasal defects requires complex surgical intervention;
• age of the child, his weight, features of physical development;
• the possibility of deterioration after surgery.

  If the child has a small unilateral cleft, the defect is eliminated in one operation. With a wide one-sided slit in most cases two operations are required, which are carried out with a pause of several months. With a bilateral defect, each part of the lip is restored during a separate operation. If the cleft lip is accompanied by a defect in the nose, the choice of approach depends on the opinion of the surgeon. Some doctors prefer to conduct a simultaneous correction of the lips and nose, believing that this will reduce the difficulty in mastering the speech skills and adaptation of the child. Other experts suggest that you perform separate operations on the plastic of the lip and nose, prescribing the plastic of the nose at the time when the child is 5-6 years old. According to them, surgery at this age will avoid disproportion of the nose. If a cleft lip is formed together with a split palate, two or more operations may be necessary. Additional operations are performed in some cases to correct a smile line or remove a postoperative lip scar. Such events are most often postponed until the onset of adolescence.

Types of plastic with cleft lip are:

• cheiloplasty - is carried out at the cleft of the upper lip;
• rhinochaeloplasty   - appointed when correction is necessary not only lips, but also correction of the muscles of the oral cavity and cartilage of the nose;
• rhinochaelogatoplasty   - used in severe pathologies of the facial skeleton in violation of the structure of the alveolar process ( the bone to which the teeth are attached).

Cheiloplasty
  During this plastic surgery, deformities in the lips and nose are eliminated and the anatomical and functional usefulness of the lip is restored. Depending on the severity of the defect, the correction can be performed during one operation or several successive stages. In the process of surgical treatment, the doctor performs a reposition ( restoration of the correct position) tissues and their connection. All methods that are used by modern surgeons in eliminating a cleft lip can be divided into three categories. The key difference is the shape of the cut on the lip.

The methods of the cut are

• Linear way.   The positive side of this method is the inconspicuous postoperative scar. The disadvantage of such operations is insufficient lengthening of the lip, so they are not carried out in the presence of large crevices. Linear cuts include the methods of Evdokimov, Limberg, Millard.
• The method of a triangular flap.   This group includes techniques developed by Tennyson and Obukhova. Their principle is to correct the defect with the help of triangular flaps. This method allows to obtain the necessary elongation of tissues and to form a symmetrical lip shape. The negative side of the method is the formation of a transverse scar on the fold between the mouth and nose.
• The method of quadrangular flap.   This category includes the methods proposed by Hagedorn and Le Mazurye. They consist in correcting a defect with a quadrilateral flap. These methods are used in the plastic strongly pronounced crevices.

  In the case of bilateral cleavage of the lip, cheiloplasty is performed in two stages. Sometimes, correction of the cleft on both sides is carried out first, followed by correction of the defect in the nose area ( rhinoplasty). In other situations, unilateral correction of the cleft is performed together with nose correction ( rhinochaeloplasty). Then, during the second stage, the gap is repaired from the other side.
After cheiloplasty, postoperative scars remain on the patient's face. If the operation was performed professionally, and after it there were no complications, the scars look in the form of thin threadlike strips, which are almost imperceptible.
  Residual deformities in the area of ​​the lip or nose remain after the first cheiloplasty in 70 - 80 percent of the operated. As they mature, postoperative defects may become more pronounced. In such cases, reconstructive cheiloplasty is performed to correct cosmetic defects.

Rhinoheyloplasty
  This type of plastic involves the simultaneous correction of the upper lip and nasal septum. Such operations can be carried out both independently and be part of a comprehensive surgical treatment. Distinguish primary and secondary rhinocheyloplasty. The purpose of the primary rhinocolabel is to eliminate the incorrect position of the nasal cartilage and restore the anatomical integrity of the lip.

Secondary rhinochaeloplasty is performed in cases when, after the first operation, various deformations develop immediately or over time.

The indications for secondary rhinoheyloplasty are:

• shortening of columella ( part of the septum in advance of the nose);
• flattening of the tip of the nose;
• deformation of the wings of the nose.

  In the case of secondary rhinoheyloplasty, incisions are made along the edges of the existing postoperative scar. After this, the cartilages of the nose are released and their correct position is restored. Next, the upper lip tissue is sutured and stitches are applied.

Rinoheilognathoplasty
  This type of plastic surgery is a complex operation, during which a number of problems are solved.

The objectives of rhinoheillogplasty are:

• elimination of deformity of the anterior jaw;
• improving the shape of the upper lip;
• correction of nasal defects.

This operation can be performed together with cheiloplasty or after it. Rinohaylognoplastiku recommended to patients in cases where the cleft lip combined with cleft palate. In the process of surgical intervention, the mucosal flaps on both sides of the slit exfoliate, which are used to correct the nasal opening in the area of ​​splitting of the alveolar process. To restore the integrity of the jaw, a periosteum graft, removed from the anterior surface of the lower leg, is used. The wound is sutured by moving fragments cut from the upper lip.
  After rhinochaelognoplasty, orthodontic treatment is indicated after 3 months.

Under what anesthesia is the operation performed?

Cleft lip surgery can be performed with local or general anesthesia.

Local anesthesia
  Local anesthesia is used in cases where patients are operated on with incomplete and shallow crevices. Anesthesia is performed by the method of infiltration anesthesia ( frost) by entering a solution of novocaine or trimecain.

General anesthesia
  With local anesthesia, the child often behaves restlessly, making it difficult to perform the operation. Therefore, in case of bilateral clefts and other complex types of defect, the operation is performed under general anesthesia. Freezing tissues with novocaine can also be used with this type of anesthesia, especially if newborns are operated on. Infiltration increases tissue volume, which facilitates their dissection.

The stages of general anesthesia are:

• sedation;
• induction ( anesthesia);
• enter the main anesthetic;
• intubation ( pulmonary ventilation);
• way out of anesthesia.

  Premedication is performed in order to prepare the patient for the operation, reduce the level of anxiety, enhance the effect of the anesthetic and reduce the secretion of the salivary glands. This procedure is carried out using a combination of drugs, one of which is most often atropine.
  Entering into anesthesia is carried out using the inhalation method. Through a special mask, the child breathes gas, which consists of oxygen and an anesthetic drug. With a more adult patient, induction can be performed intravenously. After the child falls asleep, a catheter is inserted into the vein ( with intravenous induction, it is administered immediately) through which the anesthetic drug is supplied. The choice of anesthetic is carried out by the anesthesiologist in accordance with the age of the child.

Intubation is carried out using a tube that is inserted into the respiratory tract and is connected to a special apparatus. Intubation provides the patient with normal breathing during surgery.
  During the operation, the anesthesiologist controls the flow of the drug to ensure the state of anesthesia. With the help of medical equipment, the doctor monitors the well-being of the child, checking blood pressure, breathing and heart activity.

Upon completion of the operation, the anesthesiologist stops the flow of the drug and makes sure that the patient recovers breathing independently. After that, the tube is removed from the respiratory tract.
  The child is in the intensive care unit for 2 to 3 hours after the operation, where he is observed by the doctor.

The duration of rehabilitation after surgery

The duration of rehabilitation depends on the characteristics of the child, the nature of the operation and how the children's body responded to the anesthesia. In the process of recovery of the patient after surgery, there are several stages.

Stages of rehabilitation are:

• stationary;
• polyclinic;
• recovery.

Inpatient rehabilitation
  The purpose of this stage of rehabilitation is to provide conditions for the correct healing of a postoperative wound and the prevention of complications. If surgery was carried out with local anesthesia, you can begin feeding in a few hours. After general anesthesia, the doctor determines the time of the first feeding.
  To avoid skin maceration ( swelling), on the seams on the lip do not bandage. Every day it is necessary to treat the seams with an antiseptic. Drug therapy during inpatient rehabilitation is based on a complex of drugs and has several goals.

The objectives of drug therapy are:

• anesthesia;
• detoxification;
• prevention of bacterial infections;
• correction of violations of water-salt metabolism;
• stimulation of tissue regeneration;
• support immune functions.

  In order to protect the seams from food, and the nasal cavity from narrowing, a tampon of gauze is inserted into the patient's nose. The stitches are removed after 7–10 days, after which a special tube is inserted into the nose hole, which is left for 3 months. This helps prevent the deformation of the nasal cavity and the wings of the nose. To prevent discrepancy of postoperative sutures, the patient should avoid injuries to the face.
  To enhance the effect of the operation in some cases, the child is assigned to wear a special headgear. The device is a supporting bandage that passes through the upper lip, fastening in the cheek area. Such a dress helps prevent lip from stretching and preserve the integrity of postoperative sutures. The duration of use of the device is determined by the doctor. So that the child does not self-injure the seams, the movements of the hands are limited with a tire or other device.

Polyclinic rehabilitation
  This stage of rehabilitation begins with the discharge of the child from the hospital. The discharge date is determined by the doctor who assesses the patient’s general condition. Polyclinic rehabilitation includes a systematic visit to a medical institution and activities aimed at eliminating residual effects after surgery.

Rehabilitation
The task of this stage is the restoration of all body functions and the return of the patient to a normal lifestyle. If the operation was performed late, the child may need the help of such doctors as an ENT ( otolaryngologist), orthodontist, speech therapist, dentist. Observation of these specialists is necessary in order to prevent bite disorder, defects in the formation of the dentition, problems with speech.

This period lasts at least a year. Only after 12 months, the doctor can make a conclusion about how successfully the operation was performed and whether all functions were fully restored. In the presence of aesthetic or functional problems, the following stages of surgical treatment are planned.

Complications
  One of the complications of surgical treatment of cleft lip is the divergence of the wound edges. This may occur due to errors in the process of intervention, the development of the inflammatory process in the wound, the trauma received by the patient after the operation. Shallow scars in the area of ​​the vestibule of the mouth are considered as a postoperative complication. Over time, exerting pressure on the alveolar process, scars cause deformation of the upper jaw. In addition, this defect does not allow subsequent treatment by an orthodontist.

Other complications after surgery are:

• face deformity;
• narrowing of the nasal opening;
• deformation of the wings of the nose;
• speech impairment.

  Cleft lip entails disability. This does not mean that children born with this anomaly are physically inferior. With timely correction of the defect does not develop complications. At the same time, if a child is born with such an anomaly in the family, the pediatrician is obliged to send him for a disability examination. The basis are disorders of the digestive and respiratory systems or speech formation. Disability is established until the elimination of violations between the ages of 3 and 7 years.

To receive compensation for disability, the child must undergo an examination. To do this, the parent must contact the social security authorities. A child is deregistered only after the end of the rehabilitation period. Methods of rehabilitation should be focused not only on the plastic of the defect, but also on the correction of comorbid disorders. This is, first of all, respiratory and digestive disorders. Also, in order to deprive a child of a disability group, he must have no speech defects. If the cleft lip caused heavy, irreparable violations, the group remains for life.

Plastic results

  After the plastic of the cleft lip in the area of ​​the nasolabial triangle there remains a barely noticeable scar. This scar can later be easily corrected with a laser. The position and length of the postoperative scar depends on the method of operation used. It is worth noting that the well-supplied tissue of the face heals very quickly. The earlier the treatment was taken, the less visible the scar is. This is due to the fact that in childhood cartilage and bone tissue is not yet formed. As a result of this plastic defect occurs more easily and with less complications.

How to feed a newborn with a cleft lip?

  How to feed a newborn with a cleft lip is determined by the type of defect. So, if there is only a small unilateral cleft lip without other combined anomalies, breastfeeding is possible. However, in this case, it will be somewhat different from normal breastfeeding. Firstly, the child must not be placed horizontally, but slightly upright or half-sitting. Secondly, feeding should be carried out in small portions.

Deep, through defects of the upper lip require the use of special nipples, which are different in shape from the ordinary. This is due to the fact that such volume crevices are accompanied by weakness and dysfunction of the muscles of the maxillofacial apparatus. As a result, the child has difficulty sucking. The most common are the nipples from the firms NUK and Avent. These nipples are put on the bottle ( same or another company), where pre-express breast milk. The pacifier is recommended to move as far as possible to the root of the tongue. If the sucking process is difficult, then the hole in the nipple is recommended to do more. Mom herself can do this with ordinary scissors.

If the cleft of the upper lip affects the sky, then special nozzles are used. These nozzles have the form of liners, which are placed in the mouth of the child, thus closing the defect. With massive through crevices, when the defect is too large, and the reflex sucking and swallowing is disturbed, they are transferred to feeding through the probe.

It is very important to preserve breastfeeding and not switch to artificial mixtures, if, of course, the child does not have associated metabolic pathologies ( for example, lactase deficiency). It is necessary to do this, because children born with a cleft lip are prone to frequent colds. In the same milk contains all the necessary substances to strengthen the immune system.

Why are children born with a hare lip?

  There are several opinions about why children are born with a cleft lip. Today, heredity is considered the most studied premise of this pathology.

Heredity
  Numerous studies among close relatives have shown that the risk of developing a hare lip is as high as possible for those children in whose family anomalies of the maxillofacial apparatus have already been encountered. This is due to the phenomenon of a genetic mutation in the TBX-22 gene. As a result of this mutation from 8 to 12 weeks of intrauterine development, the alveolar processes do not coalesce.
  According to the same research, the probability of developing a hare lip in a child reaches 4 to 5 percent if one of the parents suffered from a similar pathology. The risk percentage is doubled if both parents had a hare lip.

Environmental factors
  At the same time, some children with a cleft lip do not have relatives with a similar anomaly. This indicates the involvement of external factors in the development of a hare lip. Today, it is generally accepted that mother’s bad habits play a crucial role in the development of this anomaly. It has been proven that women who smoke have a 6–7 times higher risk of having a baby with a cleft lip than non-smokers. If a woman abused alcohol during pregnancy, the risk to the child will be more than 10 percent.

Such external factors as infections or the use of drugs during pregnancy can increase the likelihood of having a baby with a cleft lip. Herpes, measles, coxsackie and cytomegalovirus viruses have the greatest teratogenic effect on the fetus. If a pregnant woman has suffered one of these infections in the first trimester of pregnancy, then the risk of developing a fetal lip in the fetus ( even if the mother does not smoke and does not abuse alcohol) increases several times.

Another factor that increases the risk of developing a cleft lip is medication. Antidepressants have the highest risk ( fluoxetine), anticonvulsant drugs ( phenytoin), cytostatic drugs ( methotrexate). Even if the mother took these medicines before pregnancy, they can still have a negative effect on the fetus. This is due to the long-term elimination of drugs from the body, as well as their teratogenic effect on the cells of the body.

It should be noted that the maximum risk of developing a hare lip is observed with simultaneous exposure to several causes.

Is the hare lip inherited?

  According to modern theories about the causes of hare lip development, this defect is inherited. However, to date, the type of inheritance of the disease is unknown. It is possible that this is an autosomal dominant mode of inheritance, in which the anomaly is passed down from generation to generation. It is known that the risk of hacking lip inheritance increases if both parents suffer from defects of the maxillofacial apparatus.

If a couple already had a child with a similar pathology, then the risk of its development for a subsequent child is from 8 to 10 percent. If the parents suffered from this anomaly, then the probability increases to 50 percent. However, one hundred percent risk of transmission of the cleft lip is not inherited. Scientists have found that the disease appears due to the complex interaction of genetic predisposition and environmental prerequisites. Therefore, the risk of having a child with this anomaly, despite the hereditary predisposition, can be reduced to zero, if we take into account all the factors that provoke the formation of a defect. It is necessary to be examined for the presence of chronic infections, to take the necessary trace elements ( for example, folic acid) still during pregnancy planning, and also to exclude smoking and the use of alcohol in expectation of the child.

What does a cleft lip look like after surgery?

  The operation, which is carried out with a hare lip, restores the defect of tissues, regardless of the type of plastic used. After its implementation, the anatomical integrity of the lip is restored, and the associated deformations are eliminated.

During the operation, the surgeon restores the correct position of the tissues and connects them. After that, in the region of the nasolabial triangle remains subtle postoperative scar. The location of the scar depends on the type of operation performed. So, if plastic surgery was performed in a linear fashion, then a barely noticeable scar remains in the lip area. If the triangular flap method was used, then a transverse scar is located on the fold between the mouth and the nose. The number of scars corresponds to the number of clefts. If there was a bilateral cleft, then on both sides of the median line remains along the scar.

With deep defects, when the lip dissection reaches the wings of the nose, the nose is also plasticized. In this case, on both sides of the slit flakes of mucous tissue are peeled off, which go to the plastic of the nasal opening in the cleavage zone of the alveolar process. The extent of the scar then depends on the professionalism of the surgeon and the quality of the rehabilitation period. As a rule, if there are no complications, the scars have the appearance of thin filamentary strips, which are almost imperceptible.

It should be noted that today, thanks to modern technology, it is possible to eliminate scars ( or make them less noticeable) any volumes.

Is the hare lip visible on the ultrasound?

  The hare lip can be diagnosed by ultrasound from the 16th week of pregnancy. Some experts claim that cheilosis is visible on ultrasound much earlier, namely from week 14. However, most often this anomaly is detected in the period from 4 to 5 months of intrauterine development.

It is important to note that the first routine ultrasound examination during pregnancy is carried out somewhat earlier ( from 12 to 14 weeks). Therefore, it is impossible to see a formed vice during this period. However, subsequently, ultrasound diagnostics is not absolutely true. This is explained by a large percentage of errors, since the images on the screen are interpreted by different experts in different ways. Proof of this is the fact that only from 5 to 10 percent of anomalies are detected during the period of intrauterine development. Most parents will find out about this vice after birth.

When is surgery with a cleft lip necessary?

  The time for the surgical treatment of the cleft lip is determined by the attending physician. It is believed that the optimal time for the operation is the first year of a child’s life, namely, the period between 6 and 8 months. Of course, the degree and extent of the defect, the nature of the anomaly ( location), the weight of the child and other features of its development, as well as the presence of associated complications.

Contraindications for the operation in the first year of life are:

• prematurity of the child and its low weight;
• diseases of the cardiovascular system;
• breathing problems;
• concomitant congenital malformations.

  A number of experts believe that the operation performed at the age of 6 to 8 months is more appropriate, since it contributes to the better development of the upper lip and nose. At the same time, babies at that age react hard to blood loss that occurs during surgery. This is especially difficult for premature babies who already have congenital anemia ( people have anemia). In addition, in children of the first year of life, the upper lip is small in size, which is an obstacle to surgical intervention. After 4 - 5 months the condition of the child allows the operation ( or several operations) in full, while significantly reducing the risk of complications. The rate of development of bone tissue in the middle of the face stabilizes, which is a favorable condition for the operation.

It happens that a hare lip requires a multi-stage surgical intervention. This happens when it is combined with the cleft palate and other facial vices. In this case, the timing of the surgery is stretched. Given this, it is necessary to know that the correction of the defect is best completed by the age of three, that is, before the formation of speech.

If the defect affects the bone and cartilage structures of the face, then the operation is scheduled for a period of 4-6 years. The final surgical correction of the jaw and nose is best done after 16 years, when the growth of the facial bones stops.

Cleft lip in children (cheilosis) is a congenital pathology of the structure of the nasal cavity and deformity of the upper jaw, which is externally manifested by a characteristic cleft located in the labial region. The hare's lip in children in the photo looks ugly, besides, it prevents the child from eating normally, speaking, and also has a negative effect on the psychological state of the baby. Along with cleft lip, children often have parallel cleft palates - a pathology that manifests as cleft palate. Diagnosis of a hare lip is possible even at the stage of intrauterine development; for this, it will be sufficient to conduct a classical ultrasound examination after 8 weeks. Treatment involves only a surgical technique, includes a combination of several tactics.

Causes of cleft lip:

Why are children born with a hare lip? The cause of the development of a malformation arises at the level of genes, and TBX22 mutates. Having a baby with cleft lip is caused by the following reasons:

Severe toxicosis, especially in the third trimester.
  Stress during pregnancy
  Antibiotics
  Unfavorable ecological atmosphere
  Alcohol, drugs, smoking
  Late delivery and diagnosis of problematic pregnancy

All the above factors have a particular danger in the first trimester.

Varieties:

Depending on the location of the defect are distinguished:

Unilateral cleft
  Two-sided hare lip

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

Full form - a deep cleavage from the nose to the lip is formed, it can be one- or two-sided
  Incomplete form - formed as a result of the unregulated nasal and maxillary divisions

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

Signs:

Symptoms of hare lips are specific, the diagnosis is made after an external examination of the newborn. On the face of the child a cleft forms on the upper, less often the lower lip.

Important!Surgical intervention for cleft lip correction should be carried out as soon as possible in order to normalize the process of eating, swallowing, etc.

Cleft lip in newborns is manifested by the following features:

Obstructed milk sucking
  Malocclusion
  The teeth grow at the wrong angle, the gap between the teeth, the poor quality of the teeth.
  Slurred speech - rhinopalia

Diagnostics:

Diagnosis of cleft lip and cleft palate is not difficult, it is carried out on 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 get a genetic counseling and to undergo appropriate genetic tests to find out the likelihood of recurrence of the pathology in the newborn.

Treatment of cleft lip in a child:

Treatment of the hare lip involves surgery, and, usually, it takes place in several stages. Plastic surgery for cleft lip is performed on children who have been born for a period of 39-40 weeks, and also have no associated health problems.

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

Insufficient weight gain
  Pathological abnormalities in the gastrointestinal tract, heart work
  Problems of development of the nervous system and endocrine disorders

Important!Before planning an operation to correct a hack lip in a newborn, it is necessary to weigh the pros and cons, as there is a high probability of massive blood loss.

Cleft lip surgery:

The result of successfully performed cheiloplasty is the restoration of the normal structure of the jaw bone structure, the elimination of all those having defects on the face. In addition, the surgeon sets himself the task of creating all the conditions for the child to develop normally as he grows older.

According to international protocols for the treatment of cleft lip, the last surgical interventions should be carried out before the age of three years, during this period the formation of speech occurs. Possible speech defects should be eliminated by consulting a speech therapist.

Methods of surgery

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

Rhinoheyloplasty

The operation is indicated in the presence of defects in the structure of cartilage tissue, bones, as well as improper localization of muscle tissue in the mouth. Such intervention is considered difficult from the point of view of technology, however, in the overwhelming majority of cases, it eliminates the defect and ensures the normal functioning of the child.

Rinoheylognatplatistika

Rinoheylognatplatistika allows to solve the following problems:

Restores the anatomical structure of the lip
  Removes the cartilage defect of the nose
  Allows you to create a normal muscular frame
  Eliminates the underdevelopment of the alveolar process
  This operation also belongs to the category of complex, requires high qualifications and skills from the surgeon.

Postoperative period

After completion of the reconstructive work, the surgeon takes in split tissue, and a tampon is placed in the nasal passage to preserve 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 a narrowing of the lumen, and also to prevent the wings of the nose from forming correctly. The stitches are removed on the tenth day after the operation.

Forecast:

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

Remember that a hare lip is not a sentence, if you visit a doctor in a timely manner and have a properly performed operation, your child will be no different from peers, and will lead a normal life.

Cleft palate (cleft palate, cleft lip, honey. Heilhoschisis, (cheiloschisis))   - belong to congenital malformations of the maxillary region of the face. There are some differences between these pathologies.

Cleft lip, or cheilosis, (which translates as "cleavage") looks like a cleft lip, which sometimes has a large size and affects the nasal cavity.

The wolf's mouth is a hard and / or soft palate (the cleft of the sky), resulting in a communication between the two cavities, oral and nasal.

In some cases, the child may have both malformations. The approximate ratio of children born with this pathology to healthy babies is 1: 2500.

Disease photography

Causes

Soft and hard tissues of the maxillofacial area are formed by the end of the 8th week of pregnancy. The correct tab of these structures is influenced by both hereditary and external factors.

Also, chromosome breakdowns can affect the development of the defect. Regardless of the type of defect - cleft palate or cleft lip, the causes of their occurrence are the same.

The share of hereditary factors for the occurrence of cheilosis or cleft palate accounts for about 25%.

This issue has not been fully studied. Genetics come to the conclusion that the cause of the development of these pathologies is the action of several genes at once. This is also indicated by the fact that the risk of the appearance of the cleft palate and cleft lip in the next generations is only 7%.

Chromosome abnormalities account for only 15%. In this case, the newborn has other multiple severe malformations, combined into whole syndromes.

The remaining 40% comes from external pathogenic factors that affected the fetus in the first 2 months of pregnancy. Some factors come straight from the mother’s lifestyle and can be easily corrected:

• smoking during pregnancy, which increases the risk of developing abnormalities in 2 times;
• narcotic substances cause a hare lip or cleft palate in children 10 times more often;
• excessive use of alcohol and its substitutes;
• the use of certain groups of antiepileptic drugs and antibiotics;
• lack of vitamin B9 (folic acid) that every pregnant girl needs to take, starting from the first weeks of gestation.

There is a group of internal risk factors that, unfortunately, a pregnant cannot affect (non-modifiable)

• age of the pregnant woman over 35-40 years;
• fetal hypoxia in early pregnancy;
• partial chorionic detachment, which causes insufficient nutrition of the tiny fetus and inhibits its development.

And finally, external environmental factors:

• chronic intoxication with pesticides, benzene, mercury or lead.

This can happen if the expectant mother lives near industrial plants or works in hazardous production.

Manifestations of the disease

Cleft palate

Cleft lip

Despite the causes of the disease, external manifestations are quite typical. Already during the first ultrasound, the future mother will be told about the presence and severity of the defect in the baby. So at the birth of such a child, the team of doctors will provide him with all the necessary assistance.

• Heilosis looks like a vertical "gap" in the tissue of the upper lip (see photo above). It can be barely noticeable, or it can be extended to the nostrils. The lesion can be localized on one side or immediately on both. Babies may experience problems with the act of sucking, so special bottles are used for feeding. Sometimes doctors have to resort to tube feeding.

In the future, children may have problems with their teeth (wrong bite, lack of some teeth) and speech (nasal voices and problems with pronunciation).

• Wolf's mouth in children may be invisible during external examination of the newborn. However, looking into the oral cavity, you can see a vertical hole in the tissues of the upper palate. From the first seconds of their life, such babies experience problems with breathing and sucking and get all the help they need.

In addition to the problems that are characteristic of cheilosis, children with a wolf's mouth can develop infectious diseases of the ears () and facial sinuses (). This is due to the intake of inhaled air or fluids from the nasal cavity to the middle ear.

Defect Types

Two large groups of anatomical defects are classified on the basis of various signs.

Classification of cheilosis:

• By localization:
  • Defect of the upper lip;
  • Defect of the lower lip (extremely rare);
  • Defect of the upper and lower lips.
• On the side of defeat
  • Unilateral splitting (most often on the left);
  • Bilateral splitting, symmetric and asymmetrical.
• By severity
  • Full nonunion, which stretches to the nostrils;
  • Partial nonunion, including microforms of the cleft lip, which can be barely noticeable and do not interfere with the normal nutrition and breathing of the baby.
• By severity
  • Mild severity (isolated defect of the soft tissues of the lip);
  • Moderate and severe (combined with defects of the maxillary bone of varying severity).

The classification of cleavage of the sky (cleft palate)

The principles for classifying the median cleavage of the upper palate are slightly different.

• According to external signs:
  • Explicit cleft (diagnosis is not difficult);
  • Hidden cleft, in which there is only a deep muscle defect, and the mucous membrane remains intact. When viewed from such a newborn, the oral cavity looks normal.
• By severity:
  • Incomplete (splitting only the soft palate);
  • Complete (cleft soft and hard palate);
  • Through (defect affects not only the sky, but also the bone structure of the upper jaw - the alveolar process).
• Through defects are divided into:
  • Unilateral;
  • Bilateral.

Also, both pathologies can be divided into complicated (otitis, sinusitis) and uncomplicated.

The combination of cleft lip and cleft palate belongs to a separate classification category.

Diagnostics

Adequate diagnosis of cleavage of the palate or lips does not present much difficulty. As already noted, the diagnosis of “cleft palate” and “cleft lip” becomes apparent on ultrasound in 1–2 trimesters of pregnancy.

External examination of the newborn allows you to make an accurate diagnosis. However, for a more complete survey it is sometimes necessary to resort to certain research methods:

• radiography   maxillofacial area for the assessment of bone defects;
• audiometry or hearing research. Evaluated either by using special equipment, or by careful observation of the baby (his reaction to auditory stimuli). It is necessary in case of extensive crevices with a high risk of hearing loss, even deafness;
• olfactory test   (estimated facial expressions and behavioral reactions of the child to certain categories of pungent odors);
• general blood analysis   is obligatory for all newborn babies, however, in babies with a defect, special attention should be paid to it. An increase in the level of white blood cells - leukocytes, specific inflammatory proteins (, ceruloplasmin) and acceleration () indicate the accession of an infection, which can be quite difficult for weakened babies.

Pathology treatment

The main method of treating these pathologies is surgical.

Cleft lip surgery is called cheiloplasty. Most often, it is performed closer to 6 months of age, however, in some cases, the baby may need urgent surgery (during the first month of life).

This is usually associated with extensive defects.

Depending on the affected tissue perform:

• Isolated cheiloplasty - stitching the skin, subcutaneous tissue, muscle layer and the mucous membrane of the lips;
• Rinohejloplasty (lat. "Rino" - nose) - additional correction of the nasal cartilage;
• Rinognatocheyloplasty - the formation of the muscular frame of the mouth area.

Unfortunately, one surgery can not do. In the first 3 years of life, the baby will have to lie down 3-4 times on the operating table.

The success of the treatment of cheilosis tremendous. In most cases, the child remains only a slight asymmetry of the lips and a barely noticeable scar. And already in adulthood, a person will be able to turn to a beautician, who will help eliminate minor defects.

Treatment for cleft palate is referred to as uranoplasty. The timing of this operation differs from cheiloplasty - the optimum is the age of 3-4 years. An earlier operation can harm the growth of the upper jaw.

In case of extensive through crevices, the operation is delayed up to 5-6 years. However, by the beginning of the school period, most children receive all the necessary assistance and are no different from their peers.

To ensure that parents do not have fears for the child’s life and health before surgical treatment, the baby wears a special device, the obturator, which creates an internal barrier between the nasal and oral cavities. With him, the child can normally eat, breathe and talk.

Surgery - only one of the stages of treatment. The child will definitely need the help of a speech therapist who will form the correct speech. A problem with the bite and improper growth of the teeth will be decided by the doctor - orthodontist with the help of the bracket system.

Unfortunately, some children may have problems in the emotional-volitional and social spheres. Therefore, the help of a child psychologist will be most welcome. The kid will feel confident and will not have problems in communicating with peers.

Photo of children before and after surgery

Wolf maw before and after surgery

Cleft lip before and after surgery

Result plastics

Prevention

In order to reduce the risk of having a child with a similar defect, the expectant mother should lead a healthy lifestyle and follow all the recommendations of the doctor. Indeed, more than 50% of the success of pregnancy and the birth of a healthy baby in this case depends on the behavior of the mother and her closest environment.

Forecast

The forecast is very favorable. Thanks to modern methods of surgical plastic surgery, orthopedics and speech therapy, children with such a diagnosis are almost no different from those around them and lead an absolutely fulfilling life. It is important to take seriously the long-term treatment and rehabilitation of the child.

At an early age, babies can have problems with feeding and weight gain, and, accordingly, with neuro-psychological development. Therefore, you should master specialized feeding techniques and use additional sources of nutrients (energy complexes, vitamins).

Even with successful correction of the defect, the child is shown regular observation by specialists - maxillofacial surgeon, neurologist, otorhinolaryngologist and orthodontist dentist. Visit these doctors at least once a year, the child will be up to 17-19 years until all the tissues of the maxillofacial region are fully formed.

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- a congenital defect formed by tissues of the nasal cavity and upper jaw that are not accrete in the prenatal period and which is characterized by a cleft lip. The cleft lip is manifested by external deformity, nutritional problems and the formation of speech, but the general psychosomatic development of the child usually does not suffer from this. Along with cleft lip in newborns with maxillofacial defects, cleft palate - wolf mouth often occurs. The fact of the presence of such defects in the fetus can be established in utero using ultrasound. Treatment of the hare lip is performed surgically - by cheiloplasty; with combined malformations, rhinoheyloplasty, rhinoheilognoplasty.

General information

Cleft lip (cheilosis) is a malformation of the maxillofacial region, which is a cleft lip. With a hare lip, 0.04% of babies are born, among which boys predominate. The formation of cleft lip and palate occurs before the 8th week of pregnancy, when the maxillofacial organs are laid. Facial clefts are rarely isolated defects, in every fifth case they represent one of the components of severe congenital syndromes. Specialists in the field of maxillofacial surgery, dentistry, speech therapy, and pediatrics are involved in the correction of facial clefts, rehabilitation of impaired functions, and rehabilitation of patients with such congenital abnormalities.

Causes of Cleft Lip

The formation of a cleft lip, as well as the cleft palate, is conditioned on the gene level. Mutations in the TBX22 gene that cause splitting of the lip can be triggered by toxicosis, stress, abuse of antibiotics, radiation or infectious effects, drug use, alcohol, or smoking of the expectant mother. The effect of these factors in the first 2 months of pregnancy is especially dangerous. Another risk factor for the development of a hare lip is late (after 35-40 years) labor. A certain role in the formation of the defect is given to the gynecological and somatic pathology of the pregnant woman.

According to the scale of influence on the formation of cleft lip, adverse factors are arranged in the following sequence: chemical (22.8%), mental (9%) mechanical injuries (6%), biological (5%), physical (2%), etc. To determine the birth of a child with a cleft lip can be according to ultrasound examination of the fetus in the later stages of pregnancy. Parents who already have a child with a cleft lip are shown medical and genetic counseling before planning their next pregnancy.

Classification of cheilosis (cleft lip)

As a rule, a cleft is formed on the upper lip, on one side of its midline. Less commonly, the defect appears on both sides or on the lower lip. Unilateral cleft lip is more often formed on the left. In a bilateral defect, the protruding maxillary process of the maxilla is often noted.

Allocate incomplete and complete form of the hare lip. Partial cleavage is usually one-sided in the form of a recess on the lip. It is formed as a result of nonunion between the middle nasal and one of the maxillary processes. Full splitting of the lips is characterized by a deep crack (cleavage), ascending from lip to nose on one or two sides. This is caused by nonunion of the nasal process with the left and right maxillary. The depth and extent of the defect may be different. In mild cases, cleavage affects only the soft tissues of the lips; in heavy - the defect is associated with the palatine bone and the upper jaw bone.

The cleft lip can occur in isolation, but more often is accompanied by other anatomical defects of the upper jaw: crevices of the hard or soft palate, nose deformities, etc. Determining the form of the defect, severity, combination with another maxillofacial pathology allows you to determine the tactics of managing patients with cleft lip and the choice of methods for correcting congenital malformations.

Manifestations of cleft lip

Lip splitting is determined by an external examination of the child immediately after birth. The presence of a cleft lip is indicated by a characteristic deformation of the face with a one- or two-sided cleft in the upper or lower lip. If the hare lip is not subjected to correction, it can cause a decrease in the child's personal self-esteem. In infants with cleft lip, sucking and swallowing are difficult. If the crevices of the lips are deep and large, nasal feeding may be necessary. Further, due to the deformation of the teeth and occlusion, the processes of chewing food are disturbed.

In 70% of cases, it may be necessary to perform additional interventions to correct residual deformities of the lips 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, the development of cicatricial deformity of the lip on the part of the mucous membrane is possible, which may require the implementation of plastic surgery of the anterior oral cavity.