The keys to cleft palate

Cleft palate or cleft lip is an embryonic anomaly that causes some newborns to have an incomplete upper lip.

What is a cleft palate?

Embryonic anomaly, in which the organic assembly of the polystructures involved in the anatomofunctional configuration, usually of the upper third of the face, in a greater or lesser degree of extension, determine among other possible: more or less immediate perceptions, for relatives, relatives and clinicians, of the interruption of the individual or shared continuity of the soft palate and more in extension, of the palatouveal set, to be able to include, if the process is more developed, the alveolomaxillary region and even, to go beyond towards the nasolabial and facial parts, uni or bilaterally, without forgetting other cleft areas, of more scope, even towards the orbit and craniofacial areas.

Why does it occur?

The answer cannot be totally explanatory and it would be necessary to consider hereditary factors, very evident and recognizable and easy to verify, as they occur in certain societies of consanguinity or shared genetics, to put it briefly, and others, due to infections and maternal affections in the first phases of gestation or extraordinary environmental phenomena: radiation, medications, environmental contamination, etc., although not always easy to determine and that can lead to “natural” or spontaneous possibilities, which are difficult to justify. In all cases, the clinician should support and mix with geneticists and researchers from various and unlikely fields, to clarify and learn more about the subject.

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Does it cause pain?

It would be necessary to define pain, how, where and to whom? . Nowadays, serial ultrasound monitoring of pregnant women can alert, and we will only refer to the expectant mother and those around her, that more or less extensive anomalies are occurring in the formative process of the fetus (those affected are monitored, not only regionally, but also from the general point of view, to determine other concomitant organic anomalies, cranial, cardiac, genital, etc.), every day, in an earlier, more accurate and perceptible way. This can serve to warn the environment of the existence of this type of affections, which we are reluctant to call diseases. For the fetus and later, the newborn, usually does not seem to mean any painful clinical symptoms, derived from the cutaneous, mucosal and even osseous dehiscences, to which we refer. In this case, in the oral and maxillofacial territory. Another thing is the post-surgical or orthopedic pain that comes with the treatment of the cleft, although it is controllable.

Can children born with this pathology eat and drink without problems?

In most patients, feeding is possible in a natural way and should even be promoted, so that the newborn enjoys the undoubted benefits of breastfeeding, which also indirectly helps parents and relatives, when they see the newborn, who is able to overcome difficulties not infrequently enlarged by third parties, due to its anomaly. In complex cases, i.e. with extensive clefts, sometimes associated with other serious malformations, cardiorespiratory and swallowing dysfunctions, etc., can be determined, which may require extraordinary vital support, which may require extraordinary vital support, ranging from specific positioning of the affected person in sophisticated incubators and even, from the beginning, associated with labiolingual fixation surgery (to prevent the tongue from moving to the oropharynx and obstructing the airway) or even the use of bone distraction techniques for mandibular advancement, for the same purpose. Even starting with endotracheal intubation or tracheostomy. Sometimes it is necessary to use feeding tubes or even gastrostomies for the same support purposes, always with the intentions and illusion of professionals and relatives, of temporariness, although not easy to achieve, in these cases of intensive and very specialized clinical-surgical activity (1).

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How is it treated? Is it solved with a single operation?

Surgically in clinically established cases, and we say so, because sometimes there are embryological fissure-like fissures, at different levels, which are not necessarily susceptible to cruel treatment. In the most common morphologically how, the isolated palatal or labial ones, the intention should always be to resolve them in a single intervention. In the more complex, simple or bilateral labionasopalatine, it is usual to intervene first of all the lip in its space and in the immediate one, in which they are influenced (nasolabial and alveolomaxillary regions). Here, surgery is differentiated in terms of surgical timing and two surgical times are usually mandatory, the lip, at around six months and the palate, within the first year. These are clear interventions, under general anesthesia, with hospitalization and postoperative controls, in Children’s Postoperative Resuscitation Units or even Pediatric Intensive Care Units.

The treatment of the fissure, is not surgical in an integral way, other Specialists and diverse Professionals, are usual for its control and pre and postoperative follow-up, for periods that can exceed several years and even almost for life. We refer to Otorhinolaryngologists, Orthodontists, Phoniatrists, Psychiatrists, Odontologists, Stomatologists, Psychologists, Social Assistants, etc. In underdeveloped countries with almost “epidemic” incidences of this pathology, the surgeon must assume polyvalent activities, such as those mentioned above, if there are no referrals and not infrequently, associate with different specialties for complex latent craniofacial surgeries. The rehabilitations with implantological procedures, nowadays, are a reference in the complementary treatment of the palatal lip, usually already adult, but also in orthodontic phases. Not only to make up for bony interruptions of the arches and dental absences, but also for other more or less concomitant factors, which may require dental implants for pterygomaxillary, zygomaticomalar and/or facial epithesis, if necessary (2).

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What derived problems can occur?

We have mentioned how different specialties should train relatives and patients in social and integration aspects. Also to make clear, from the first moment, that in spite of therapies of first magnitude, of the natural organic sequels, that the own anomalies can cause in the malformative, phoniatric, masticatory, dental levels, etc., others, are derived or even can be produced, by therapeutic supports, well indicated, carried out and meticulously carried out. It is not infrequent that this type of patients feel attracted by the sanitary life with labor intentions, that they get to establish themselves and it is probably due to the fact that they feel that they have been cared for and attended with love, understanding and care. This is, in the first place, from their relatives and, perhaps, from the professionals and hospital or related personnel who have been attending them over the years.