What is a cleft lip. Cleft lip: causes and treatment of pathology Cleft lip from what

cheiloschisis or cleft lip- This is a congenital anomaly of the facial region, in which the upper lip is divided into two parts. Cleft lip in this case can be limited only to the upper lip, but can also affect the upper palate, combined with other malformations.

Statistical data

There is a certain relationship between race and the frequency of this pathology. Compared to fair-skinned Asians, cleft lip is twice as common. The Negroid race is characterized by the formation of a defect in 50 percent of newborns.

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 5th inhabitant suffered from the Chernobyl accident, there is an annual increase in the number of children with 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 days of ancient civilizations. Anomalies were assigned religious significance. In ancient Egypt, it was believed that people born with this defect were punished by the gods. Representatives of other cultures associated vice with a sign of the introduction of representatives of evil forces into a person. 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 to attempt the surgical treatment of a cleft lip were the ancient Egyptians. During the excavations, mummies were discovered, on the remains of whose faces there were signs of an overgrown cleft lip. The defect was sewn together by Egyptian healers with the help of thin animal veins.
The Chinese were the first to describe the procedure for correcting this anomaly. The principle of the method was based on cutting out an even gap and its subsequent stitching in parts. In the middle of the 17th century, special plates began to be used for facial reconstruction.
Ayurveda explains the reasons for the formation of a defect in an interesting way ( an ancient science of healthy living that originated in ancient India). According to Ayurveda, cleft lip belongs to the group of diseases Janma-vala-pravritta ( diseases acquired in the mother's womb). Factors in the development of such pathologies is the wrong behavior of a woman during pregnancy. It was believed that a woman could give birth to a child with a split lip if she was sexually active during pregnancy, committed sinful deeds, and often experienced anger and irritability.

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

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

Lip Anatomy

The lips are formed by several layers of different tissues.

The main tissue layers that form the lip are:

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

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

The muscular layer of the lip is represented mainly by the circular muscle of the mouth. Part of its muscle fibers is located circularly, forming a rounded sphincter. When these fibers contract, the lips close and press against the teeth. Another part of the fibers runs 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 oral fissure opens. The muscular layer of the lips also includes a number of facial muscles.

Mimic muscles located in the thickness of the lips are:

• muscle that raises the upper lip;
• muscle that lifts the upper lip and wing of the nose;
• muscle that raises the corner of the mouth;
• zygomatic minor and major muscles;
• buccal muscle;
• muscle that lowers the upper lip;
• muscle that lowers the corner of the mouth;
• subcutaneous muscle of the neck.

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

The structure and anatomy of the upper jaw

According to the anatomical structure in the upper jaw, a body and four bone processes are distinguished. The body of the upper jaw is a hollow bone with a large airy 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 fuses with the frontal bone and is involved in the formation of the nasal cavity;
• palatine process, which is involved in the formation of the hard palate ( bony plate that separates 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 fuses with the zygomatic bone.

Intrauterine development of the face

The embryonic tubercles involved in the intrauterine development of the face are:

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

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

The maxillary tubercles, unlike the mandibular ones, do not reach the midline. 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 growth and convergence of the embryonic tubercles, crevices are formed between their processes.

Embryonic clefts are:

• median cleft, which is formed at the point of convergence of the maxillary or mandibular tubercles;
• transverse cleft, which is formed by the maxillary and mandibular tubercles;
• oblique and lateral cleft lip, formed at the site of convergence of the nasal process of the frontal tubercle and the processes of the maxillary tubercles.

Reasons for the formation of a defect

The reasons for the formation of a defect are:

• endogenous factors;
• adverse environmental conditions;
• the influence of radiation;
• fetal intoxication with chemicals;
• lack of vitamins;
• wrong way of life of the mother;
• taking medications;
• infectious diseases of a pregnant woman;
• other external factors.

Endogenous factors

Endogenous causes of cleft lip formation are:

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

Heredity
This pathology is often formed in children whose parents or other family members had a similar defect. According to statistics, if one of the parents was born with a cleft 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 arise as a result of the influence of internal and external factors, as a result of which various mutations occur at the genetic level. According to a discovery made in 1991, cleft lip develops due to a mutation in the TBX-22 gene.

Factors that can provoke an anomaly of this gene are called mutagens. By nature of origin, mutagens can be physical, chemical or biological. The most significant physical mutagen is ionizing radiation. Chemical mutagens are chemicals that cause changes primarily in the structure of DNA ( a molecule that provides storage and transmission of genetic information). Biological mutagens include various microorganisms that enter the body and cause mutations.

Age of parents
Experts define parental age, which exceeds 40 years, as one of the reasons for the formation of a cleft lip in a child. The age of the mother is of the greatest importance.

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 a male sperm and a female egg. Both male and female defective germ cells can cause the formation of a split lip.

The reasons for the inferiority of germ cells are:

• "overripe" ( an increase in the period from ovulation to the fusion of the sperm with the egg);
• addiction to alcohol;
• unfavorable environmental conditions.

Unfavorable environmental conditions

Negative environmental factors include:

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

Sources of pollution are:

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

One source of pollution that has grown in importance in recent years is motor vehicles. Car exhaust gases contain a large amount of toxic compounds that have a negative impact on the development of the fetus.

Electromagnetic radiation
An expectant mother can be exposed to electromagnetic radiation both at work and at home.

Sources of electromagnetic radiation are:

• personal computer, laptop, tablet;
• electronic books;
• Cell phones;
• devices for copying documents;
• scanners and printers;
• devices for destruction of documents;
• microwaves;
• refrigerators;
• TVs.

Radiation

Natural radionuclides are divided into terrestrial and space. A pregnant woman can be exposed to strong cosmic radiation during an airplane flight. Terrestrial radionuclides are located in the earth's crust, of which radon is the most significant. It is possible to prevent the penetration of this substance into the body using a special radiometer device.

Artificial sources of radiation are used in energy production, the creation of nuclear weapons, and the manufacture of some consumer goods. Staying close to these radiation factors, the expectant mother puts herself at risk of giving birth to a child with a cleft lip.
A large number of radiation sources are used in modern medicine.

Medical sources of radiation include:

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

Fetal chemical poisoning

Other teratogenic poisons are:

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

Vitamin deficiency

Wrong way of life

Infectious diseases

Diseases that can cause this anomaly are:

• cytomegaly;
• coxsackie virus;
• smallpox.

Medications

High risk funds are:

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

External factors

Hypoxia can cause congenital cleft lip ( oxygen starvation) fetus. Due to the insufficient amount of oxygen in the fetus, the metabolism is disturbed, which causes various pathologies in the formation of tissues. Hypoxia can be caused by diseases of the cardiovascular system, blood diseases, severe toxicosis. In some cases, a lack of oxygen provokes a predisposition to miscarriage, pathological processes in the uterus.

What does a cleft lip look like?

Unilateral cleft lip

Unilateral cleft lip can be hidden or open. An open defect is characterized by the absence of all layers of the upper lip. The cleft in this case is through, and through it the nasal cavity and the intermaxillary process are visible. With a hidden cleft of the upper lip, some of the tissues remain intact. In this case, the bone base undergoes splitting ( maxillary process) and the muscles of the lips, and the skin of the lips and their mucous membrane remains intact. Visually, such a defect is not immediately recognized, since the skin and mucous cover the cleft lip.

Bilateral cleft lip

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

Other manifestations of cleft lip

The main manifestations of cheiloschisis are:

• sucking and swallowing disorders;
• violations of the dentition;
• chewing disorders;
• speech disorders;
• other anomalies in the development of the maxillofacial apparatus.

Dentition disorders
Due to the split of the upper jaw with a cleft lip, the process of tooth growth is disrupted. Dentition disorders can be characterized by missing teeth, an incorrect growth angle, or the presence of additional teeth. The teeth of children born with a cleft lip are prone to caries and decay quickly. Sometimes, even after defect plasty, such children have malocclusion, which further requires the intervention of an orthodontist.

Chewing disorders
Violations of the chewing processes 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. Most often, a violation of the chewing process occurs due to improper bite and deformation of the teeth. Incorrect chewing also contributes to the weakness of the muscles of the pharynx and palate, which is observed with a bilateral cleft lip in conjunction with a cleft palate.

Speech disorders
Due to the violation of the integrity of the upper jaw in children, the process of formation of sounds is disrupted. This manifests itself in the development of rhinolalia. With this defect in sound pronunciation, speech acquires a pronounced nasal tone, sounds become fuzzy.

Other developmental anomalies of the maxillofacial apparatus
Most often, the cleft lip is combined with such an anomaly of development as the cleft palate. In this case, the gap cuts not only the lip, but also the upper palate. Disorders of sound pronunciation, breathing and nutrition in this case are expressed as much as possible. The defect affects not only the bone structures, but also the muscle aponeurosis ( tendon plates). Weakness and dysfunction of the muscular apparatus 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, since less oxygen enters the body. All this leads to physical underdevelopment of children. It should be immediately noted that such an unfavorable outcome is observed in cases where surgical correction of the defect is not timely resorted to.

Similarly, a cleft lip can be combined with anomalies in the development of the nose, face, and malformations of internal organs. Cleft lip is also found in the pattern of Patau syndrome. This is a chromosomal disorder characterized by the presence of an extra thirteenth chromosome. With this syndrome, multiple anomalies in the development of internal organs are noted, for example, defects in the interatrial septa and blood vessels. In children with Patau's syndrome, in addition to malformations of the internal organs, there are also multiple external anomalies. For example, narrowing of the palpebral fissure, deformation of the auricles, as well as non-closure of the upper lip ( cleft lip) and upper sky ( cleft palate).

Surgical repair of the defect

At what age is it better to have surgery?

If the defect is expressed as a bilateral cleft, the operation is not possible in the first weeks of birth and is postponed until the child reaches six months. If necessary, repeated operations are carried out after a few months.
If the damage is deep, soft tissue correction is performed at an early age. Correction of bone and cartilage structures is prescribed for a period of 4-6 years. The final surgical correction of the jaw and nose is best done after 16 years of age, when the growth of the facial bones stops.

Defect repair technique

Preparing for the operation
Any type of operation is preceded by a number of preparatory procedures. The surgeon explains to the parents the principle of the chosen technique, 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 plastic surgery, patients should not take drugs that contain acetylsalicylic acid and various anticoagulants. In some cases, surgical treatment involves some additional manipulations. These can be special dental splints or molded dental linings.

The number of operations and types of plastics in the treatment of cleft lip
The optimal method of plastic surgery of the split lip and the number of required operations are determined by the surgeon. The doctor takes note of the nature of the defect and the general condition of the patient.

Factors that a plastic surgeon takes into account are:

• type of cleft - can be complete or partial;
• type of damage to the lip - meaning one-sided or two-sided cleft;
• the presence of concomitant defects on the face - the presence of a cleft palate or nose defects requires complex surgical intervention;
• the age of the child, his weight, features of physical development;
• the possibility of deterioration after surgery.

Types of plastic surgery for cleft lip are:

• cheiloplasty- performed with a cleft lip;
• rhinocheiloplasty- is prescribed when not only the correction of the lips is necessary, but also the correction of the muscles of the oral cavity and the cartilaginous tissue of the nose;
• rhinocheilognatoplasty- is used for severe pathologies of the facial skeleton with a violation of the structure of the alveolar process ( bone to which teeth are attached).

The incision methods are

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

Rhinocheiloplasty
This type of plastic involves the simultaneous correction of the upper lip and nasal septum. Such operations can be carried out both independently and as part of a complex surgical treatment. Distinguish between primary and secondary rhinocheiloplasty. The goal of primary rhinocheiloplasty is to eliminate the incorrect position of the nasal cartilage and restore the anatomical integrity of the lip.

Secondary rhinocheiloplasty is performed in cases where, after the first operation, various deformities develop immediately or over time.

Indications for secondary rhinocheiloplasty are:

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

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

The goals of rhinocheilognatoplasty are:

• elimination of deformation of the anterior jaw;
• improving the shape of the upper lip;
• nose deformity correction.

This operation can be performed in conjunction with cheiloplasty or after it. Rhinocheilognatoplasty is recommended for patients in cases where a cleft lip is combined with a cleft palate. During the surgical intervention, mucosal flaps are exfoliated on both sides of the gap, which are used to correct the nasal opening in the zone of splitting of the alveolar process. To restore the integrity of the jaw, a transplant of the periosteum removed from the anterior surface of the leg is used. The wound is sutured by moving fragments cut from the upper lip.
After rhinocheilognatoplasty, orthodontic treatment is indicated after 3 months.

Under what kind of anesthesia is the operation performed?

Local anesthesia
Local anesthesia is used in cases where patients with incomplete and shallow clefts are operated on. Anesthesia is carried out by the method of infiltration anesthesia ( frosts) by injecting a solution of novocaine or trimecaine.

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

The stages of general anesthesia are:

• premedication;
• induction ( induction into anesthesia);
• introduction of the main anesthetic;
• intubation ( lung ventilation);
• exit from anesthesia.

Intubation is carried out using a tube that is inserted into the airways and connected to a special device. Intubation ensures that the patient breathes normally during the operation.
During the operation, the anesthesiologist controls the supply 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, respiration and cardiac activity.

At the end of the operation, the anesthesiologist stops the drug supply and ensures that the patient regains spontaneous breathing. After that, the tube is removed from the respiratory tract.
The child stays in the intensive care unit for 2-3 hours after the operation, where he is observed by a doctor.

The duration of rehabilitation after surgery

The stages of rehabilitation are:

• stationary;
• polyclinic;
• restorative.

The objectives of drug therapy are:

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

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

Restorative rehabilitation
The task of this stage is to restore all body functions and return 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 by these specialists is necessary in order to prevent malocclusion, defects in the formation of the dentition, speech problems.

This period lasts at least a year. Only after 12 months, the doctor can make a conclusion about how successful the operation was 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 the surgical treatment of the cleft lip is the divergence of the edges of the wound. This can happen due to mistakes made during the intervention, the development of the inflammatory process in the wound, the injury received by the patient after the operation. As a postoperative complication, shallow scars in the vestibule of the mouth are considered. Over time, exerting pressure on the alveolar process, scars cause deformation of the upper jaw. In addition, such a defect does not allow subsequent treatment by an orthodontist.

Other complications after surgery are:

• facial deformity;
• narrowing of the nasal opening;
• deformation of the wings of the nose;
• speech disorder.

To receive disability compensation, the child must pass an examination. To do this, the parent must apply to the social security authorities. The child is removed from the disability register only after the end of the rehabilitation period. Rehabilitation methods should be focused not only on the plasticity of the defect, but also on the correction of concomitant disorders. These are, 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 severe, irreparable violations, then the group remains for life.

Plastic results

How to feed a newborn with a cleft lip?

Deep, penetrating defects of the upper lip require the use of special nipples, which differ in shape from the usual ones. This is due to the fact that such volumetric clefts 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 teats from NUK and Avent. Such nipples are put on a bottle ( the same or another company), where breast milk is previously expressed. It is recommended to move the nipple 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 be made larger. This can be done by the mother herself with the help of ordinary scissors.

If the cleft of the upper lip also affects the palate, then special nozzles are used. These nozzles look like inserts that are placed in the child's mouth, thus closing the defect. With massive through crevices, when the defect is too voluminous, and the sucking and swallowing reflex is impaired, they switch to feeding through a tube.

It is very important to continue breastfeeding and not switch to artificial formulas, unless, of course, the child has concomitant metabolic pathologies ( e.g. lactase deficiency). It is necessary to do this, because children born with a cleft lip are prone to frequent colds. Mother's milk contains all the necessary substances to strengthen the immune system.

Why are babies born with cleft lip?

Heredity
Numerous studies among close relatives have shown that the risk of developing a cleft lip is highest in 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 studies, the likelihood of a child developing a cleft lip reaches 4-5 percent if one of the parents suffered from a similar pathology. The percentage of risk doubles if both parents had a cleft lip.

Environmental factors
At the same time, some children with a cleft lip do not have relatives with a similar anomaly. This suggests the involvement of external factors in the development of the cleft lip. Today, it is a generally accepted fact that the bad habits of the mother play a decisive role in the development of this anomaly. Women who smoke have been shown to have a 6 to 7 times higher risk of having a child with a cleft lip than non-smokers. If a woman abused alcohol during pregnancy, then the risk to the child will be more than 10 percent.

External factors such as infections during pregnancy or the use of medications 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 had one of these infections during the first trimester of pregnancy, the risk of developing cleft lip in the fetus ( even if the mother does not smoke or abuse alcohol) increases several times.

Another factor that increases the risk of developing cleft lip is medication. Antidepressants have the highest risk ( fluoxetine), anticonvulsants ( phenytoin), cytostatic drugs ( methotrexate). Even if the mother took the listed medications before pregnancy, they can still have a negative effect on the fetus. This is due to the long-term excretion 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 cleft lip is observed with the simultaneous impact of several causes.

Is cleft lip hereditary?

If a couple has 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, there is no 100% risk of inheriting cleft lip. 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 all the factors that provoke the formation of a defect are taken into account. It is necessary to undergo examinations for the presence of chronic infections, take the necessary trace elements ( e.g. folic acid) even during pregnancy planning, as well as to exclude smoking and drinking alcohol during the period of expectation of the child.

What does a cleft lip look like after surgery?

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

With deep defects, when the dissection of the lip reaches the wings of the nose, a nose plastic surgery is also performed. In this case, flaps of mucous tissue are exfoliated on both sides of the gap, which go to the plastic of the nasal opening in the zone of splitting of the alveolar process. The extent of the scar after that depends on the professionalism of the surgeon and the quality of the rehabilitation period. As a rule, if there are no complications, the scars look like thin, thread-like strips that are almost invisible.

It should be noted that today, thanks to modern technologies, it is possible to eliminate scars ( or make them less visible) of any size.

Is the cleft lip visible on ultrasound?

It is important to note that the first scheduled ultrasound examination during pregnancy is carried out somewhat earlier ( from 12 to 14 weeks). Therefore, it is impossible to see the formed defect during this period. However, even subsequently, ultrasound diagnostics is not 100% correct. This is explained by a large percentage of errors, since the images on the screen are interpreted by different specialists in different ways. Proof of this is the fact that only 5 to 10 percent of anomalies are detected during fetal development. Basically, parents learn about this defect after childbirth.

When is cleft lip surgery necessary?

Contraindications for surgery in the first year of life are:

• prematurity of the child and its low weight;
• diseases of the cardiovascular system;
• breathing problems;
• associated birth defects.

It happens that the cleft lip requires a multi-stage surgical intervention. This happens when it is combined with the cleft palate and other facial defects. In this case, the timing of the surgical intervention is extended. Given this, you need 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 prescribed for a period of 4-6 years. The final surgical correction of the jaw and nose is best done after 16 years of age, when the growth of the facial bones stops.

At the end of the first month of pregnancy, the baby's mouth is formed from two separate halves that grow next to each other. Somewhere between the sixth and eighth weeks, they fuse together to form the upper jaw. Next, the seam runs back and forth to seal the lips with the tongue. By the tenth week of pregnancy, the mouth is fully formed, and the nose has acquired a familiar structure and position.

It is a congenital defect in which the upper lip of the child is completely formed and has a hole. - a similar congenital anomaly in which the palate of the unborn child is not fully formed, but has a hole. Some children with cleft lip have only a small notch in the upper lip. Others have a full open opening that runs through the upper jaw to the bottom of the nose. The anomaly may appear on one or both sides of the child's mouth. This birth defect is called an oral cleft, or cleft lip. In children, the causes of its occurrence are still unknown.

Defects and conditions for their development vary in severity and degree with variations:

• Cleft lip (lip defect).
• Cleft palate (palate defect).
• Cleft lip and palate (both defects).
• A microform of a cleft (crack or scar).
• Unilateral cleft (one side of the lip and palate).
• Bilateral cleft (both sides of the lip and palate).

Cleft lip and cleft palate: causes

The causes of cleft lip, cleft palate, and other facial abnormalities are not well understood, but they are directly related to changes in the child's genes. It is believed that 25% of cases are due to heredity, up to 15% are chromosomal abnormalities and 60% are external causes of the birth of children with a cleft lip. The tendency to deformity may be inherited from one or both parents. The potential for developing the disease increases when it occurs with close members of the same family.

Other factors that can affect genes leading to splitting are viruses, certain medications, diet, and environmental toxins. Recent studies have identified smoking and drug use as risk factors for the development of cleft lip and palate, as well as other birth defects. In addition, the presence of diabetes significantly increases the risk of giving birth to a child with a cleft lip or without a palate. Drug use and intoxication of the body can also cause these birth defects. Cleft lip and palate can occur along with other congenital anomalies. This can lead to a number of difficulties in daily life. It is not uncommon for babies to be born with a cleft lip or palate if their relatives have had the condition or have a history of other birth defects.

Genetics and heredity

To this day, the true causes of cleft palate and lip development are unknown, but doctors believe the defects are due to genetic and environmental factors. Genetics may play a role in the development of a disease such as cleft lip. Causes of occurrence can combine several factors. If one or both parents had this deviation, this significantly increases the manifestation of the anomaly in the child. Your lifestyle during pregnancy can also make your baby more likely to develop an abnormality.

So, why does a disease such as cleft lip develop? Photos, causes and methods of treatment will help to learn more about this pathology.

• Exposure to phenytoin or drug use during pregnancy increases the risk of developing an anomaly by 10 times or more.
• Smoking during pregnancy increases the chance of developing a defect by 2 times.
• Use of alcohol, anticonvulsant drugs, or retinoic acid has been linked to birth defects, which include cleft lip and palate
• During pregnancy, vitamin deficiency, and especially folic acid deficiency, can also cause the development of a craniofacial anomaly.

There are many factors that worry about the cleft lip of children. The reasons, photos of this disease make it clear the seriousness of the situation. A cleft palate can develop as an isolated birth defect or as part of a larger genetic syndrome that can lead to more severe malformations.

Environment

During pregnancy, what a mother eats and drinks is critical to the development of her unborn child. Vitamins and nutrients enter the growing body through the mother's blood. But between a woman and her unborn baby there is a strong protective shell called the placenta. It does not allow some toxic substances to pass through and reliably protects the child in the womb. While the placenta is really good at filtering out toxins, other dangerous chemicals can pass through this barrier and enter the fetal blood stream.

Cleft lip disease has a genetic cause, so during pregnancy, you need to carefully monitor your health.

Toxic Substances

Harmful substances, such as pesticides and mercury, can enter through the blood to the child, thereby causing serious developmental disorders. In 2004, a special environmental working group studied ten newborns. The researchers found, on average, about 200 types of industrial chemicals and pollutants. 180 of these compounds are known carcinogens.
There is a theory that the human body system was formed long before the development of most harmful chemicals. Our body is simply not able to recognize and neutralize such elements.

In any case, the health community is convinced that some of these chemicals contribute to the development of birth defects. Foreign scientists have found that certain sections of genes in chromosomes 1, 2, 3, 8, 13 and 15 are associated with the formation of a cleft palate and lip. This study has taken an important step to better understand the causes of diseases, genetic and environmental.

What can be done to prevent an anomaly?

Some researchers suggest that taking folic acid during pregnancy may reduce the chances of the baby developing these abnormalities. This substance is found in most multivitamins. Folic acid is known to actually reduce the risk of another unrelated birth defect.

What chemicals can affect the development of the defect?

Finding out which substances lead to the diagnosis is a rather difficult task.
The occurrence of such a defect as a cleft lip has different reasons, but basically it is a combination of genetic factors and environmental toxins. Genes may start to develop incorrectly, but they need a little push from the outside world.

Medicines that, according to experts, can cause clefts:

• which increase or decrease blood pressure ("Pseudoephedrine" and "Aspirin").
• Antiepileptic drugs such as carbamazepine and phenytoin. Some researchers believe that the cause is actually epilepsy itself, not the drugs used to treat it.
• "Isotretinoin", or "Accutane" - a medical drug taken to treat severe manifestations of acne (acne). Do not take Accutane while pregnant. You should not plan pregnancy during the entire course of using the drug and within a month after.
• Corticosteroids such as Hydrocortisone and Cortisone. The use of these drugs during pregnancy can lead to a diagnosis of cleft lip. Causes can also serve as risk factors for pregnancy.

There are several complications that can affect infants and children with cleft lip or palate.

Feeding problems

Due to the anatomical defect, the process of breastfeeding can be quite difficult for newborns. Abnormal separation of the upper lip makes feeding uncomfortable. With such an anomaly, it is impossible to obtain a good compaction, which is necessary for the successful flow of the process. Conventional bottle-feeding nipples present the same problem. However, there are specialized utensils that contribute to efficient nutrition.

Children with a cleft palate are usually fitted with a removable artificial palate from early in life. This device limits the ability of liquids to enter the nostrils and also facilitates the ability to suck from specialized nipples.

Ear infections or partial hearing loss

Children with cleft palate most often have ear infections and associated fluid buildup in the inside of the eardrum. To limit these problems, most children with cleft palate have AEDs (tubes) passed through the eardrum during the first months of life.

Speech problems

As would be expected, developmental anomalies associated with the palate and lip can affect articulation. The most common problem is usually voice quality. Corrective surgeries can help reduce these speech problems, but most children with cleft lip or palate benefit from speech therapy with the help of a speech therapist.

dental problems

Children with cleft lip or palate often have problems with missing or distorted teeth and usually require orthodontic treatment. If the upper jaw has dysfunction, such as improper placement and positioning of the permanent teeth, then the situation calls for maxillofacial surgery.

Treatment of cleft lip and cleft palate

Doctors can now diagnose an anomaly based on ultrasound readings as early as 18 weeks pregnant. Diagnosing a cleft palate is more difficult because it is hidden inside the mouth. Once diagnosed, doctors may perform a procedure in which the amniotic fluid is removed to be tested for a genetic syndrome. In order to identify the cleft at an early stage and formulate the correct therapy, as a rule, an extensive team of specialists is required.

Surgery

Correction of the cleft by surgery usually occurs after the 7th week of a newborn's life. This type of surgery is referred to as plastic surgery. If the child's nose is affected by changes due to this defect, then rhinoplasty may be necessary. Babies born with cleft lip usually need ongoing therapy with many specialized procedures to achieve full recovery.

Cleft lip in newborns is a congenital pathology, which 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, since only about 0.04% of children are born with it. Pathology delivers not only aesthetic, but also physical discomfort. Because of 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.

The reasons

Many are concerned about the question of why children are born with this pathology. After all, if we exclude the causes that lead to the formation of a defect, then it will not develop in a 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;
• ailments of a viral nature that the mother suffered in the first three months of pregnancy;
• genetic factor. Many scientists believe that the cleft lip is the result of a mutation that occurred at the gene level;
• complications during childbearing. This group includes STDs, chronic ailments 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 cleft lip to be born in 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 ecology;
• smoking and alcohol consumption.

Kinds

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

• one-sided and two-sided;
• isolated;
• full cleft lip;
• partial;
• defect on one lip;
• light form;
• heavy 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 at the eighth week of intrauterine development. It is during this period that the laying of the maxillofacial organs begins in children.

In infants, the processes of swallowing and sucking are disturbed. The child cannot fully eat. If the defect reaches a large size, then in this case, feeding is performed through a nasogastric tube.

The following symptoms are also observed:

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

All these unpleasant symptoms can be eliminated only 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 by means of. This is the most informative method. The presence of a cleft lip is not an indication for termination of pregnancy.

Treatment

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

Cleft lip treatment 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 the lip, which was split. This method of treatment is allowed to 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- This is a surgical method of treatment, which 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 the underdevelopment of the jaw, defects in the cartilaginous tissues of the nose. Successful surgical intervention allows you to form a full-fledged frame of muscles.

Contraindications

Surgical treatment (plastic surgery) cannot be performed if:

• birth trauma;
• ailments of an infectious nature;
• malformations of various vital organs.

Such surgical manipulations are quite complex, so only a highly qualified surgeon should carry them out.

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Spastic diplegia (Little's syndrome) is one of the most common forms of cerebral palsy, in which there is a complete violation of the muscular functioning of the lower and upper extremities. In this case, we are talking about the defeat is not unilateral, but bilateral.

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

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

An adenoma formed on the thyroid gland is a benign neoplasm with clear edges, which has a fibrous capsule. Such a tumor is not soldered to the surrounding tissues, has a small 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 is growing rapidly, its immediate removal is indicated. The operation consists in excising the neoplasm together 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 (mainly an artery, more rarely a vein). Aortic aneurysm, the symptoms of which, as a rule, have little or no symptoms at all, occurs due to thinning and overstretching of the walls of the vessel. 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 birth defects concentrated in the area of ​​the vascular wall and others.

Cleft lip is a congenital malformation of tissues of the nasal cavity and upper jaw(when these tissues do not grow together to the end). Externally, the defect looks like a specific cleft of the upper lip.

Pathology is relatively rare, in about 0.04% of cases, and is more often diagnosed in boys. Often, against the background of a cleft lip, a newborn has another defect, which is a cleft in the sky ().

Prerequisites for the development of the disease can be observed even in the prenatal period with the help of ultrasound. Correction of the defect in children is carried out only by surgery. We will talk about the causes of cleft lip in the article.

How is brachydactyly of the limbs inherited in a child? Learn about it from ours.

Characteristics of the pathology

Hare lip in a child - photo:

Hare lip is called congenital defect of the bones of the maxillofacial system, which manifests itself in the form of a cleft on the upper lip. The cleft can be of various sizes, most often through it you can see the oral cavity.

In some cases, the depth of the cleft is quite significant, it can reach the nasal cavity.

The defect may be unilateral(the cleft is formed on the right or left side), or bilateral(appears immediately from 2 sides), in most cases there is a cleft that occurs in the middle of the upper lip.

Reasons for the development of a defect

Why are people born with a cleft lip? The formation of the maxillofacial system is influenced by many factors. The development of a defect can lead to such unfavorable causes how:

Differences from the wolf's mouth

Cleft lip is often accompanied by other malformations of the maxillofacial apparatus. The most common cases are when, against the background of a cleft lip, a child's palate is also observed - more serious problem, provoking serious problems with breathing, swallowing, speech.

The differences between these two ailments are in the location of the defect.

So, with a cleft lip, the soft tissues of the maxillofacial system are involved in the pathological process, in some cases, the bone tissue of the upper jaw.

The wolf's mouth is a cleft located in the area between nasal cavity and palate.

Classification

The cleft lip can be unilateral or bilateral. Depending on the depth of the cleft, they distinguish several subspecies this disease:

Symptoms and clinical manifestations

Pathology has a pronounced clinical picture, symptoms that can be seen with the naked eye. So, outwardly, the pathology manifests itself in the form of:

Why is the disease dangerous?

The defect, in addition to aesthetic problems, is accompanied by such phenomena as:

1. Difficulty swallowing.
2. Dentition disorders. If the problem is not eliminated before the moment when the first teeth begin to erupt in the baby, this can lead to the absence of some teeth, or, conversely, to the appearance of extra ones.

Over time, the child's bite is disturbed, and this is fraught with problems such as impaired digestion of food (since the child cannot chew it well), a tendency to caries.

3. Speech disorder. The child cannot pronounce certain sounds correctly, and his voice becomes nasal.
4. Hearing disorders possibility of otitis media.
5. Difficulties in adaptation. The child experiences psychological problems associated with his appearance.

Diagnostics

It is not difficult to make a diagnosis after the birth of a child, for this it is enough visual inspection newborn.

In this case, the child will also need to consult an ENT doctor.

This is necessary in order to determine if there are any other problems (eg, cleft palate, abnormalities in the structure of the nasal cavity).

You can recognize the signs of a cleft lip even in the intrauterine period. This can be done with an ultrasound as early as the 14th week of pregnancy. However, in order to finally confirm the diagnosis, it will be necessary to assemble a medical consultation.

This is very important, since this pathology is the basis for termination of pregnancy.

Of course, the decision in this case is made only by the woman herself, but at the legislative level abortions at this time in the presence of pathology are allowed(in normal cases, artificial termination of pregnancy is prohibited after 12 weeks).

Treatment and correction

The defect can only be repaired by surgery. The operation is desirable until the child reaches the age of six months(or until the moment when the baby's teeth began to erupt).

Various types of surgical operations are used, the choice of one or another depends on the severity of the pathology, its variety, the presence or absence of other defects.

Indications and contraindications

Surgery is not possible in case if:

• the child is underweight for his age;
• there are diseases of the heart and circulatory system;
• there are respiratory disorders;
• there are problems in the work of vital organs (organs of the gastrointestinal tract, endocrine, nervous system);
• if present, neonatal jaundice;
• The child was severely injured during childbirth.

In all other cases, a small patient is prescribed planned surgical operation.

How does autism manifest itself in a child? find out right now.

Varieties of corrective methods

Depending on the severity of the defect, one of the types of surgical intervention is prescribed:

Recovery period and care

After the operation, the child needs a long rehabilitation period, which is carried out in 3 stages:

Is it possible to prevent the development of the disease?

You can reduce the risk of developing a cleft lip in a child, for this you must follow the following rules:

Cleft lip is a serious disease that is not only a cosmetic defect. Pathology is often accompanied by serious health problems.

It develops as a result of exposure to adverse factors, among which the intrauterine development of the child is of decisive importance. The disease is treated only by surgery.

On the correction of facial asymmetry in newborns, you will find on our website.

You can learn about the causes and methods of correcting pathology from the video:

We kindly ask you not to self-medicate. Sign up to see a doctor!

Cheiloschisis or cleft lip is a birth defect that occurs in 0.04% of newborns. But parents of such children should not panic. They learned to get rid of the problem many years ago surgically. Treatment methods are constantly being improved. And if a child at an early age is made surgery, cleft lip becomes almost invisible.

Read in this article

What is a hare (rabbit) lip, cleft lip

The cleft lip is a congenital defect, the essence of which is the nonunion of the tissues of the nasal cavity and upper jaw. The child undergoes changes in the intrauterine period of development, after birth there is not only external deformity, but also problems in nutrition and speech. At the same time, the general psychological, neurological and physical development of the baby remains within the normal range.

The second name of the defect is cheiloschisis, it is formed at the 8th week of pregnancy and is extremely rarely a single problem, often a cleft lip is a sign of a severe congenital syndrome.

Wolf mouth and cleft lip: similarities and differences

The cleft palate and cleft lip are birth defects that share similarities between characteristics, although they are different from each other.

Causes of cleft lip development in a newborn

The defect is formed during fetal development. There are several reasons for this:

• viral infections that the expectant mother suffered in the first trimester of pregnancy (herpes, rubella, toxoplasmosis);
• sexually transmitted diseases;
• chronic pathologies of a woman expecting a child;

• uncontrolled intake of medications;
• the impact of unfavorable environmental conditions (radiation, chemical exposure);
• genetic disorders;
• hereditary predisposition, which can be judged by cases of cheiloschisis in the family;
• bad habits of the mother (smoking, drugs, alcohol);
• age of the pregnant woman (more likely to have a problem if she is over 40 years old).

Can you get cleft lip from smoking?

Smoking is not the cause of cleft lip formation in adults, but during pregnancy this habit is one of the factors that increase the risk of having a child with a birth defect. The fact is that tobacco smoke, toxins entering the body of the mother and fetus, can cause a failure at the genetic level, and the splitting of one chromosome will lead to improper formation of the organs and systems of the fetus.

In general, a cleft lip cannot be an acquired pathology.

Cleft lip in newborns: causes and consequences

Causes of cleft lip formation in newborns:

The risk of having a child with a cleft lip increases if the mother is 40 or older. The consequences of such a defect for the child will be the following:

• Nutritional problems - the baby from birth will not be able to suck and swallow food normally. Most newborns are switched to nasal tube feeding until corrective surgery is performed.
• The bite is broken, the process of chewing and swallowing food becomes impossible. Older children may not be able to eat well.
• The dentition becomes uneven, often some teeth are missing or, conversely, extra ones grow. The problem is solved only by implantation or removal of unnecessary teeth.
• The respiratory system works in an enhanced, stressful mode. Children are prone to frequent colds and respiratory tract infections.

The consequences of external deformity should not be ruled out: only newborn children cannot evaluate their appearance, and at an older age, such a difference from other babies can cause depression, psycho-emotional disorders, and the development of multiple complexes.

Symptoms of a cleft lip

The defect begins to develop on the 8th week of pregnancy, has clear signs in the born child. Therefore, it is impossible not to notice it:

• A cleft is clearly visible on the upper lip. It may be in the form of a hole or an empty gap several centimeters long, exposing part of the gum.
• A pronounced defect can lead to deformation of the upper jaw and nose. The baby cannot suckle at the breast, it is necessary to feed him through a probe inserted into the passage of the respiratory organ.
• If nothing is done to fix the problem, the child develops an incorrect bite, teeth grow unevenly, some of them are missing or superfluous appear. There are speech problems.

See interesting and useful information about cleft lip in this video:

Types of defect

The problem may be different. There are the following types of cleft lip:

• Unilateral. The cleft is formed only from one side, more often the left.
• Bilateral. The defect exists on both sides of the middle of the lip. Clefts are formed symmetrical or asymmetrical.

According to the severity of the cleft lip can be:

• Complete. This means the presence of an empty gap in the tissues of the site, deformation of the nasal lobe and maxillary process. The fissure is deep. Sometimes the palatine bone and the upper jaw have a defect.
• incomplete or partial. This is a milder case of pathology, when there is a cleft only in the lip, but the closely located areas are formed normally. Instead of an oblong hole in the soft tissues, there may be only a noticeable dent.

The defect is evaluated according to both criteria. Unilateral cleft lip may be complete or partial. The same with a bilateral defect.

Sometimes the problem is hidden. This means that there is an abnormal gap in the muscles, and the skin and mucous membranes are intact. The defect is more often formed on one lip (upper), but it happens on both.

Types of cleft palate and lips

The splitting of the palate and lips may differ in the localization of the defect:

• cleft lip - most often diagnosed;
• pathology formed on the lower lip is extremely rare.

Also, there is a complete and partial violation of the formation of jaw bones.

Unilateral cleft lip

If non-union of the processes of the nose and upper jaw is diagnosed, then a unilateral cleft of the upper lip is confirmed. The depth of the gap can vary, but it is always located on only one side of the nasal wings.

Such a defect is considered more “soft”, non-critical. It can be easily corrected; after the operation, a barely noticeable scar remains on the face.

Bilateral cleft lip

If a deep gap goes from the upper lip to the nose, covering the space on both sides of its wings, then a bilateral cleft is diagnosed. The pathology is more serious, because a series of surgical interventions and mandatory plastic surgery in the future may be required for correction.

The severity of the defect can be different - in some cases, a gap is formed only in soft tissues, often there is non-union of the bones of the upper jaw, palate.

Is the cleft lip visible on ultrasound

On ultrasound, the cleft lip can be seen and diagnosed, but often the fixation of such a pathology occurs after the birth of the child. Erroneous results of the study can be provoked by insufficiently modern equipment, lack of experience with the doctor, and the incorrect position of the fetus in the uterus.

Often, a defect is noticed already at 20-23 weeks of pregnancy, which allows parents to mentally prepare for the birth of a special baby and collect all available information about the pathology and ways to solve the problem.

Celebrities in trouble

Cleft lip after surgery may look almost the same as in completely healthy people. Examples of this are in the appearance of famous people:

• Hollywood actor Joaquin Phoenix;
• famous and beloved by the Russian audience "Musketeer" Mikhail Boyarsky;
• TV presenter.

The birth defect was so successfully eliminated that its very former presence in these people remains controversial. Only slight traces suggest that it existed. And nothing prevented these people from becoming successful in professions where appearance is of great importance.

famous people with cleft lip

A cleft lip is a frequently diagnosed pathology, many famous people were born with a similar defect, but it was successfully corrected and did not prevent them from succeeding in life, reaching certain financial heights. Here are just some of the celebrities with a history of cleft lip:

• Mikhail Boyarsky - it is believed that the artist, with his “branded” mustache, masks the scar from the operation on the cleft lip. Boyarsky himself does not give any information on this matter, so the veracity of the fact cannot be verified.
• Denis Dorokhov - KVNschik, artist, participant in the Once Upon a Time in Russia program. He does not hide the scar from the operation and confirms the fact of birth with a cleft lip. However, this did not prevent him from becoming a famous and financially independent person.
• Tom Burke - was operated on for a cleft lip as a child, which did not affect his appearance and mental abilities. At least he did not lose his talent, but was able to gain fame as an actor popular among women.

Is it possible to treat cleft lip without surgery?

Treatment of a cleft lip is carried out only by surgery. Without surgery, the child begins to have serious problems:

• he cannot fully eat;
• his speech is disturbed - it becomes "nasal", many sounds are incomprehensible to others;
• if the bones of the nose and upper palate are damaged, breathing problems occur;
• frequent respiratory tract infections are diagnosed;
• teeth grow unevenly, many are missing, extra ones may appear.

At the same time, the mental and physical development of the patient remains within the normal range, but his psycho-emotional state suffers. At an older age (adolescence), external deformity and health problems provoke prolonged depression and suicide.

Ways to get rid of the upper lip

The only method that is able to eliminate the defect is surgery. But the intervention can be carried out in different ways. The choice depends on the characteristics of the defect:

• Cheiloplasty corrects only the lip. Therefore, it is used for an incomplete defect.
• Rhinocheiloplasty involves the correction of the deformed area of ​​the nose, and lips, as well as muscles. Here the result should be not only the return of attractiveness to the face, but also the possibility of performing the functions of organs.
• Rhinocheilognatoplasty corrects deeper defects affecting bone tissue, cartilage, and mucous membranes. It involves the correction of the palate, nasal passages, jaw, muscles, lips.

Ideal age to see a doctor

If diagnosed cleft lip, plastic surgery should not be delayed. Usually the first intervention is carried out when the child is 4-6 months old. This should be done earlier, in the first weeks of life, if the disturbances are deep. In severe cases, the child is deprived of the opportunity to eat normally, which can affect other aspects of his development.The timing of the operation depends on the type of defect.

There may be several interventions if the case is complex. They are made at intervals of time, sometimes reaching several years.

Preparing for the operation

The preliminary stage before surgical correction is very important, because it will be done to a small child. Therefore, the main thing in the preparation is an examination consisting of general clinical tests (blood and urine, biochemistry, coagulation). They also do an EKG and a chest x-ray. A mandatory study is a CT or MRI of the problem area, an examination by an otorhinolaryngologist, a dentist, and immediately before the operation by an anesthesiologist.

Another important analysis is the karyotype. This is a study that establishes the presence or absence of chromosomal abnormalities.

2 weeks before the operation, the patient is stopped taking blood-thinning drugs. At an earlier stage of preparation, parents should ensure that the child develops normally physically and gains weight.

Execution Method

Cleft lip surgeryperformed under general anesthesia. The actions of the surgeon differ for different types and degrees of development of the defect:

• Sometimes it is enough to restore the integrity of the tissues of the lip. This is done in a linear way or by inserting a triangular or quadrangular flap into the gap.
• In more complex cases, the integrity of the nasal passages is corrected by correcting the position of the cartilage. The cleft lip is then removed.
• With extensive shortcomings, the condition of the jaw is first corrected with a transplant from one's own tissues, defects in the nasal cartilage. Then the lip is corrected.

If the cleft is incomplete, local anesthesia may also be used. The duration of the operation depends on its complexity.

Recovery period

Rehabilitation is complicated by the fact that the patient is small. But doctors and parents are doing everything so that there are no problems during this period:

• tampons are placed in the nasal passages immediately after the operation;
• then they are replaced with plastic devices to prevent narrowing of the holes;
• the seams are treated with antiseptics, after 7-10 days they are removed;
• in case of serious intervention, a frame is put on to protect the operated tissues from injury;
• limit hand movements to keep the seams intact;
• regularly show the baby to doctors.

Number of operations for correction

With an incomplete defect, a small cleft lip, a single surgical intervention is sufficient. And if the second is carried out, then it is purely cosmetic, in order to make the scar invisible.

If the problem affects many tissues, part of the nose, jaw, it is necessary to do several operations. Re-correction is carried out after 3 months in difficult cases.

Rhinocheiloplasty

It is possible that the first operation to correct soft tissues is performed at the age of 6 months, and the defect of the part of the nose is removed at 3-6 years. The final intervention to eliminate the problems of the development of the jaw and the external respiratory organ is best done at 16 - 18. At this time, bone growth slows down, and it is possible to do everything more accurately.

Is it possible to operate for free

Cleft lip repair surgerywill cost the family free of charge if there is a medical policy and a quota. In this case, the costs fall on the budget of the region where the child lives.

But sometimes the quota has to wait a long time, and this can harm the health of the baby. Then you have to pay yourself 30,000 - 80,000 rubles. The exact amount depends on the extent of the defect and, accordingly, the scale of the operation. The level of the clinic and the qualification of the surgeon increase the cost.

Watch the video about cleft lip treatment options:

How much does cleft lip surgery cost?

The price of cleft lip correction surgery is quite high if we consider the work of private clinics:

• if it is necessary to correct only the labial fissure - 20-80 thousand rubles;
• if additional nose correction is required - 30-100 thousand rubles;
• if it is necessary to form a muscular frame after correction, in addition to the total cost, you will have to pay 30-40 thousand rubles.

The indicated cost includes all stages of surgical intervention, but does not take into account plastic surgery.

Features of life if a child was born with a cleft lip

If a child was born with a cleft lip, then the operation will be shown to him only after reaching a certain age. BUT care for him is necessary on a daily basis, and in this regard, doctors give the following recommendations:

nipple with cleft lip

If the child can suck, that is, his main reflex remains within the normal range, then you can use the nipple with a cleft lip. The dummy will perfectly hide a shallow cleft of the upper lip - this is important when walking, visiting public places (parents will not be embarrassed by others, they will not have to explain and tell everyone, catch interested looks).

Before the operation, it is imperative to wean the baby from the pacifier, because it will be painful for him to use it (due to stitches, inflamed tissues), and this will extend the rehabilitation period for an indefinite time (the constant irritation factor will work).

Features of feeding with cheiloschisis

What you need to know about feeding a child with cheiloschisis:

Practical and convenient when feeding children with the pathology under consideration will be special bottles with spoons already fixed on them or syringes with a nipple. Ordinary bottles can also be used, but with long silicone nipples - the mother herself will make a hole in them, calculating the speed of feeding into the baby's oral cavity.

Watch this video about the rules for feeding a child with a cleft lip and palate:

Preventive methods when planning pregnancy

In order for the fetus to develop normally, and the child does not have such a problem as cheiloschisis, the expectant mother needs:

• at the planning stage, be carefully examined for the detection of STIs, other dangerous viral and bacterial infections;
• to be treated for a chronic disease, if any, to prevent exacerbations during pregnancy;
• lead a healthy lifestyle, without tobacco, alcohol and drugs;
• consult with geneticists if there are cases of pathology in the family;
• protect yourself from any harmful effects of the environment (move to another city, if necessary);
• planning a pregnancy at a young age;
• even before it, bring the state of health to optimal indicators, that is, eat well, drink vitamins, move a lot;
• Do not take any medication without a doctor's recommendation.

Cleft lip plastic surgery It is not always just an aesthetic operation. In many cases, it returns the ability to eat normally, talk, feel their own usefulness and attractiveness. Modern surgery is able to get rid of the defect so qualitatively that 90% of patients do not remember it, and 10% have slight signs of its former presence.