Cleft palate (Palatoschisis)
Summary/Definition
A congenital cleft of the tissues of the hard and soft palate, known as a cleft palate or palatoschisis, is characterized by a communication between the oral and nasal cavities. In most cases, this condition can be detected immediately after birth, but in concealed (submucosal) clefts, the separation only involves the muscles and bones of the mucosa, making the cleft invisible. This can delay the diagnosis. Cleft lip is a condition that is most often detected during antenatal examinations, and it is common to see the simultaneous presence of both cleft palate and cleft lip in a newborn. Cleft palate can be differentiated into complete and incomplete clefts, as well as hidden (submucous) clefts. In the case of simultaneous cleft lip and palate, such a disease is divided into a complete cleft lip and palate and incomplete, depending on the direction and degree of non-union. These anomalies are formed during the intrauterine development of the fetus, when for some reason there is no fusion, and the child is born with a cleft palate. To date, the exact causes of this anomaly remain unclear, and it is thought that they may be related to both hereditary factors and environmental exposures, including the mother having health problems or taking certain medications. Hereditary factors may include chromosomal abnormalities in the fetus.
Symptoms
The main manifestation of cleft palate, which becomes apparent immediately after birth, is impaired swallowing and sucking. This can lead to milk coming out through the nose, which is dangerous for the baby’s normal breathing. It may also make it difficult for air to pass through the air passage that connects the middle ear and mouth. This can be accompanied by frequent inflammation due to dysfunction of the eustachian tube and other factors. If inflammation such as otitis media occurs frequently, it can lead to hearing loss in the child. Children with this abnormality may also have differences in tooth development compared to children without this abnormality, and the appearance of teeth may affect the contouring of the face as the child grows.
Diagnostics
Cleft palate can be confirmed visually during a physical examination after birth. Recently, there have also been cases where this condition has been diagnosed by prenatal ultrasound, but it is difficult to fully differentiate the condition. A submucosal cleft palate can be detected during the child’s growth by noticeable difficulty in swallowing food or when speech begins to develop. The earlier the necessary measures are taken, the more effective the treatment of cleft palate will be; therefore, the active involvement of the parents is crucial.
Treatment and course of the disease
The treatment of cleft palate includes surgery, speech therapy, prevention and treatment of otitis media, and orthodontic surgery. Surgical treatments for cleft palate include uranoplasty, bilateral uranoplasty, von Langenbeck palatal repair, etc. Uranoplasty is usually performed at around 10 to 12 months of age, with the child placed on its side or stomach to prevent possible restriction of breathing. Feeding the child is possible 4 hours after surgery. In some cases, children can be fed with a syringe or a spoon.
Complications
Complications of cleft palate include speech disorders including pronunciation disorders, difficulty eating, ear problems caused by eustachian tube dysfunction, and hearing and bite disorders. Bleeding or infection may occur at the surgical site after surgery, and fistula formation is common.
