Cleft palate is more common and can occur alone or in conjunction with cleft lip. Not only does cleft palate have soft tissue deformities, but most children with cleft palate may also have varying degrees of bone tissue defects and deformities. They have far more severe physical dysfunction in sucking, eating and speech than cleft lip. The jaw growth disorder also often leads to a collapsed midface and, in severe cases, a disc-shaped face with a misaligned bite (often antimandibular or open jaw). Therefore, the multiple physiological dysfunctions caused by cleft palate deformity, especially language dysfunction and dental malocclusion, adversely affect the daily life, study and work of the affected children, and also easily cause psychological disorders in the affected children.
Etiology
The cause of cleft palate is not fully understood, but it is thought to be related to nutritional deficiencies in food during pregnancy, endocrine abnormalities, viral infections and genetic factors.
Prevention
To avoid the occurrence of cleft palate, preventive care is needed. During pregnancy, pregnant women should avoid partial diet, ensure adequate intake of vitamins B, C, D, folic acid, calcium, iron and phosphorus, maintain a calm state of mind, avoid mental tension, refrain from taking antitumor drugs, anticonvulsants, antihistamines, ketamine and certain sleeping pills for pregnancy vomiting, refrain from smoking and alcohol abuse, avoid exposure to radiation and microwaves, etc.
Feeding
The reasons why feeding of young children with cleft lip and palate is more difficult than normal children.
1. Due to the cleft lip and palate of the affected child, the oral and nasal cavities are connected and a complete airtight structure cannot be formed in the mouth to produce the negative pressure needed for effective sucking.
2. Due to the change in the direction and attachment of the muscles of the lip and palate, the development and tension of the muscles are insufficient. This causes the tongue to retract; at the same time, the tongue is overdeveloped and the tongue is not able to wrap the nipple effectively when sucking by lifting it up.
3, due to the shortening or inability to lift the soft palate resulting in imperfect function of the soft palate and affect sucking and swallowing.
Feeding method
1, pay attention to the position, take a sitting position or 45b angle holding position, do not lie down to avoid choking and coughing; use face-to-face feeding method to facilitate observation.
2.When the child sucks milk, block the cleft lip area with your finger to help the lip close.
3. Use a plastic bottle with a cross-shaped opening, because the cross-shaped opening will open only when pressed and the child will not choke.
4.Use the squeeze feeding method, that is, buy bottles or syringes or droppers that can be squeezed for feeding.
5.Place the pacifier in a non-cracked area to avoid excessive local stimulation.
6.Early (1 month after birth) orthodontic treatment, such as wearing orthodontic appliances that cover the entire alveolar ridge and hard and soft palate to create negative pressure in the mouth and improve tongue movement, can have a significant improvement on feeding.
Psychological treatment
Psychosocial assessment of the child and his or her family should be performed as regularly as possible because of the growth and development of the child with cleft lip and palate. This is usually done by a neurorehabilitation physician. When problems are identified, the child should receive professional developmental/cognitive assessment, guidance, counseling or other assistance as needed.
As the child grows older, provide them with knowledge of cleft lip and palate deformities and encourage them to become active participants in the treatment plan. Advise the child’s guardians that they should be aware of the child’s understanding of the treatment discussion and should make an effort to let the child know as much as possible about the treatment plan.
Classification
Usually cleft palate can be classified into four types.
(i) soft cleft palate, which is not complicated by cleft lip.
(ii) Soft and hard cleft palate, often complicated by unilateral incomplete cleft lip.
③ unilateral complete cleft palate, starting from the uvula, to the incisal foramen, oblique to the lateral incisors all cleft, both sides of the alveolar process separated by the mucosa, often complicated by unilateral complete cleft lip.
④ Bilateral complete cleft palate, often coexisting with bilateral complete cleft lip. The cleft is split on both sides at the lateral incisors and the lower end of the nasal septum is free.
In clinical practice, type ③ cleft palate is the most common and type ④ is the least common. In addition to each of these types, a few atypical cases can be seen: such as complete on one side and incomplete on the other; missing palatal lobe; submucosal cleft (hidden cleft); partial cleft of the hard palate, etc. In addition to this, there is a common classification of cleft palate in some units in China, i.e., it is classified as degree I, II, or III.
Comorbidities of cleft palate
Due to the presence of a cleft between the oral cavity and the nasal cavity, a cleft palate cannot create the necessary negative pressure in the oral cavity when sucking breast milk, resulting in difficulty in sucking breast milk, which often leads to malnutrition, otitis media and respiratory tract infections.
Treatment principles
The treatment of cleft palate is a long-term and complex process that requires the collaboration of specialists in oral and maxillofacial surgery, orthodontics, speech training, psychiatry and psychology to achieve satisfactory results.
Optimal age
In terms of the timing of cleft palate surgery, surgery can be done at 5-6 months of age, and as much as possible, cleft palate repair can be done before 1 year of age. Otherwise, feeding, hearing or speech problems are likely to occur. Early (1 month after birth) orthodontic treatment is needed, such as the fitting of an orthodontic appliance. If the jaw is too small (e.g., Piro’s syndrome), mandibular distraction osteogenesis is required at 3 months of age.
Parental preparation for surgery
The child should be at least 5-6 months old, weigh at least 7 kg, have no other serious organ deformities, and have no adverse symptoms such as fever, cough, runny nose, or diarrhea.
Let the child get used to spoon feeding one week in advance.
Surgical approach
It has been shown that plow flap repair of the hard palate performed in conjunction with cleft lip repair is effective in reducing the cleft width of the palate without significantly affecting the early growth of the maxilla. The following principles are followed in the design and operation of cleft palate repair: strive to reconstruct the morphological structure of the palatal sail raphe; extend the length of the soft palate as much as possible; and avoid or minimize surgical treatment.
Postoperative precautions
1, after cleft palate surgery, it is advisable to make the sick child’s head on one side so that blood or saliva can flow out of the mouth. Children with weak muscles can fall back and affect breathing when they are drowsy, so an oral airway can be placed; oxygen can be given if necessary.
2.Post-operative spoon feeding: After the child is fully awake for 4 hours, he can be fed with a small amount of sugar water and observed for half an hour, if there is no vomiting, he can be fed with liquid food.
3.The child should be fed with liquid food within 4 weeks after surgery, and then changed to semi-liquid food in the next 2 weeks, and then can be fed with general food afterwards.
4.It is strictly forbidden to put fingers and playthings into the mouth after surgery to prevent the incision from cracking.
5.To prevent infection of the wound, the child’s mouth should be cleaned daily, and the child should be encouraged to drink more water, and antibiotics should be routinely applied for 3-5 days after surgery.
6, cleft palate surgery may not remove the sutures, let it absorb and fall off on its own.
7. One month after surgery, the child should return to the hospital for a follow-up visit to check the recovery of the surgery. For children older than 3 years old, they should do voice training under the guidance of physicians 3 months after the surgery in order to form correct pronunciation.
8. If there is no special, the follow-up should be done once a year.
Follow-up treatment after cleft palate surgery
1.Speech therapy: About 90% of the children can start speech therapy around 4 years old, while about 10% of the children also need palatopharyngoplasty to rebuild the function of palatopharynx because of the underdevelopment of palatopharynx. Then speech therapy can be performed.
2.Orthodontic treatment: After the permanent teeth erupt at the age of about 6 years old, the child still needs to go to the orthodontic department for orthodontic consultation or treatment of teeth.
3.Alveolar cleft bone graft repair: Children with alveolar cleft should come to the hospital around 7 years old for pre-consultation and preparation for alveolar cleft repair surgery.
4.Children with severe jaw development deformity may need orthognathic surgery at the age of 16.