Cleft lip (or cheiloschisis) is a congenital malformation formed in the prenatal period by unfused tissues of the upper jaw and nasal cavity, characterized by the formation of a cleft of the upper lip.
The cleft can be of various sizes, often you can even see the oral cavity through it. Its depth in some cases is so significant that it can even reach the nasal cavity.
Statistics
Cleft lip in children is one of the most common and frequent congenital defects. One in 1,000 newborn babies is born with this anomaly. It has been noted that boys are most often born with cleft lip. It is also observed that in most cases it is left-sided. In addition, there is some dependence of the incidence of this defect on race. For example, cleft lip is twice as common in Asians compared to fair-skinned people. And for the Negroid race, the formation of an anomaly is typical for almost half of all newborns.
Today there is a tendency to increase the number of children born with this pathology. Undoubtedly, this fact can be associated with the deterioration of the environment, as well as with the emergence of a considerable number of factors that, one way or another, influence the formation of congenital anomalies in general. For example, in the Republic of Belarus, where almost every fifth resident suffered as a result of the Chernobyl accident, there is an annual increase in the number of newborns with cleft lip.
Among modern stars, the famous American actor Joaquin Phoenix has a scar that indicates a surgical repair of a cleft lip. In addition, there is also information that such Russian celebrities as Mikhail Boyarsky and Andrei Makarevich were born with a cleft upper lip.
Facial anatomy
Lips are skin-muscular formations that are located around the entrance to the oral cavity on the anterior surfaces of the jaws. They are divided into upper and lower, and together they form the oral cavity.
Lips are formed in several layers:
- cutaneous - numerous subcutaneous blood vessels are visible through it, giving the lips a pink color;
- loose connective tissue - it contains a large number of choroid plexuses, sebaceous glands and nerve fibers;
- muscular - it is predominantly represented by the orbicularis oris muscle; when various parts of its fibers contract, the lips can close, press against the teeth and move forward, and also when the fibers contract, the oral fissure opens; This layer also includes some facial muscles, with the help of which the lips can change position, thereby expressing various human emotions and feelings;
- mucous - it lines the inner surface of the lips and on their outer surface passes into the skin layer. The zone of this transition is called the lip border, which, in turn, has a bright red color due to the highly translucent vessels. A large number of excretory ducts of the salivary glands of the upper lip emerge onto the surface of this layer.
The upper jaw is a fairly massive paired bone that is involved in the formation of the oral cavity, nose and eye sockets. Its front surface is covered by the upper lip. The body of the upper jaw is represented by a hollow bone with a rather large air sinus, which is called the maxillary (or maxillary). It has a connection with the nasal cavity through a wide opening.
There are also four bone processes in the upper jaw:
- frontal - participates in the formation of the nasal cavity, fused with the frontal bone;
- palatine – takes part in the formation of the hard palate;
- alveolar - equipped with dental cells designed to attach eight teeth;
- zygomatic – fuses with the zygomatic bone.
Intrauterine facial development
This is a rather complex process of formation and fusion of tissues and bones, which begins by the end of the first month of intrauterine development.
At the fourth week of pregnancy, the embryo can already distinguish five processes (tubercles) that limit the oral cavity: the frontal, paired maxillary and paired mandibular. They participate in the intrauterine formation of the face and gradually grow, merging with each other.
The nasal process of the frontal tubercle and the processes of the maxillary tubercles take part in the formation of the upper jaw and upper lip. As a result of the convergence and growth of the tubercles, clefts are formed between the processes.
Fetal clefts:
- median - develops at the convergence of the mandibular or maxillary tubercles;
- transverse - formed by the mandibular and maxillary tubercles;
- oblique and lateral - formed at the convergence of the processes of the maxillary tuberosities and the nasal process of the frontal tuberosity.
Already by the beginning of the eighth week of embryonic development, the fusion of facial clefts is completed with the formation of the main lines of the face. If for some reason complete fusion of the processes of the embryonic tubercles does not occur, then such clefts persist in the future in the form of congenital anomalies. For example, if the transverse cleft does not heal, a pathologically large mouth is formed (macrostomia), and if the lateral cleft persists, a cleft lip is formed.
Cleft lip. Causes
The improper formation of the maxillofacial apparatus is influenced by many different reasons. The following factors can lead to the development of a congenital defect:
- Hereditary predisposition. Cleft lip most often develops in children whose relatives, primarily parents, had a similar defect. According to statistics, if at least one of the parents was born with a cleft lip, then the probability of having a baby with the same anomaly reaches four percent. In the case where the cleft lip was formed in both parents, then the risk of developing the defect is nine percent.
- Experts define the age of parents over 40 years as an undoubted reason for the development of a cleft lip in a child. Of course, the age of the mother matters most.
- Adverse effects of various chemicals on the body of the expectant mother at the beginning of pregnancy. These include smoking, drinking alcohol, drugs, medications, as well as unfavorable environmental conditions and eating food contaminated with various chemicals.
- Biological inferiority of germ cells, that is, their inability to form a cell with a full set of chromosomes, formed as a result of the fusion of an egg and a sperm (the so-called zygote). Both female and male defective reproductive cells can provoke the development of a cleft lip.
- Infectious and viral diseases, including sexually transmitted infections. Infections of both a bacterial and viral nature have a harmful effect on the fetus. The virus can act directly, causing infection of the fetus, or indirectly, causing an increase in temperature in the mother (hyperthermia). Infections caused by bacteria also contribute to overheating of the mother and child, which can cause the development of a cleft lip. Such diseases are, for example, rubella, measles, herpes, cytomegalovirus.
- The impact of unfavorable physical factors on the body of a pregnant woman, for example, severe hypothermia and overheating, injuries, as well as exposure to radiation.
- Oncological diseases of the mother (in particular, tumors in the uterine area).
- Severe toxicosis in the first trimester.
- Stress and emotional distress.
- Multiple pregnancy.
- Poor nutrition, including insufficient intake of essential vitamins and minerals into the pregnant woman’s body. The most dangerous is considered to be folic acid deficiency. It is necessary for the normal development of all fetal systems. Folic acid is actively involved in cell division and tissue growth. In addition, during gestation, the expectant mother must receive vitamins A, E, C. The body’s need for vitamin B6 also increases by approximately 30 percent. Women who are vegetarians are more likely to give birth to a child with a cleft lip due to a lack of vitamin B12.
- Diabetes mellitus in an expectant mother.
- Obesity.
- Complicated pregnancy, which is accompanied by the threat of miscarriage or uterine bleeding.
- Anemia and diseases of the cardiovascular system.
There is evidence that taking folic acid during planning and during pregnancy itself can significantly reduce the likelihood of a child developing congenital anomalies. It is found in most prenatal multivitamins, as well as in foods such as spinach, lettuce, beans, broccoli, asparagus, citrus fruits, nuts, tomatoes, corn, avocados, and others.
Characteristic
Cleft lip or cheiloschisis is a congenital pathology of the fetus that occurs during the formation of the maxillofacial elements. A gap appears in the child’s upper lip, through which the oral cavity is partially visible. It can damage not only the lip, but also lead into the nasal cavity.
The active process of formation of the maxillofacial system occurs from 4 to the end of 11 weeks. It is at this time that the middle nasal fusion occurs with the right and left maxillary processes. The appearance and location of the gap depends on which process with which the fusion will be disrupted. The earlier the exposure to a damaging factor occurred, the higher the risk of developing pathology and the more serious it can be.
The violation occurs with a frequency of 1 in 2,500. According to some reports, it occurs more often in boys. In rare cases, the defect is accompanied by a cleft palate - a cleft in the middle part of the palate.
Symptoms
A cleft lip is detected by a neonatologist during an external examination of a newborn child immediately after birth in the delivery room. The presence of a defect is indicated by the presence of a characteristic deformation of the baby’s face with a cleft in the upper lip.
Children with this congenital anomaly have significant difficulty sucking and swallowing. If the lesion is deep, the baby may even need to be fed through a tube. In the future, as a result of deformation of the teeth and bite, the processes of chewing food may be disrupted.
Disturbances in the development of the dentition are also manifested by an irregular angle of tooth growth, the presence of additional teeth or the omission of some of them, as well as an increased susceptibility to caries. In such cases, orthodontic treatment may be required, including bite correction, and sometimes even implantation of missing teeth or transplantation of excess teeth.
In a child with a cleft lip, the processes of sound formation are disrupted, which manifests itself in the form of a disorder of speech function (so-called rhinolalia). In such patients, speech is unclear, with problematic pronunciation of consonants and a rather pronounced nasal sound (“nasal”).
If the pathology is not subjected to the necessary and timely correction, it can subsequently cause a significant decrease in the child’s personal self-esteem.
Prevention
To minimize the risk of having a child with a cleft lip and cleft palate, expectant parents should:
- to refuse from bad habits;
- plan your pregnancy in advance;
- get tested for STIs and TORCH;
- consult a geneticist if one of your relatives has this pathology;
- avoid unnecessary use of medications;
- eliminate stress;
- plan pregnancy at a young age.
This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.
Diagnostics
It is possible to recognize signs of a cleft lip in the prenatal period using ultrasound examination as early as approximately 14 weeks of pregnancy. But in order to definitively confirm the diagnosis, you will need to organize a medical consultation.
This is necessary, since this anomaly is an indication for termination of pregnancy. Undoubtedly, in this case, the decision is made only by the pregnant woman herself, but at the legislative level, in the presence of a congenital pathology, abortions for medical reasons at this stage are allowed (in other cases, for a period of more than 12 weeks, artificial termination of pregnancy is already prohibited).
It is not difficult to make a diagnosis after birth; this requires only a visual examination of the newborn baby by a doctor.
Such a child will require a mandatory consultation with an otolaryngologist (ENT). This is necessary to determine if there are any other abnormalities (for example, abnormalities in the structure of the nasal cavity or cleft palate).
Classification
There is no generally accepted classification of cleft lip and palate. However, 4 groups are clearly defined:
- Clefts of the soft palate only
- Clefts of the soft and hard palate
- Complete unilateral cleft lip and palate
- Complete bilateral cleft lip and palate
This group does not apply to isolated cleft lips and incomplete fissures. The Kernahan classification differentiates cleft lip, palate, and alveoli. The boundary between the clefts of the primary and secondary palate is determined by sharply defined openings.
Treatment
Treatment of cleft lip is carried out through one or even several plastic surgeries, depending on the characteristics of each type of defect. Surgical correction of congenital cleft lip is performed for children who were born at term and do not have any contraindications (birth injuries, congenital defects of vital organs, acquired diseases, etc.). Surgical treatment of cleft lip should best be performed at the age of 3–6 months. In the case of a more severe defect, it is permissible already in the first days or month of the baby’s life, provided there is sufficient weight gain, as well as the absence of anemia, pathology of the cardiovascular, digestive, nervous and endocrine systems.
There are three types of plastic surgery aimed at correcting this problem.
Cheiloplasty - this type of treatment is the simplest because it does not require correction of any other tissues. During the healing period of the sutures, a cotton swab is inserted into the nose in order to in no case allow tissue fusion. Usually 10 days after surgery, the sutures are removed.
Rhinocheiloplasty is a more severe type of surgical treatment, when in addition to an aesthetic result, it is necessary to achieve functional convenience. This operation is performed both on the affected lip itself and on the muscles of the facial region.
Rhinocheilognatoplasty is the most complex type of operation, which includes the previous two types, but also with correction of the respiratory canals.
Carrying out surgical treatment in the first two weeks of a child’s life has a beneficial effect on the further development of the lip and nose, and also significantly reduces the anxiety of parents. But it should be taken into account that at this age children have too small anatomical dimensions of the lip, some of their functions are imperfect, and the tendency to blood loss is significantly increased.
With the surgical removal of a cleft lip, restoration of its integrity and anatomical structure, correction of deformities of the nose, palate and other facial defects is achieved.
Correction of cleft lip should be completed by the age of three, when speech begins to develop. Subsequently, speech therapy treatment is carried out, which is aimed at eliminating speech defects, as well as cosmetic treatment in order to eliminate the postoperative scar.
Forecast
The prognosis is very favorable. Thanks to modern methods of surgical plastic surgery, orthopedics and speech therapy, children with a similar diagnosis are almost no different from those around them and lead absolutely fulfilling lives. It is important to approach the child’s long-term treatment and rehabilitation with all seriousness.
At an early age, babies can have problems with feeding and weight gain, and, accordingly, with neuropsychic development. Therefore, you should master specialized feeding techniques and use additional sources of nutrients (energy complexes, vitamins).
Even with successful correction of the defect, the child is advised to undergo regular observation by specialists - a maxillofacial surgeon, a neurologist, an otolaryngologist and an orthodontist. The child will visit these doctors at least once a year until he is 17-19 years old, until all the tissues of the maxillofacial area are fully formed.
