Cleft lip (cheiloschisis)
This congenital anomaly is often colloquially referred to as a "harelip". The anomaly presents as a tissue defect of the upper lip of varying severity.
Defect characteristics:
- The cleft may be limited to the vermilion border or extend through the entire thickness of the lip up to the base of the nose.
- The defect can be either unilateral or bilateral.
Functional consequences: The presence of a complete defect critically disrupts the natural process of suckling, as the infant is unable to create the necessary vacuum in the oral cavity. For this reason, infant feeding is carried out using expressed breast milk.
Surgical treatment: The pathology is eliminated by plastic closure of the defect. The primary surgical technique involves the creation and transposition of local tissue flaps. Traditionally, there are three main stages (designated by Roman numerals I, II, III) of upper lip repair. In clinical practice, classical techniques are used according to:
- Malcheny;
- Mirault;
- Moreau-Simon;
- König.
Cleft palate (palatoschisis, uranoschisis)
Cleft palate occurs due to impaired normal fusion of the maxillary processes with the vomer during the embryonic period.
Classification of the anomaly:
- By localization: unilateral and bilateral.
- By extent of involvement: isolated non-fusion of the hard palate only, or combined cleft of the hard and soft palate.
Pathogenesis and clinical presentation: In palatoschisis, a direct communication is formed between the oral and nasal cavities. This leads to the infant's physical inability to perform suckling movements, and the ingested milk is regurgitated into the nasal passages. If cleft palate is combined with a cleft lip, there is a sharp and life-threatening impairment of not only feeding but also the respiratory process.
Care and treatment specifics:
- Feeding: Carried out using special devices — from a spoon or a feeder cup.
- Surgical tactics: Surgical intervention is performed in the early postnatal period. The main goal of the repair is the complete anatomical separation of the nasal and oral cavities. Technically, this is achieved by repositioning the tissues of the palatonasal septum.
Macrostomia (macrostomia)
Macrostomia is a congenital failure of fusion of the corner of the mouth, which can be unilateral or bilateral. As a result, an excessively wide oral fissure is formed.
Clinical manifestations:
- Pronounced impairment of the infant's feeding process.
- Continuous drooling due to the inability to fully close the lips.
- Secondary irritation and maceration (inflammation) of the skin around the mouth due to saliva exposure.
Treatment: As with other clefts, the only method of correction is surgical plastic repair of the anatomical defect. The operation should be performed in infancy to ensure the normal physical development of the infant.
Briefly: answers to topical questions
What are the anatomical forms of upper lip cleft according to the degree of severity?
The anatomical forms of upper lip cleft (cheiloschisis) vary by the volume of affected tissues. The defect may involve only the vermilion border or extend across the entire lip up to the nose.
According to localization and character, the following forms are distinguished:
- Unilateral clefts — occur more frequently, predominantly on the left side (for example, a lateral cleft in the projection of the upper lateral incisor).
- Bilateral clefts — affect both sides of the lip.
- Hidden forms — may present as subcutaneous or submucosal clefts.
What is the pathogenetic mechanism of respiratory impairment in combined cleft lip and palate?
The pathogenetic mechanism of respiratory impairment in combined cleft lip and palate (cheiloschisis, palatoschisis) is caused by a direct anatomical communication between the oral and nasal cavities. This leads to severe disorders of the sucking and swallowing acts in the newborn. As a result, food and milk flow into the nose and enter the nasopharynx, causing aspiration. This pathological process is accompanied by a sharp impairment of respiratory function and can lead to a life-threatening complication — aspiration pneumonia.
With which genetic syndromes are congenital facial clefts most frequently associated?
Sources indicate that facial clefts are described as part of more than 200 syndromes. Specifically, cleft palate is included in Robin sequence, cleft lip or cleft palate is a sign of Patau syndrome, and cleft hard palate occurs in Klippel-Feil syndrome.
The term "schisis" (schisis) always means clefting: cheilo — lip (cheiloschisis), palatum — palate (palatoschisis).
Class and exam questions
Cleft lip impairs the suckling process, which is why the infant must be fed expressed breast milk.
Cleft lip impairs the suckling process, which is why the infant must be fed expressed breast milk.
In addition to the inability to feed normally (milk flows into the nose), the infant experiences a sharp disruption of the act of breathing.
In addition to the inability to feed normally (milk flows into the nose), the infant experiences a sharp disruption of the act of breathing.
Plastic surgeries for the closure of lip, palate, and corner-of-the-mouth defects are performed in infancy (in the early postnatal period).
Plastic surgeries for the closure of lip, palate, and corner-of-the-mouth defects are performed in infancy (in the early postnatal period).
What else to study on this topic
- Stages of upper lip plastic surgery according to Malcheny
- Features of flap transposition according to Mirault and Moreau-Simon techniques
- Surgical technique for defect closure according to König
- Methods of tissue transposition of the palatonasal septum during uranoplasty
- Variants of isolated non-fusion of the hard palate
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