Incident, factors, detection and correction of Cleft lip and palate
The cleft lip or cleft palate (cleft lip and palate scientifically) is an opening in the region of the lip or palate , caused by not closing these structures, which occurs between the fourth and tenth week of pregnancy . The adjective cleft refers to the similarity with his nose split a hare .
It is a congenital anomaly that occurs during the formation and development of the fetus , which the patient has oral-nasal communication due to perforation in the palate , where it is possible to observe the nasal septum and the inferior turbinate. You can reach the hard palate and soft palate .
Although extremely rare, injuries can occur from palatine syphilis untreated.
Types of cracks
Cracks may be: unilateral (one side only reach the lip) and bilateral (two side slits of the lip), complete (when they reach the lip and palate) or incomplete (only one of these when they reach structures), and so atypical range from milder forms, such as scar lip and uvula bifida (when the uvula appears split into two), even more severe forms, such as large cracks and palate. Cleft lip and palate may also be associated with other malformations whether face or other body parts. Cleft palate leave the channel in contact with the oral nasal.
The Caucasians have an estimated incidence of 1.84 / 1,000 births, which is higher among lower in yellow and Negroid (black).
Its incidence in the presence of family fissures in the following proportions:
- a) normal parents = 0.1% chance of having a child fissured
- b) normal parents and a son cracked = 4.5% chance of having another child fissured
- c) a parent and a child cleft = 15% chance of having another child fissured
In Brazil, it is estimated that every 650 births, a child born with cleft lip and palate.
There are several factors that have been implicated in its onset, such as the use of alcohol or cigarettes, performing X-ray in the abdominal region, the ingestion of drugs such as anticonvulsants or corticosteroids during the first trimester of pregnancy, nutritional deficiencies, infections, Apart from heredity .The only way to fix them is through surgery.
Detection and correction
Currently, thanks to improvements in ultrasound , cleft lip can be diagnosed even before birth. This allows, soon after birth, corrective surgery is performed.Today there are techniques that allow the surgery early, up to 1 week of life.
The first lip surgery is usually performed at three months of age, when the child must have 5 kg. Already the hard palate surgery is performed only at twelve months of age. For good food and child does not recede food through the nose into the hard palate surgery, breastfeeding techniques are developed and the persistence of the mother key factor in its success. If even then the mother can not breastfeed, she is driven to do the milking and give breast milk in a bottle, because the concern is that the baby sucking evil will have little weight gain. Some authors advocate the use of palatal plates pre-molded, easy to handle to help with breastfeeding.
In the case of the slit extend to the palate, there is greater risk of children aspire food causing infections such as ear infections and pneumonia . Ear infections can harm the development of speech and language. Anemia is also common in oral clefts usually fixable with a balanced diet and ferrous sulfate. Breastfeeding is indicated to prevent infections, fight anemia and strengthen the muscles of the face and mouth, and to maintain the production of mother’s milk. When the baby does not gain enough weight, we resort to food supplementation, but not discontinue breastfeeding because the act of sucking causes no increase in the bond between mother and baby.
- Holding the baby in an upright position, so that the nose and mouth become higher than the breast;
- Fill opening cleft lip with the breast (you can use a special plaque – shutter – to cover the palatal cleft);
- Encourage and help mom, guiding her that it is necessary “to close the cleft” so the baby can suckle well and supporting her because feedings are usually long;
- Some babies need to be fed by orogastric tube, cup, bottle, spoon, what the baby adapt better.
Without proper treatment, the cracks can cause serious sequel such as hearing loss, speech problems and nutritional deficit, beyond suffering with prejudice. You can complete the rehabilitation of patients with cleft lip and palate. The earlier the intervention, the better. The treatment is long, but worth it starts from birth to adulthood through several corrective surgeries and aesthetic.
A multidisciplinary team should be involved in this rehabilitation, such as doctors , nurses , speech therapists , nutritionists , dentists , psychologists , pharmacists and social workers. The exchange of information between professionals is essential to treat the child as a factor directly influences the other, with respect to the teeth, speech, the face, the features food and psychosocial development.
Parents who discover their child with cleft lip and palate should seek all kinds of guidelines to allow them full rehabilitation of his son. It is recommended that parents remain calm, because the rejection, denial and guilt can be considered normal at first, but with professional help, the parents and the baby can have a healthy and happy life.
There are several surgical centers in Brazil with skilled and competent in the care of patients with cleft lip and palate by SUS, private and philanthropic.Google