Wolf mouth – the congenital deformation representing splitting of fabrics of a hard and soft palate at which there is a message between an oral and nasal cavity. The children who were born with similar defect from the moment of the birth experience difficulties with independent breath and food; lag behind in physical development, badly put on weight, often are ill, and at more advanced age suffer from speech frustration (rinolaliya). Correction of a crevice of the sky (a wolf mouth) is carried out by a surgical way by means of reconstructive interventions (an uranoplastika, a velofaringoplastika) with the subsequent orthopedic, logopedic, physiotherapeutic rehabilitation.
Wolf mouth () – the congenital malformation of maxillofacial area representing the splitting of a soft and hard palate leading to violation of processes of breath, food, sound education. Defect is formed as a result of a delay of accretion of shoots of the top jaw with an unpaired bone of front department of a skull – a soshnik. With a wolf mouth in the world 0,1% of newborns are born.
At a wolf mouth splitting of the sky can be: full - with a crevice in a hard and soft palate and incomplete – with an opening in the sky. Existence of a wolf mouth is often combined with bifurcation of a uvula - a shoot of a back part of a soft palate as a result of violation of connection of medial, lateral palatal shoots and a nasal partition. The wolf mouth is one of the most frequent congenital defects.
Formation of splitting of the sky is caused genetically: during the work with data of interpretation of human genome the British scientists in 1991 found the gene responsible for development of a wolf mouth is the changed TBX22 gene located in the H-chromosome. As the factors leading to changes at the gene level and promoting formation of palatal defect serve teratogenny impacts on a fruit. Today dependence between formation of a cleft lip and a wolf mouth at the child and addiction of future mother to alcohol, tobacco smoking and drugs is accurately tracked.
The risk of formation of a defective top jaw increases at obesity of mother and a lack of folic acid of its diet. Also development of a wolf mouth is promoted by the environmental problems of the area of accommodation of the pregnant woman transferred it toxicosis and sharp infections, mental or mechanical injuries. In the first three months of development the fruit is most vulnerable and susceptible to different influence of the damaging factors, during this period there is a formation of maxillofacial bodies.
Features of a structure and development of the sky
The top sky is the anatomic barrier dividing an oral and nasal cavity. Evolutionarily the sky developed at the organisms adapting to life on the land. It is formed by two parts: hard and soft palate. The hard palate is in a forward part of an oral cavity and is formed by a bone basis of palatal shoots of the top jaw and horizontal plates of palatal bones.
Behind it the soft palate which consists of muscles, an aponeurosis and glands is located. Muscles of a soft palate provide change of its situation during the pronouncing sounds and meal. Thanks to fabrics of a soft palate food and water when swallowing does not get into a nose and a nasopharynx. In the center of the rear edge there is a uvula of a soft palate. Formation of the top jaw formed by two bones which grew together in the middle begins with the 8th week of an embryogenesis. At first from rudiments of an internal surface of a jaw there is a formation of palatal shoots which gradually growing together with each other and a nasal partition, form a hard palate.
Genetic failure in the period of laying of maxillofacial system leads to development of defects - to a nezarashcheniye of an upper lip and the sky. It is possible to distinguish presence of a wolf mouth at a fruit on ultrasonography only on late terms of pregnancy. Children with a cleft lip and a wolf mouth are painful since the air inhaled by them is not warmed and is not humidified that leads to development of inflammatory processes of airways and an inner ear. At such patients changes of a maxillofacial skeleton, a zubochelyustny row, the hearing aid are noted. Nezarashcheniye of the sky and an upper lip can meet separately or be combined together and with other maxillary pathology.
Manifestations of a wolf mouth
Difficulties at children with splitting of the sky begin with the birth moment since aspiration of amniotic liquid in airways is at the time of delivery possible. Breath of the newborn with a wolf mouth is complicated, sucking is impossible because of what lag of the child in the weight and development is observed. Feeding of the kid before operation is carried out by means of the special spoons which are putting on on small bottles.
Existence of a crevice of the sky breaks normal functioning of the top respiratory and digestive ways, development of the speech and hearing, and also can cause decrease in a self-assessment of the identity of the child. At the children having a wolf mouth the speech in connection with violation of process of the correct formation of sounds is changed. Speech frustration are expressed in the open rinolaliya causing FFN or ONR.
The palate defect leads to a free vykhozhdeniye through a nose of the inhaled air, and also to hit in a nose of food and liquid. Liquid through a crevice in the sky can get in Eustachian tubes and bosoms of a nose that promotes development in such patients of otitis and sinusitis. At a wolf mouth existence of deformation of a bite and the teeth breaking process of chewing of food is noted.
Treatment of a wolf mouth
Today congenital defects of development of the sky successfully are eliminated by means of surgery during which integrity of an alveolar shoot is restored, an upper lip and plasticity of the top sky is carried out. Successful treatment of a wolf mouth requires combination of efforts of many medical disciplines: pediatrics, maxillofacial surgery, orthodontics, therapy, logopedics, otolaryngology, neurology. Before carrying out operation on plasticity of the sky for babies use of the special obturators facilitating sucking and feeding is appointed. Performance of plasticity of a hard palate at early children's age is difficult in view of the small sizes of an oral cavity therefore only carrying out cycle plasticity – sewing together of a soft palate, recommended from 8-month age is possible.
The principles of treatment of patients with a wolf mouth
Operations on elimination of congenital maxillofacial defects are usually performed step by step. The number of interventions can vary from 2-3 to 5-7 and even more. The age of carrying out correction of a wolf mouth is defined by the experts observing the child since the birth in individual indications, but not earlier than 3-6 months (usually in later terms). The end of treatment, including the recovery period, has to be complete to age of 6-7 years.
The age from 3 to 7 years is favorable for carrying out additional cosmetic operations on improvement of appearance of the child after full rehabilitation he could visit general education educational institution as mental and intellectual development of children with a wolf mouth does not differ from those at healthy children. After correction of a palate defect and passing of a full course of rehabilitation children are struck off the register on disability.
The pro-thinned-out clinics in which there are all necessary experts are engaged in treatment of maxillofacial defects: pediatrician and micropediatrician, surgeon, orthodontist, teacher logopedist, psychologist and social worker. The modern plastic medicine is designed not only to help the child to get rid of an outer defect, but also to overcome consequences of a mental trauma from feeling of the inferiority for further full adaptation in society.
Correction of a wolf mouth by an uranoplastika method
The problem of restoration of the correct anatomical structure of a soft and hard palate, and also average departments of a throat is solved by carrying out an uranoplastika. As the classical option of an uranoplastika at a wolf mouth solving these problems serves operation on Limberg's method. Uranoplastika across Limberg is the main technique of treatment of a congenital palate defect today. At a sky crevice combination to a cleft lip the heyloplastika – operation on correction of an upper lip is also carried out.
Before carrying out an uranoplastika individual planning of operation is carried out, plastic material for elimination of defect of splitting of the sky is selected. Modern methods of an uranoplastika and qualification of plastic surgeons provide restoration of full-fledged anatomical structure of the sky at 92-98% of patients.
Radical correction of defects of a soft and hard palate means the solution of a difficult complex of tasks: restoration anatomic correct continuity of each layer of a soft and hard palate and their sizes; elimination of a vicious attachment of palatal and pharyngeal muscles, anatomic their correct connection; an exception of injury of the nerves providing reduction of these muscles at operation; performance of stable fixing of the restored anatomical structures, forms and functions of the sky.
It is more preferable to carry out a radical uranoplastika to children at the age of 3-6 years. At 3-5-year age operate the patients having not through crevices of the sky; from 5 to 6 years – with through one - and bilateral crevices. Implementation of a radical uranoplastika is not recommended at children of early age since it can cause an arrest of development of the top jaw. Performance of the sparing ways of an uranoplastika is possible before achievement of 2 years by the child of age.
In the presurgical period carrying the "floating" obturator promoting normal feeding, breath, formation of the correct speech is recommended to children. The obturator is removed in 2 weeks prior to carrying out an uranoplastika.
Postoperative leaving includes observance of a bed rest within 2-3 days, reception only of the wiped food, plentiful alkaline drink. The careful attention is paid to care of a mouth: before meal irrigations of a mouth are carried out by weak solution of permanganate of potassium. It is several times a day recommended to inflate balloons. From 14th days carrying out a special set of exercises and manual massage of a soft palate is necessary.
For the purpose of prevention of a postoperative infection antibiotics are appointed to 5-7 days, for knocking over of a pain syndrome - anesthetics. On a face after an uranoplastika there is a postoperative hem. The extract from a hospital is carried out for 21-28 day after operation.
Further long and laborious work on restoration of a full-fledged palatal and pharyngeal smykaniye and mobility of the sky by means of physiotherapeutic techniques of treatment is necessary to patients.