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Cleft lip

Cleft lip – the congenital defect formed by not accrete tissues of a nasal cavity and top jaw in the pre-natal period and which is characterized by a lip crevice. The cleft lip is shown by external ugliness, problems in food and formation of the speech, however the general psychosomatic development of the child usually does not suffer from it. Along with a cleft lip splitting of the sky – a wolf mouth often occurs at newborns with maxillofacial defects. The fact of presence of similar defects at a fruit can be established still vnutriutrobno by means of ultrasonography. Treatment of a cleft lip is carried out by a surgical method – by means of a heyloplastika; at the combined defects – rinokheyloplastik, rinokheylognatoplastik.

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Cleft lip

Cleft lip () – the malformation of maxillofacial area representing a nezarashcheniye of an upper lip. With a cleft lip 0,04% of babies among whom boys prevail are born. Formation of crevices of a lip and sky happens till 8th week of pregnancy when maxillofacial bodies are put. Crevices of the person seldom are the isolated defects, in every fifth case they represent one their components of heavy congenital syndromes. With such congenital pathology experts in the field of maxillofacial surgery, stomatology, logopedics, pediatrics are engaged in correction of crevices of the person, restoration of the broken functions and rehabilitation of patients.

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Reasons of development of a cleft lip

Formation of a cleft lip, also as well as a wolf mouth, is caused at the gene level. TBX22 gene mutations causing emergence of splitting of a lip can be provoked by toxicosis, stresses, abuse of antibiotics, radiative or infectious effects, the use of drugs, alcohol or smoking of future mother. Action of these factors in the first 2 months of pregnancy is especially dangerous. One more risk factor of development of a cleft lip – late (after 35-40 years) childbirth. A certain role in formation of defect it is allocated for gynecologic and all-somatic pathology of the pregnant woman.

On a scale of influence on formation of a cleft lip adverse factors settle down in the following sequence: chemical (22,8%), mental (9%) mechanical injuries (6%), biological (5%), physical (2%) etc. It is possible to define the child's birth with a cleft lip according to ultrasonic examination of a fruit at late stages of pregnancy. Medico-genetic consultation is shown to the parents who already have the child with a lip crevice before planning of the following pregnancy.

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Classification of a heyloskhizis (cleft lip)

As a rule, the crevice is formed on an upper lip, on the one hand from its average line. Less often defect is shown on both sides or on a lower lip. The unilateral nezarashcheniye of a lip is more often formed at the left. At bilateral defect presence of the speaker forward of an intermaxillary shoot of the top jaw is often noted.

Allocate an incomplete and full form of a cleft lip. Partial splitting usually unilateral in the form of deepening on a lip. It is formed as a result of not union among themselves average nasal and one of maxillary shoots. Full splitting of a lip is characterized by the deep crack (chip) which is going back from a lip to a nose from one or two parties. It is caused by not union of a nasal shoot with left and right maxillary. Depth and extent of defect can be various. In mild cases splitting affects only soft tissues of a lip; in heavy - defect is connected with a palatal bone and a bone of the top jaw.

The cleft lip can meet separately, but is followed by other anatomic defects of development of the top jaw more often: crevices of a hard or soft palate, deformations of a nose, etc. Establishment of a form of defect, degree of expressiveness, a combination to other maxillofacial pathology allows to decide on tactics of maintaining patients with a cleft lip and the choice of methods of correction of congenital defects.

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Displays of a cleft lip

Splitting of a lip is defined at external survey of the child right after the birth. Existence of a cleft lip is indicated by characteristic deformation of the person about one - or a bilateral crevice in the upper or lower lip. If a cleft lip not to subject correction, it can cause decrease in a personal self-assessment in the child. At babies with a cleft lip processes of sucking and swallowing are complicated. If lip crevices deep and big, feeding via the nasal probe can be required. Further because of deformation of teeth and a bite processes of a chewing of food are broken.

Violation of development of a tooth alignment is shown by the admission of some teeth or existence additional, the wrong angle of growth of teeth, tendency to caries. At such violations orthodontic treatment and correction of a bite, and sometimes - change superfluous or implantation of missing teeth can be required. At children with a cleft lip violation of process of formation of sounds is noted that is shown by disorder of speech function (rinolaliy). The speech at such patients indistinct, with the expressed nasal sound ("twang") and a problem pronunciation of concordants.

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Principles of treatment of a cleft lip

Correction of a cleft lip is carried out during one or several reconstructive plastic surgeries taking into account features of each option of defect. Carrying out plastic correction of congenital crevices of a lip is shown to the children born in time and who do not have contraindications (the combined defects of vitals, patrimonial injuries, acquired diseases, physiological jaundice, etc.). – it is better for heyloplastik to carry out expeditious elimination of a cleft lip at 3-6-month age. In case of heavy defect, its implementation in the first days or month of life of the child on condition of a sufficient increase in the weight, absence of anemia, pathology of intestines, cardiovascular, endocrine or nervous systems is possible.

Carrying out a heyloplastika in the first two weeks after the birth favorably influences development of a lip and nose further, and also reduces mental uneasiness of parents. However, at children at this age the anatomic sizes of a lip are still very small, some physiological functions are imperfect, tendency to blood loss is increased. At surgical elimination of a crevice of a lip restoration of its anatomical structure and integrity, elimination of deformations of the sky, a nose, other front defects, and also creation of prerequisites for the correct development of maxillofacial system at children's age is reached.

Correction of a cleft lip has to be complete by 3rd years when formation of the speech begins. At later age the logopedic treatment directed to elimination of speech defects, and cosmetic treatment on elimination of a postoperative hem is carried out. Taking into account the available defects of a lip, nose, the sky and an alveolar shoot as reconstructive operations carry out a heyloplastika, a rinokheyloplastika or a rinokheylognatoplastika.

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Ways of correction of a cleft lip

Carrying out primary heyloplastika includes restoration of anatomic, esthetic and functional full value of the split lip. It is carried out in the first days after the child's birth with a cleft lip. Various techniques of a heyloplastika which are carried out to children of early age are offered; their choice is defined by a form of defect and the decision of the surgeon dictated by aspiration to achievement of optimum result.

Primary rinokheyloplastika is carried out in need of correction of a cleft lip, cartilages of a nose and an abnormal arrangement of muscles of oral area. It is technically more difficult surgery, and its carrying out is shown at heavy defects of a lip, deformations of a nose and defects of a facial skeleton. Options of performance of a rinokheyloplastika can be various and are defined by specific features of congenital defects.

For the solution of tasks of restoration of anatomic full value of a lip, elimination of cartilaginous deformation of a nose, formation of a full-fledged muscular framework in a mouth, and also to elimination of defects of an alveolar shoot and underdevelopment of departments of the top jaw on the party of splitting resort to performance of a rinokheylognatoplastika. Carrying out a rinokheylognatoplastika allows to create conditions for the correct development of the top jaw, a nose and lip.

The plastic reconstructive maxillofacial surgery is able to help the children born with a cleft lip today, to achieve the good esthetic and functional remote results of operations in 85-90% of cases and to adapt them to full-fledged life in society. Operations of a heyloplastika are performed after comprehensive inspection of the child confirming his functional readiness for performing surgical treatment.

After end of a repozition and sewing together of the split tissues of a lip and nose in the nasal course the gauze tampon for protection of area of seams against food and slime, and the prevention of narrowing of a nasal opening is established. After extraction of a tampon in the nasal course for 3 months the plastic tubule for prevention of its narrowing and deformation of a wing of a nose is established. For 7-10 day after operation remove seams. The postoperative seam on a lip remains is swept up, but in the subsequent it is possible to reduce its manifestations by means of cosmetology procedures.

In 70% of cases carrying out additional interventions on correction of residual deformations of a lip and nose at more advanced age can be required. After carrying out a heyloplastika judge achievement of functional and esthetic results in a year after performing plastic surgery. In some cases development of cicatricial deformation of a lip from a mucous membrane is possible that performance of plasticity of a threshold of an oral cavity can demand.

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Cleft lip - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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