The keys of cleft palate

Written by: Dr.Prof. Francisco Hernández Altemir
Published: | Updated: 20/11/2018
Edited by: Top Doctors®

Palatal cleft or cleft lip is an embryonic anomaly that causes some newborns to have an incomplete upper lip.


What is a cleft palate?

Embryonic anomaly , in which the organic assembly of the poliestructures that intervene in the anatomofunctional configuration, usually of the upper third of the face, to a greater or lesser extent, determine among other possible: more or less immediate perceptions, for relatives, familiar and clinical, of the interruption of the individual or shared continuity of the soft palate and more in extension, of the palatouveal set, to be able to include, if the process is more developed, the alveolomaxillary region and even, to surpass towards the nasolabial and facial parts, in a unilateral or bilateral way, without forgetting other cleft areas, of more reach, even towards the orbit and craniofacial zones.


Why is it produced?

The answer can not be completely explanatory and hereditary factors should be considered, very evident and easily recognizable, given in certain societies of consanguinity or shared genetics, to say it briefly and others, by infections and maternal affections in the first phases of pregnancy or extraordinary environmental phenomena : radiation, medications, environmental pollution, etc., although not always easy to determine and that can lead to "natural" or spontaneous possibilities, difficult to justify. In all cases, the clinician must support and mix with geneticists and researchers from various and improbable fields, to clarify and learn more about the subject.


Does it cause pain?

It would be necessary to define the pain, how, where and to whom?. Today, serial ultrasound surveillance of pregnant women can alert and we are only going to refer to the future mother and those around her, that more or less extensive anomalies are happening in the formative process of the fetus (those affected are controlled, not only regionally, but also, from the general point of view, to determine other concomitant organic anomalies, cranial, cardiac, genital, etc.), each day, earlier, more accurately and perceptibly. This can serve, to prevent the environment, the existence of these types of conditions, which we resist to call diseases. That for the fetus and subsequently, the newborn, usually does not seem, that they mean any painful symptoms, derived from cutaneous mucous and even bone dehiscence, to which we refer. In this case, in the oral and maxillofacial territory. Another thing is post-surgical pain or orthopedics , which involves the treatment of fissures, however controllable.


Can children born with this disease eat and drink without problems?

In most patients, feeding is possible naturally and should be promoted, so that the newborn enjoys the undoubted benefits of breastfeeding, which also indirectly helps parents and family when they see the newborn , that is able, to overcome difficulties not infrequently enlarged by third parties, due to its anomaly. If complex cases are involved, that is, with extensive cracks sometimes associated with other serious malformations, cardiorespiratory dysfunctions, deglutition, etc. can be determined, which may require extraordinary vital support, ranging from specific positioning of the affected person, in incubators. sophisticated and even from the beginning also, associated with labiolingual fixation surgeries (to prevent the tongue, can move to the oropharynx and obstruct the airway) or even, the use of bony distraction techniques, for mandibular advancement, for the same effects. Starting from endotracheal intubations or tracheostomies. Sometimes it is forced, to use, feeding tubes or even gastrostomies with the same support purposes, always with intentions and illusion of professionals and family members, of temporality, although not easy to achieve, in these cases of intensive clinical and surgical activity. very specialized (1).


How is it treated? Is it solved with a single operation?

Surgically in the clinically established and say so, because there are sometimes embryological feints of type fissure, at different levels, which are not necessarily susceptible to bloody treatments. In the most common morphologically how, palatal or isolated labial, the intention must always be to resolve them, in a single intervention. In the most complex , labiapaso-palatina, simple or bilateral, the usual thing is to intervene in the first place the lip in its space and in the immediate one, in which they are influenced (nasolabial and alveolomaxillary regions). Here, the surgery is differentiated, in terms of the surgical moment and are usually mandatory, two surgical times , the lip , around six months and the palate , within the first year. They are clear interventions, under general anesthesia, in a hospitalization regime and postoperative controls, in Children Units of Postoperative Reanimation or even Pediatric Intensive Care.

The treatment of the fissured, is not surgical in an integral way, other Specialists and diverse Professionals, are habitual for their control and pre and postoperative monitoring, for periods that can surpass several years and even almost, for life. We refer to Otolaryngologists, Orthodontists, Phoniatricians, Psychiatrists, Dentists, Stomatologists, Psychologists, Social Workers, etc.. In less developed countries with almost "epidemic" incidences of this pathology, the surgeon must assume polyvalent activities, such as the ones mentioned, if there are no referrals and not infrequently, associate with different specialties, for complex latent craniofacial surgeries.. The rehabilitations with implantological procedures, nowadays, are a reference in the complementary treatment of the palatal lip, usually already adult, although also, in orthodontic phases. Not only to replace bony interruptions of the arches and dental absences, but also due to other more or less concomitant factors, which may require dental implants with a pterygomaxillary, zygomaticomalar and / or facial epithesis, if applicable (2).


What derivative problems can occur?

We have commented, how various Specialties should train family members and patients in social and integration aspects. Also make it clear, from the first moment, that despite therapies of the first magnitude, natural organic sequelae, that the anomalies themselves can cause malformation, phoniatric, masticatory, dental, etc., others, are derived or even can produce, through therapeutic supports, well indicated, performed and meticulously carried. It is not uncommon for this type of patients to be attracted to the health life with work intentions, which come to be established and is probably due to what they feel, that they have been cared for and cared for with affection, understanding and care. This is, of their relatives, in the first place and perhaps, of the professionals and hospital or related personnel, who have been attending them, over the years.

1-R. Garcia Romero 1, C. Martín de Vicente 1, E. Gracia Cervero 1, D. Gros Esteban 1, T. Ureña Hornos 1, JI. Labarta Aizpun 1, F. Hernández Altemir 2, R. Escartin Villacampa 3, V. Rebage Moses 4: "Cleft palate and cleft lip. Clinical review "1 Pediatric Service. 2 Oral and Maxillofacial Surgery Service. 3 Child Surgery Service. 4 Neonatal Unit. Miguel Servet, Zaragoza. Cir Pediatr 2004; 17: 171-174
2-Hernández Altemir F., Hernández Montero Sofía, Hernández Montero Susana, Hernández Montero Elena, Moros Peña
Manuel: "Chronology of the eruption would implant". Spanish Journal of Oral and Maxillofacial Surgery, ISSN 1130-0558, ISSN-e2173-9161, Vol. 32, No.. 3, 2010, pages. 108-109

Disclosure article sent to Topdoctors on Monday, November 17, 2014

The keys of the cleft palate

Professor Dr. Don Francisco Hernández Altemir


*Translated with Google translator. We apologize for any imperfection

By Dr.Prof. Francisco Hernández Altemir
Oral and Maxillofacial Surgery

Eminence internationally in Oral and Maxillofacial Surgery, Prof. Dr. Francisco Hernandez Altemir is also Medical Stomatologist, Doctor of Medicine and Surgery, Founding Member of the European Society of Oral and Maxillofacial Surgery, founder of the specialty of Oral and Maxillofacial Surgery in the Aragonese Community and Assistant Professor Extraordinary at the University of Zaragoza. Pioneer cephalometric and panoramic radiography in Spain, with reference to these techniques has numerous technology patents scientific contributions such as vibrating ultrasonic surgical instruments, cardiac massage instruments, surgical gloves, face mask, etc.


Special meaning in the Medical-Surgical and environment would be meant as applied universally, among others (you) your work and surgical techniques, Transcraneofaciales Access to the Skull Base and adjacent structures for exploration and / or extirpation of tumors and / or pathologies, hitherto inaccessible rarely, if not through mutilation by this fact, became unthinkable. Also note, how was impeller, diffuser and creator of techniques on the management of the airway as intubation Nasotracheal low fibroscopy and more recently endotracheal intubation by Via Submental that is preventing many tracheostomy, making it well means facilitate patient comfort and enhance the activity of Oral Surgery and Head and Neck.




*Translated with Google translator. We apologize for any imperfection

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