Cleft palate

The wolf mouth is an anomaly of the development of congenital genesis, which is manifested by the non-healing of hard and soft areas of the sky, as a result of which the nasal and oral cavities are connected.

The appearance of the defect is due to the delay in the growth of the opener with the outgrowths of the upper jaw. The frequency of pathology reaches 0.1% among children born.

Splitting is possible complete when there is an uninfected area of soft and hard areas, or incomplete - when only an opening in the sky is observed. Among all the innate mutations, the wolf's mouth is considered a common anomaly, which is sometimes noted with a bifurcation of the tongue.

To the causes of the occurrence of the wolf's mouth is the genetic breakdown that occurs in the TBH22 gene. However, there are factors contributing to the formation of this defect. These include mutagenic effects on the fetus, both from the outside world, and the organism of the future mummy. A special role in the occurrence of mutation is played by smoking, drinking alcohol and drugs during pregnancy.

Also, do not forget about diseases such as endocrine pathology, metabolic disorders and insufficient intake of folic acid. The risk of the emergence of pathology increases with the presence of toxicosis in pregnant women, past infectious pathologies, mental or mechanical traumatizations.

It is worth noting that it is in the first three months of pregnancy, when the fetus is particularly vulnerable, is the laying of the structures of the maxillofacial device. Negative impact of damaging factors during the first trimester leaves the most significant imprint on the health of the fetus.

[1], [2], [3], [4]

Causes of wolf mouth

Despite the assumptions about the genetic path of development of pathology, it is separately accepted to single out factors that increase the risk of this pathology. For many years of research, several predisposing factors have been identified. These include an aggravated responsibility, when the family has already seen cases of pathology. If one of the parents in the genus had a wolf mouth, then the risk of this pathology in a baby increases by 7 times in relation to other children.

In the case when the parents have this developmental defect, the likelihood of the baby forming a wolf's mouth varies from 10% (if the pathology is noted in one of the parents) to 50% (if both).

The causes of the wolf's mouth are also the way of life of the pregnant woman, because smoking, drinking alcohol and drugs have a negative impact not only on the formation of the wolf's mouth, but also the development of the whole organism as a whole. Statistics indicate the fact that smoking a pregnant woman from 1 to 10 cigarettes a day increases the probability of splitting the sky 30 times. At the same time, a pack of cigarettes increases the risk to 70%.

Do not forget about various diseases of infectious genesis, intrauterine infections, concomitant chronic pathology of the future mother, including sexually transmitted infections. All these pathological conditions and disturbances in the work of organs and systems are the background for the appearance of the wolf mouth.

Of the environmental factors that have a negative impact, it is necessary to note the occupational hazards of both parents, living in areas contaminated by radioactive or chemical exposure. In addition, the probability of not only the development of an anomaly in the maxillofacial area but also of other organs during the first pregnancy after 35 years increases. The very process of bearing a fetus is quite difficult for a woman, not counting the possible complications in childbirth.

The reasons can be the violation of metabolic processes with the development of obesity, the use of drugs in a large dosage, especially those drugs that are contraindicated in pregnancy. Among the concomitant factors include insufficient intake of folic acid, the impact of stressful situations with a violation of the psychoemotional state and toxicosis of pregnant women.

Given these factors, it can be concluded that the mutation can result from the harmful effects of a large number of factors, including accidental breakage. Genes found with the study are guilty only in 5% of cases, in connection with which further search continues.

[5], [6], [7]

Signs of a wolf mouth

Since birth, signs of wolf mouth can complicate the process of labor, as there is a risk of aspirating to the baby of amniotic fluid by respiratory organs. The process of breathing for a baby gives many difficulties, sucking is almost impossible.

As a consequence, the child can not fully develop due to insufficient intake of oxygen and the development of brain hypoxia. The lack of adequate nutrition also inhibits the growth of the baby, which threatens the development of rickets and underdevelopment of organs. Such children lag behind their peers, as the physical and mental level is at a lower development.

Feeding the baby with an anomaly requires a special approach, because this requires a special spoon, which is put on the bottle. Thus, speech and hearing are affected, which significantly reduces a child's self-esteem, not counting a visual defect.

The formation of speech is difficult due to improper growth of teeth, and expression of speech disorders is represented by rhinolaly. Due to an incorrect bite, there is a violation of the chewing process, because of which the food is not thoroughly crushed and poorly digested in the stomach.

The defect of the sky causes a free transport of inhaled air from the nasal to the oral cavity. The same thing is observed in the process of eating, when liquid and food can enter the nasal cavity. In addition, liquid through the cleft can be thrown into the eustachian tubes and nasal sinuses with the onset of otitis or sinusitis.

The development of frequent respiratory diseases is due to the lack of warming of the air and its purification while passing through the upper respiratory tract.

Hare's lip and wolf's mouth

Quite often cases of forming a hare's lip parallel to the wolf's mouth are recorded. In addition to the anomaly of the upper lip, there are other mutations in the structure of the facial part and the apparatus for providing the auditory function.

Hare-lipped and wolf mouth are formed in the 1st trimester of pregnancy, when all the organs are laid. Anomalies of development are noted when there is not enough tissue for the normal construction of facial structures, or it does not fuse properly.

Hare's lip is a cleft of the upper lip visually resembling a narrow opening in the skin. In some cases, non-spreading extends to the nasal region and the bony structures of the upper jaw, the gums.

The palatine defect or the so-called wolf mouth can involve hard and soft parts in the pathological process. These anomalies are localized on one or both sides of the oral cavity. Due to the fact that the formation of the sky and lips is noted separately, the developmental anomaly can be noted together or separately from the wolf mouth.

Mutation of the cleft lip is the fourth most common among congenital developmental anomalies. The causes of the appearance of a combined developmental anomaly are still not known, so there is no prevention to prevent these mutations. There is an opinion that genetic factors in combination with environmental factors play a role in shaping the hare's lip with the wolf part. Especially the risk of development in children increases if the mutation is observed in parents or relatives.

In addition, a certain risk is present when a pregnant woman uses certain medicines. They increase the likelihood of an anomaly in the development of the lips and the palate. Among these drugs should be allocated anti-bicycles, funds that include Accutane, as well as cytostatics used to treat cancer, for example, methotrexate. Also, the appearance of a mutation in a fetus can be triggered by viruses or other chemicals. Quite often, these mutations can be one of the manifestations of a disease.

The cleft palate in children

In most cases, it is just such a congenital pathology, as a wolf's mouth, in children that causes the appearance of many problems. The cleft in the sky is laid in the process of intrauterine development, in particular in the first 3 months of pregnancy. Sometimes there is a mutation of the wolf mouth in combination with the hare lip.

Based on the severity of the pathological process, four types of pathology are distinguished. Thus, the mutation can be manifested by the non-healing of the soft part of the sky, soft in combination with the solid part, as well as complete uninflation of both sites on one side or both.

When diagnosing a mutation, it is sufficient for the physician to perform a visual examination and assess the severity of the process, in particular the violation of breathing, speech and swallowing functions. In addition, with the help of instrumental diagnostic methods, the diagnosis is confirmed, and hearing damage, abnormalities of the skull structure, patency of the nasal cavity passages and many other defects are established.

Approximately 75% of all cases of wolf mouth in children is the only developmental anomaly. However, if it is available, it is recommended to proceed as early as possible to treatment in order to avoid the appearance of disturbances in the functioning of other organs and systems.

The wolf's mouth in newborns

In view of the fact that the wolf's mouth in newborns is not so rare, sometimes in combination with other defects, scientists around the world are trying to find those genes that cause the development of the mutation. At the moment there are only 3 genes responsible for the congenital anomaly of development. However, of all cases, they play the leading role in only 5%, in the remaining 95%, the breakdown is noted in other carriers of information.

The wolf's mouth from the moment of birth leads to many problems. Even in the course of labor, there is the possibility of aspirating the baby to amniotic fluid in the respiratory tract. In addition, there are violations of the respiratory function and the act of breast sucking, as a result of which the baby lags behind in development and does not gain sufficient weight for his age. The brain experiences hypoxia, that is, an insufficient supply of oxygen as a result of inferior breathing, which leads to a delay in both physical and mental development. Feeding these children is carried out with a special spoon, which is put on the bottle.

The cleft in the sky prevents normal digestion, breathing, speech formation, auditory function, and also causes a decrease in the child's self-esteem. Incomplete speech arises from improper growth of the teeth, which is manifested by open rhinololia.

In children, frequent respiratory diseases are noted, since air enters the respiratory tract cold, not moistened and not purified. In addition, the inhaled air freely leaves through the nose, and food through a defect also enters the nasal cavity, which leads to frequent sinusitis.

Wolverine Mouth Syndrome

Formation of a gap in the soft and hard areas of the sky occurs during pregnancy, in particular, in the first trimester. Anomaly development can be the only pathology in a baby or be a clinical sign of another disease. So, the wolf mouth can be observed with syndromes such as Stickler or Lois-Dits.

Syndrome of the wolf's mouth causes violations in many functions of the body. So, through the gap in the sky, food and liquid during feeding can freely penetrate into the nose with the development of sinusitis. The ingestion of food into the Eustachian tube leads to the development of such complications as otitis media.

The process of digestion is also disturbed in view of the incorrect formation of the occlusion due to improper development of the teeth. The baby requires special feeding, since breast sucking during the newborn period or using a regular spoon does not allow the ingestion of food.

As for the respiratory function, the act of inhalation does not provide sufficient oxygen to the lungs, which leads to brain hypoxia and the development of complications. In addition, uncontaminated, unrefined and unheated air immediately enters the respiratory tract, which contributes to frequent inflammatory processes.

Despite the severity of the situation, after all, with the help of surgical intervention and the further work of the speech therapist, an ENT doctor and a neurologist with a baby allow you to restore the disturbed functions.

Diagnosis of the wolf mouth

Taking into account the fact that the developmental anomaly is formed in utero, when the organs and systems are being laid and developed, early diagnostics of the wolf's mouth is carried out during pregnancy, when the period reaches 14-16 weeks. Each pregnant woman during registration passes a planned ultrasound, with the help of which the fetus is visualized and the development anomalies are present (if any). Such studies are periodically repeated throughout the pregnancy, since not all mutations can be detected on the first ultrasound.

In addition, this process controls the growth and development of the fetus, which is also very important. However, not always the cleft palate can be diagnosed at this time, and its severity can only be established after the birth of the baby.

Accurate diagnosis is carried out after examination of the patient's pharynx by a doctor after birth. Often there is a combination pathology, when except for the wolf mouth there is a hare lip, but do not get upset, because defects can be concealed with the help of a surgical operation even before complications develop.

[8], [9]

Treatment of the wolf mouth

For a long time already treatment of the wolf mouth has been carried out by the surgical method, with which the cleft of the alveolar process, the defect of the upper lip, is effectively closed, after which the plastic of the upper palate is performed. However, in addition to surgery, furthermore, the help of speech therapists, otolaryngologists, pediatricians, a neurologist and many other specialists is needed to restore impaired functions and prevent the emergence of new complications.

Before the operation in newborns, the act of breast sucking is difficult, therefore special obturators are used for them, which allow to avoid throwing food and liquids into the nasal passages.

Of course, surgery requires a lot of experience of surgeons in the maxillofacial department, since the oral cavity of the baby is small, which makes it difficult to perform a surgical procedure. In this case, preference is given to veloplasty when the soft palate is sewn. Such an operation is allowed at 8 months of age.

In some cases, surgical treatment is carried out with the help of several operations. Depending on the severity of the developmental anomaly, surgical intervention can be performed after a year or at the age of 5-7 years.

After the first operation, there will be a marked improvement, which will allow normalizing the process of breathing and digestion. In the future, with the help of plastic, a visual defect is eliminated, which increases the self-esteem of the baby. However, after the operation, a speech therapist, dentist, and otolaryngologist is required to treat those complications and impaired functions that were caused by this pathology.

Operation with a wolf mouth

In order to restore the normal structure of the alveolar process and the lips, plasticity of the palate is performed. Operation with a wolf mouth is performed no earlier than 6 months, and together with the rehabilitation process takes about 5 years. Operations are recommended to be carried out step by step, when the first surgical intervention provides elimination of the defect, which allows restoring the respiratory and digestive function, and further operations are necessary to correct the visual defect.

Timely treatment allows avoiding such serious complications as brain damage due to insufficient oxygen supply to tissues. After surgery, you need the help of a speech therapist, dentist, neurologist, ENT doctor and other narrow specialists to restore physiological functions.

The operation is carried out by the method of uranoplasty, in particular by the method of Limberg. This surgical intervention is considered the most effective for today. If, in addition to this pathology, there is such a defect as a hare lip, then the operation is performed by the method of cheyloplasty.

A positive effect of uranoplasty is observed in 95% of patients. In the postoperative period, you should observe bed rest for the first few days, eat crumbled food and drink plenty of alkaline liquid. Using a solution of potassium permanganate, rinse the mouth after eating. It is also necessary to inflate balloons 3-4 times a day, and starting from the third week - to conduct a special set of exercises and perform a soft-sky massage.

To prevent infection of a postoperative wound, it is necessary to take 7 days of antibacterial drugs, and to reduce the severity of the pain syndrome - pain medication. After uranoplasty, a scar may remain on the face.

Prevention of wolf mouth

Effective prevention of wolf mouth has not been developed, as there are no methods that would affect the genetic information. However, with the help of some recommendations it is possible to reduce the risk of developmental anomaly in the baby.

When planning pregnancy, a woman is recommended to undergo a thorough examination to determine the available contraindications. This applies to infectious diseases, as well as organ pathology, which can have a negative impact on fetal development.

Before pregnancy, folic acid should be taken at a dosage of 400 mcg, and at the onset of pregnancy, the dose should be increased to 600 mcg.

A prerequisite is the refusal to take medicines that are prohibited during pregnancy. If a woman needs constant intake of any medications, for example, antihypertensive or hypoglycemic, the doctor should choose the optimal medicines and doses in order to avoid a negative effect on the fetus.

Prevention also consists in the refusal of alcoholic beverages, narcotic drugs and smoking. In addition, a woman should pay more attention to outdoor walks, avoid stressful situations and sleep enough.

Forecast of the wolf mouth

In most cases, the prognosis of the wolf mouth is favorable, provided that surgical intervention is performed. Thus, the defect in the sky is closed and the respiratory and digestive function is restored. Further treatment is required for a speech therapist, ENT doctor, neurologist and dentist to eliminate complications that have been associated with an anomaly of development.

Of course, the treatment course takes more than one year, but in the end the child becomes the same as his peers, which increases his self-esteem. The first operation eliminates the defect, and the subsequent operations are aimed at correcting visual anomalies.

If a wolf's mouth is detected in the process of pregnancy, the fetus should be reassured by the future mummy and explained that the defect is easily eliminated and that the prognosis is favorable. Even in the case of a combined pathology with a hare lip, all the same, with the help of surgical intervention, the baby will not differ from the other children, either physically or mentally.

The cleft palate is not a threat to the life of the baby, provided timely treatment and assistance in the process of labor. This developmental anomaly requires a special treatment approach for 5 years, which ultimately provide the desired result.

[10], [11], [12], [13]