Soft palate cleft: causes, symptoms, diagnosis, treatment

Cleft soft palate occurs when the embryonic rudiments of the soft palate do not fuse. The palatine plates do not fuse completely along the midline, which is realized in various defects of the soft palate - from the most insignificant, for example, when only the uvula is split (uvula bifida), to a complete cleft of the soft palate, often affecting the hard palate and even the upper jaw ("cleft palate") and upper lip ("harelip"). These anomalies in the development of the upper jaw cause a number of significant functional disorders related to sucking, swallowing and phonation. Newborns are not able to latch on to the breast on their own, so they are fed with a spoon or an elongated nipple. Due to the fact that a large amount of liquid pours out through the nasopharynx into the nose, feeding such a child is delayed for hours so that he receives the necessary amount of nutrients. The lactation process in the mother is quickly depleted due to the lack of reflex stimulation by the sucking process. Children with cleft palate are significantly delayed in their development and often do not live to be 1 year old. The development of phonation in such children differs significantly from the norm: they cannot pronounce closing sounds, for example, the consonants n, t, k, they have a sharply manifested open nasal tone when pronouncing the consonants n and m. As a result of the fact that the nasal cavity remains constantly open from the side of the oral cavity, the pronunciation of closing sounds, especially b, v, g, is accompanied by the release of air through the nose.

Treatment of cleft soft palate. Treatment of cleft soft palate is only surgical and is the prerogative of maxillofacial surgeons, so we will focus only on some general provisions of this treatment. The method of surgical intervention depends on the size of the cleft and its shape. The most successful interventions are implemented with narrow and short clefts, the operation of U-shaped soft palate defects encounters significant difficulties. Surgical intervention is advisable to perform on a child between the 12th and 20th months of life, when he begins to speak. If the operation is performed later, when the child has formed certain distorted phonetic skills, then it is necessary to carry out specialized speech therapy and phoniatric rehabilitation of the speech function. If the operation is performed on an adult, then the phonetic defect is practically not amenable to correction.

As one of the options for soft palate plastic surgery for this defect, we present the Trele technique. Local, application and infiltration anesthesia. The mucous membrane is incised around the defect, 1-2 mm from its edge. One half of the uvula (then the other) is pulled upward with anatomical tweezers to the roof of the oral cavity. The mucous membrane is separated from the oral and pharyngeal surfaces (on both sides) from the muscular layer of the uvula. Then, relaxing incisions are made along the inner alveolar edges; bleeding from the palatine arteries is stopped. Then, 2 flaps are separated and mobilized - one from the mucous membrane of the nasopharynx, the other from the mucous membrane of the oropharynx, with a muscular layer located between them. Thus, for subsequent plastic surgery of the soft palate, one three-layer flap is prepared on both sides: the inner layer (nasopharyngeal) from the mucous membrane, the middle layer is muscular, and the outer oropharyngeal, like the inner one, is from the mucous membrane. Then the defect is sutured layer by layer. First, the sutures are applied to the inner layer, bringing together the tops of the split uvula. The first suture is applied to the top of the uvula, the rest - to the brought together edges of the nasopharyngeal flaps of the mucous membrane, while the nodes should be located in the nasopharynx cavity. Then the muscle flaps are sutured with two or three catgut sutures, while it should be borne in mind that the success of the operation depends on the quality of the connection of the muscle flaps. The operation is completed by applying sutures to the mucous membrane of the oropharynx. Turundas soaked in an antibiotic solution are inserted into the remaining incisions on the sides of the alveolar processes in order to maintain the position of the brought together and sutured edges of the flaps.

In the postoperative period, the nasal and oral cavity is irrigated with weak solutions of disinfectants for 2 weeks and a liquid diet is prescribed. Nasopharyngeal sutures are removed spontaneously, sutures from the oral cavity, like tampons, are removed on the 8th-10th day after the operation. There are other methods of plastic surgery for cleft soft palate.

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