Splitting of the soft palate: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Splitting of the soft palate occurs in the absence of fusion of embryonic rudiments of the soft palate. The palatine plates fully fuse along the middle line, which is realized in various defects of the soft palate - from the most insignificant, for example, in the splitting of only the uvula bifida, to the complete cleavage of the soft palate, often exciting and firm palate, and even the upper jaw ("wolf" mouth ") and the upper lip (" hare lip "). 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 take their own breast, so they are fed with a spoon or an elongated nipple. Due to the fact that a large amount of liquid is poured through the nose into the nose, the feeding of such a child is delayed by hours so that it receives the necessary amount of nutrients. The process of lactation in the mother is rapidly depleted because of the lack of its reflex stimulation by the sucking process. Children with a wolf's maw considerably lag behind in development and quite often do not live up to 1 year. The development of phonation in these children differs significantly from the norm: they can not pronounce the closing sounds, for example consonants n, t, k, they have a pronounced nasal effect when pronouncing the consonants n and m. As a result of the fact that the nasal cavity remains constantly open from the side oral cavity, the pronunciation of the closing sounds, especially b, c, d, is accompanied by an air outlet through the nose.
Treatment of cleft palate. The treatment of cleft palate cleavage is only surgical and is the prerogative of maxillofacial surgeons, therefore we will focus only on some general provisions of this treatment. The method of surgical intervention depends on the size of the cleft and all forms. The most successful interventions are realized with narrow and short crevices, handling U-shaped soft-sky defects meets significant difficulties. Operative intervention is advisable to produce 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 made to an adult, then the phonetic defect is practically not corrected.
As one of the variants of the soft palate plastic for this defect, we give the Trelew technique. Local anesthesia, application and infiltration. The incision of the mucosa is made around the defect, receding from its edge by 1-2 mm. One of the halves of the tongue (then the other) is pulled upward with an anatomic forceps to the arch of the oral cavity. Separate the mucosa from the oral and pharyngeal surface (from both sides) from the muscular layer of the tongue. Then, laxative incisions are made along the internal alveolar margins; stop bleeding from the palatine arteries. Next, two flaps are removed and mobilized: one from the mucous membrane of the nasopharynx, the other from the mucous membrane of the oropharynx, and the muscle layer lies between them. Thus, for the subsequent plasty of the soft palate, a three-layer flap is prepared on both sides: an inner layer (nasopharyngeal) of the mucosa, the middle layer - the muscular and external oropharyngeal as well as the inner one, from the mucous membrane. Then the defect is layer-by-layer closed. First, the seams are applied to the inner layer, bringing the apex of the split tongue together. The first stitch is placed on the tip of the tongue, the rest on the adjacent edges of the nasopharyngeal flaps of the mucosa, while the nodes must be located in the nasopharyngeal cavity. Then, suture the muscle grafts with two or three catgut sutures, and it should be borne in mind that the success of the operation depends on the quality of the muscular flap joint. Complete the operation by applying sutures to the mucous membrane of the oropharynx. In the remaining incisions along the sides of the alveolar processes insert turuns, impregnated with antibiotic solution, in order to maintain the position of the close and sewn edges of the flaps.
In the postoperative period within 2 weeks irrigation of the nasal cavity and mouth is made with weak solutions of disinfectants and a liquid diet is prescribed. Nasopharyngeal sutures are removed spontaneously, the sutures from the oral cavity, like tampons, are removed on the 8th-10th day after the operation. There are other methods of plastic cleft palate.
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