The palatal cleft, also known as wolf’s throat or cleft palate as it is popularly called, is a congenital malformation that occurs while still inside the mother’s womb during fetal development. It can affect the entire length of the roof of the mouth up to the base of the nose, leaving an open channel between them. In addition to the opening, there can also be a split in the uvula (the soft tissue at the back of the throat). This cleft occurs more frequently in female children, unlike cleft lip, which affects more boys. During pregnancy, it is already possible to detect the presence of a palatal cleft, but only after birth can any treatment or intervention be performed. The palatal cleft occurs due to the improper closure of the craniofacial structures. Therefore, once discovered, the best course is to stay calm and prepare for all procedures after the baby is born.
IMPORTANT: This malformation typically occurs between the 4th and 12th week of gestation. It can be clearly seen through ultrasound scans as the pregnancy progresses, most accurately in the second trimester.
What Causes Palatal Cleft?
The real cause of palatal cleft is still unknown, but medicine points to strong indications of genetic and environmental factors, such as:
- Family history of clefts
- Nutritional deficiencies
- Exposure of the pregnant woman to radiation
- Illnesses during pregnancy
- Certain medications
- Alcohol consumption
- Use of cigarettes and drugs
Cases of palatal cleft are also linked to the age of the parents, having abdominal x-ray exams during pregnancy and the use of anticonvulsants or corticosteroid-based medications during the first trimester, the time when the baby is in complete formation. In some cases of palatal cleft, it can also cause physiological changes affecting the eustachian tube and leading to hearing problems in the child. Due to velopharyngeal insufficiency, the child may also have speech difficulties. The deformation caused by palate cleft does not only affect the child’s appearance, but impacts nutritional, hearing, respiratory, dental, and especially emotional and social factors. As soon as they are born some babies with a palatal cleft cannot feed and suck breast milk normally. Therefore, they are fed with spoons or bottles. For those who can breastfeed, they usually nurse for a shorter time because the air intake makes them feel full more quickly. Thus, they get hungry sooner and feed more often than usual.
Treatment
Treatment requires a specialized medical team that works together, such as a speech therapist, dentist, an otolaryngologist, and a plastic surgeon. The corrective surgery for palatal cleft is recommended only from age 2 and is performed in stages. Since this is a delicate repair aiming to correct both the bone and muscle parts of the face and to ensure proper breathing, the procedures are carried out meticulously. Surgical repair also focuses on preventing the child from developing a nasal-sounding voice.
Surgery
Usually, the first step of the repair surgery is the bone palate, which is elongated so that the remaining treatment and closure can be continued. During the entire reconstruction process, the child receives an orthodontic appliance that allows for adequate feeding and also covers the palatal cleft. Right from birth, the entire initial treatment plan is put in place and will be complemented and adjusted as the child’s needs and functional problems arise. These problems will occur as the child grows, so the support of a speech therapist is extremely important for speech rehabilitation from the beginning. After all bone and muscle repair, plastic intervention is performed, leaving the child with a small scar. If the proper treatment is followed, the child can have a normal life, feed and speak normally, and participate socially just like any other child. Surgical repairs must be performed at the appropriate time, not too early to avoid interrupting bone development, but not too late so as not to affect the child’s speech.
Duration
The success of the treatment will depend on the professionals and on the dedication of the parents to regular follow-up. The palatal cleft can cause phonetic, orthodontic, chewing, and even hearing issues, but in general, there is treatment for all of them. The treatment is lengthy and is only completed on average around 18 years of age, when all the facial bone structure has consolidated. Throughout these years, follow-up with all related specialists is essential. There is no way to prevent it, except by avoiding risk factors such as unnecessary exams, alcohol, smoking, drugs, and improper medications during pregnancy. Also see: Cleft Lip – What It Is and Why It Happens Photo: King97tut