Cleft palate

Japanese: 口蓋裂 - こうがいれつ（英語表記）Cleft palate

What is the disease?

A cleft palate is a defect in the mouth and nose. Distance ( Heda ) On the roof of the mouth crack ( Crack ) This is a disease in which the palate is born with the palate (Figure 10). protrusion ( Tokki ) The palate is formed when two tissues join together from the left and right sides. The palate is formed around the 8th to 12th week of pregnancy, but if an abnormality occurs during this process, the result is a cleft palate.

What is the cause?

In addition to genetic factors, it is thought to occur due to a complex interaction of factors that hinder the baby's normal development in the mother's womb. For example, at around 10 weeks of pregnancy, the tongue is present between the palatine processes, but as the lower jaw grows, the tongue moves downward and the palatine processes stick together.

However, if the lower jaw is too small, the tongue will remain between the palate processes. Intervention ( Kaizai ) And the palatine process Healing ( Yugo ) This can prevent the gums from coming together, resulting in a cleft palate. In such cases, a wide, U-shaped cleft palate is seen.

How symptoms manifest

There are various types of cleft palate depending on the severity. Soft palate ( What kind of ) There is a cleft only in the back part of the palate called the palate roof, Mucous membrane ( Year ) In some cases, the palate is normal, but the muscle is torn (called submucous cleft palate).

Treatment methods

It is difficult for babies with cleft palate to drink directly from their mother's breast. We recommend feeding them with an artificial nipple for cleft palate. If the cleft is large, we recommend using a hotspot. floor ( Sho ) It is called Baby bed ( Prescription ) Place the (plastic plate) in your mouth.

Taking into consideration the development of language, cleft palate surgery is generally performed around 12 to 18 months of age. However, early surgery, depending on the surgical method, may hinder the growth and development of the upper jaw and cause problems with the alignment of the teeth. For this reason, some facilities perform two-stage surgery in which the soft palate is closed at around 12 months of age and the hard palate is closed at around 18 months of age. Speech therapy is necessary after surgery. In addition, babies with cleft palate Serous otitis media ( Graduate school ) and require follow-up by an ENT specialist.

What to do if you notice an illness

While obvious clefts in the palate are easy to diagnose, submucous cleft palate can be easily overlooked. If your baby has poor feeding or a nasal sound, seek professional medical attention.

What you need to know as a patient

As mentioned in the section on cleft lip and palate, in addition to surgery, speech therapy, otolaryngology, correction ( Resilience ) Team medical care, including dentistry, is required.

Juntaro Nishio

Figure 10. Cleft palate types
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Figure 10. Cleft palate types

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　口蓋裂とは口と鼻を隔(へだ)てている上あご（口の蓋）に亀裂(きれつ)が生じて生まれてくる病気のことをいいます(図10)。口蓋は口蓋突起(とっき)という組織が左右からくっついて形成されます。妊娠8～12週ごろに口蓋が形成されますが、その過程で異常が起これば口蓋裂となります。

原因は何か

　遺伝的要因に加えて、赤ちゃんが母親の胎内で順調に発育していく過程を妨げようとする要因が複雑に作用して発生すると考えられています。たとえば、妊娠10週ごろには舌が口蓋突起の間に存在していますが、下顎が大きくなり舌が下方に移動して口蓋突起がくっつきます。

　しかし、下顎が過度に小さい場合には口蓋突起の間にいつまでも舌が介在(かいざい)して口蓋突起の癒合(ゆごう)（くっつくこと）を妨げ、口蓋裂が発生する場合があります。このような場合にはU字型の幅広い口蓋裂がみられます。

症状の現れ方

　口蓋裂にも程度によっていろいろな型があります。口蓋全体が切れている場合や、軟口蓋(なんこうがい)と呼ばれる口蓋の奥の部分だけに裂があったり、口蓋の粘膜(ねんまく)は正常ですが筋肉が切れている場合（粘膜下口蓋裂といいます）などがあります。

治療の方法

　口蓋裂の赤ちゃんでは、おかあさんのおっぱいを直接飲むことは困難です。口蓋裂専用人工乳首による哺乳をすすめます。また、裂が大きい場合にはホッツ床(しょう)と呼ばれる哺乳床(ほにゅうしょう)（プラスチックのプレート）を口にはめます。

　言語の発達面を考慮して口蓋裂の手術はおおむね生後12～18カ月ごろに行います。しかし、早期に手術をしますと、手術の方法によっては上顎の成長発育を妨げ、歯の噛み合わせが悪くなる場合があります。そのため、軟口蓋部を12カ月ごろに閉鎖し、18カ月ごろに硬口蓋を閉鎖する二期的手術を行う施設もあります。手術のあとは言語治療が必要です。また、口蓋裂の赤ちゃんは滲出性中耳炎(しんしゅつせいちゅうじえん)を引き起こす場合が多く、耳鼻咽喉科によるフォローアップが必要です。