II.

Palatoschisis
Definition
Palatoschisis is congenital abnormalities caused by face developmental
disorders during the sixth and ninth weeks of pregnancy. A palatoschisis happens if
the tissue that makes up the roof of the mouth does not join together completely
during pregnancy. For some babies, both the front and back parts of the palate are
open. For other babies, only part of the palate is open.
Etiologies
The causes of orofacial clefts among most infants are unknown. Some children
have a cleft lip or cleft palate because of changes in their genes. Cleft lip and cleft
palate are thought to be caused by a combination of genes and other factors, such as
things the mother comes in contact with in her environment, or what the mother eats
or drinks, or certain medications she uses during pregnancy.
Research indicates that the genes a child inherits from their parents
occasionally makes them more vulnerable to developing a cleft lip or palate. A
number of genes have been identified that may be responsible. In some cases there is
a family history of clefts, although most children of parents with clefts will not
develop them.
Another potential cause may be related to nutrient deficiency during
pregnancy, chemicals exposure such as teratogenic drugs, and trauma. Cleft lip and
cleft palate may also occur as a result of exposure to viruses while the fetus is
developing in the womb.
Recently, CDC reported on important findings from research studies about
some factors that increase the chance of having a baby with an orofacial cleft:
o Smoking, women who smoke during pregnancy are more likely to have a baby
with an orofacial cleft than women who do not smoke.
o Diabetes, women with diabetes diagnosed before pregnancy have an increased
risk of having child with orofacial cleft, compared to women who did not have
diabetes.
o Use of certain medicines, women who used certain medicines to treat epilepsy,
such as topiramate or valproic acid, during the first trimester of pregnancy
have an increased risk of having baby with orofacial cleft, compared to

women who didnt take these medicines.

Types
o Incomplete cleft palate, a cleft in the back of the mouth in the soft palate.
o Complete cleft palate, a cleft affecting the hard and soft parts of the palate.
The mouth and nose cavities are exposed to each other.
o Submucous cleft palate, a cleft involving the hard and/or soft palate, covered
by the mucous membrane lining the roof of the mouth. May be difficult to
visualize.

Image 1. Types of cleft palate. A)Normal B&C)Incomplete cleft palate

D) Complete cleft palate

Image

2.

Submucous cleft palate

Image 2. Submucous cleft palate
Diagnosis
Cleft palate is not usually diagnosed during the ultrasound scan and are nearly
always diagnosed soon after birth. A physical exam of the mouth, nose, and palate
confirms the presence of cleft palate after a childs birth. However, some clefts such
as a submucous cleft palate, where the cleft hidden by the lining of the roof of the
mouth, may not be detected for several month or even years.
Treatment
A typical care plan timetable for cleft palate is described below:
o Following birth to six weeks: feeding assistance, support for parents, hearing
o
o
o
o
o
o

test and paediatric assessment

Six to 12 months: surgery to repair a cleft palate
18 months: speech assessment
Three years: speech assessment
Five years: speech assessment
Eight to 11 years: bone graft to the cleft in the gum area
11-15 years: orthodontic treatment and monitoring jaw growth

Complications
o Eating problems and high risk of aspiration, with separation or opening in the
palate, food and liquids can pass from the mouth back through the nose.
o Dental problem, children with clefts are more prone to a larger than average

number of cavities and often have missing, extra, malformed, or displaced

teeth requiring dental and orthodontic treatments. In addition, children with
cleft palate often have an alveolar ridge defect. A defect in the alveolus can be
(1) displace, tip, or rotate permanent teeth, (2) prevent permanent teeth from
appearing, and (3) prevent the alveolar ridge from forming. These problems
can usually be repaired through oral surgery.
o Ear infections, children with cleft palate are at increased risk of ear infections
since they are more prone to fluid build-up in the middle ear behind the
eardrum. If left untreated, ear infections can cause hearing loss. To prevent this
from happening, children with cleft palate usually needs special tubes placed
in the eardrums to aid fluid drainage, and their hearing needs to be checked
once a year.
o Speech problems, children with cleft may also have trouble speaking. The
palate plays an important role in helping child form sounds for speech. If a
cleft palate is not repaired with surgery, it will lead to speech problems when
the child is older. These childrens voices dont carry well, the voice may take
on a nasal sound, and the speech may be difficult to understand