A.4. Discuss the pathophysiology of cleft lip and palate in neonates and in children older than 5 years.
Answer:
A cleft palate is responsible for some major physiologic disorders. The pharynx communicates extensively with the nasal fossae and the oral cavity. The complex mechanisms of swallowing, breathing, hearing (through the eustachian tube), and speech are therefore impaired.
The presence of a cleft lip and palate results in neonatal feeding difficulties. The neonate cannot suck because the cleft makes the creation of a negative pressure seal difficult. Breastfeeding can be impossible, and bottle-feeding is challenging. Without intervention, affected children suffer from growth difficulties or failure to thrive.
Children with a cleft palate have middle ear disease because abnormal anatomy of the nasopharynx adversely affects eustachian tube function. Chronic middle ear effusion produces varying degrees of conductive hearing loss and recurrent otitis. Nasal septation between food and air is absent, creating a nonphysiologic mixing chamber in the nasopharynx. Frequently, this is associated with chronic rhinorrhea which must be distinguished preoperatively from infection.
Secondary defects of tooth development, growth of the ala nasi, and velopharyngeal function (contact between the soft palate and the posterior pharynx for speech and swallowing) can also occur. Speech is typically nasal with an inability to generate the so-called plosives (p/k/d/t) and fricatives (s/f ).
The detrimental impact of orofacial clefts is seen at both the individual and societal levels, with high economic burden and increased morbidity and mortality at all ages, particularly in association with other syndromes. Psychological problems can be considerable as children approach school age and peer association.
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