Diagnosis of submucosal cleft palate by an otorhinolaryngologist
- Authors: Andreeva I.G.1, Tokarev P.V.1, Marapov D.I.2, Andreev N.A.3
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Affiliations:
- Children’s Republican Clinical Hospital
- Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education
- Chain of Dental Clinics “Dens”
- Issue: Vol 30, No 1 (2024)
- Pages: 35-41
- Section: Original study
- Submitted: 28.03.2024
- URL: https://journals.eco-vector.com/2310-3825/article/view/629561
- DOI: https://doi.org/10.33848/fopr629561
- ID: 629561
Cite item
Abstract
BACKGROUND: A hidden or submucosal cleft palate is a rare form of isolated clefts characterized by damage to the speech-producing structures of the articulatory apparatus with intact mucous membrane of the palate. Patients with submucosal cleft palate require special attention from an otorhinolaryngologist because this anatomical malformation leads to middle ear damage and significantly affects the hearing and quality of life of patients.
AIM: To determine additional diagnostic criteria for submucosal cleft palate and identify CT markers of submucosal cleft palate, to assess its impact on the function of the middle ear.
MATERIALS AND METHODS: The study included 16 patients with submucosal cleft palate who underwent examination and treatment at the Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan.
RESULTS: Their median age at diagnosis was 6.5 (range, 3–13) years, and 62.5% of the cases were first suspected by an ear–nose–throat specialist. During the initial examination, a significant decrease in hearing was already noted in 14 (87.5%) patients, otitis media with effusion in the mucosal stage in 21.9%, adhesive otitis media in 21.9%, and chronic otitis with cholesteatoma in 18.8%. Frequent purulent otitis media were observed in the anamnesis in 56.3% of patients (n = 9), and frequent rhinosinusitis in 87.5% (n = 14). Non-partial adenotomy was performed at the place of residence in 5 patients (31.3%), which aggravated rhinolalia. In 62.5% (n = 10) submucosal cleft palate was compensated and rhinolalia was not observed. Three CT markers of submucosal cleft palate were revealed: a wedge-shaped defect in 3D skull reconstruction, a defect of the palatine bone and a shortened vomer in the coronal projection, and displacement of the posterior nasal spine in the sagittal projection.
CONCLUSIONS: Cases of submucosal cleft palate demonstrate the need for ear–nose–throat specialist and pediatricians to know this pathology in order to conduct timely and correct comprehensive rehabilitation of patients.
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About the authors
Irina G. Andreeva
Children’s Republican Clinical Hospital
Author for correspondence.
Email: arisha.andreeva2008@mail.ru
ORCID iD: 0000-0001-9669-2707
MD, Cand. Sci. (Medicine)
Russian Federation, KazanPavel V. Tokarev
Children’s Republican Clinical Hospital
Email: facesurg@yandex.ru
ORCID iD: 0000-0003-2439-5492
MD, Cand. Sci. (Medicine)
Russian Federation, KazanDamir I. Marapov
Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional Education
Email: damirov@list.ru
ORCID iD: 0000-0003-2583-0599
MD, Cand. Sci. (Medicine)
Russian Federation, KazanNikita A. Andreev
Chain of Dental Clinics “Dens”
Email: nikitosandreyev1990@gmail.com
ORCID iD: 0000-0002-1071-0896
Russian Federation, Kazan
References
- Leslie EJ, Marazita ML. Genetics of cleft lip and cleft palate. Am J Med Genet C Semin Med Genet. 2013;163C(4):246–258. doi: 10.1002/ajmg.c.31381
- Rahimov F, Jugessur A, Murray JC. Genetics of nonsyndromic orofacial clefts. Cleft Palate Craniofac J. 2012;49:73–91. doi: 10.1597/10-178
- Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011;12:167–178. doi: 10.1038/nrg2933
- Kasimovskaya NA, Shatova EA. Congenital cleft lip and palate in children: Prevalence rate in Russia and worldwide, risk factors. Current Pediatrics. 2020;19(2):142–145. EDN: KLJAJX doi: 10.15690/vsp.v19i2.2107
- Inoyatov ASh, Saidova MA, Shodmonov KE. The analysis of factors of the congenital defects of maxillofacial area promoting development. Vestnik Soveta molodykh uchenykh i spetsialistov Chelyabinskoi oblasti. 2016;3(4):51–55. EDN: XHUDFL
- Mardanov AE, Smirnov IE, Mamedov A.A. Congenital cleft of the lip and palate in children: pathogenetical significance of matrix metalloproteinases. Russian pediatric journal. 2016;19(2):106–113. EDN: WAAPCZ doi: 10.18821/1560-9561-2016-19(2)-106-113
- Mamedov Ad.A. Congenital cleft palate and ways to eliminate it. Moscow: Detstomizdat; 1998. 309 p. (In Russ.)
- Bogoroditskaya AV, Sarafanova ME, Radtsig EY, Prityko AG. An otorhinolaryngologist’s view on the problem of children with submucous cleft palate. Medical Council. 2015;(15):72–75. EDN: VIBPBD doi: 10.21518/2079-701X-2015-15-72-75
- Boboshko MYu, Lopotko AI. Eustachian tube. Saint Petersburg: Dialog; 2014. 384 p. (In Russ.)
- Sharma RK, Nanda V. Problems of middle ear and hearing in cleft children. Indian J Plast Surg. 2009;42 (Suppl):S144–148. doi: 10.4103/0970-0358.57198
- Andreeva IG, Krasnozhon VN. Anatomical predictors for the development of otitis media with effusion in children with congenital cleft lip and palate. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2018;24(1):29–35. EDN: YULKQL
- Gyanwali B, Li H, Xie L, et al. The role of tensor veli palatini muscle (TVP) and levetor veli palatini [corrected] muscle (LVP) in the opening and closing of pharyngeal orifice of Eustachian tube. Acta Otolaryngol. 2016;136(3):249–255. doi: 10.3109/00016489.2015.1107192
- Heidsieck DS, Smarius BJ, Oomen KP, Breugem CC. The role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems. Clin Oral Investig. 2016;20(7):1389–1401. doi: 10.1007/s00784-016-1828-x
- Casselbrant ML, Mandel EM, Rockette HE, et al. Adenoidectomy for otitis media with effusion in 2-3-year-old children. Int J Pediatr Otorhinolaryngol. 2009;73(12):1718–1724. doi: 10.1016/j.ijporl.2009.09.007
- Bluestone CD. Studies in otitis media: children’s hospital of Pittsburgh University of Pittsburgh progress report–2004. Laryngoscope. 2004;114(11 Pt 3 Suppl 105):1–26. doi: 10.1097/01.mlg.0000148223.45374.ec
- Krasnozhen VN, Andreeva IG, Tokarev PV. Exudative otitis media in children with congenital cleft lip and palate. Rossijskaya otorinolaringologiya. 2018;(4(95)):121–127. EDN: XWPJGX doi: 10.18692/1810-4800-2018-4-121-127
- Djurhuus BD, Skytthe A, Faber CE, Kaare C. Cholesteatoma risk in 8,593 orofacial cleft cases and 6,989 siblings: A nationwide study. Laryngoscope. 2015;125(5):1225–1229. doi: 10.1002/lary.25022
- Harris L, Cushing SL, Hubbard B, et al. Impact of cleft palate type on the incidence of acquired cholesteatoma. Int J Pediatr Otorhinolaryngol. 2013;77(5):695–698. doi: 10.1016/j.ijporl.2013.01.020
- Andreeva IG. Diagnosis of submucosae cleft palate and its effect on the middle ear. In: Proceedings of the XI International Interdisciplinary Congress on Diseases of the Head and Neck Organs, 19-21 June 2023. Saint Petersburg; 2023. P. 84–85. (In Russ.) Available from: https://headneckcongress.ru/static/sbornik/tez.pdf
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