CLEFT PALATE. Cleft palate is the re sult of failure of union, in embryo, of the ele ments of which the palate is composed. Cleft palate, including the velum uvula, hard palate and alveolar process, with harelip, either single or double, invariably is congenital.
Defects of the palate resulting from trauma or disease do not occur as frequently as con genital defects.
Every developing child, prior to the second month of gestation, has a cleft palate. A child who has a complete congenital cleft palate, has In the palate at birth, with rare exceptions, the normal amount of tissue, although it is not united in the middle line. It is cleft. Nature does not often fail to develop the necessary tissues to form a normal palate, but sometimes does fail to bring them into apposition and unite them. Cleft palate is not, therefore, with few exceptions, due to arrested development nor absence of palatal tissues, but, as the child's age advances, the arch spreads and the muscles, for want of proper activity due to the separa tion, fail to develop as the other muscles do that are normally employed.
There are, anatomically, 15 forms of cleft palate, some but slightly and others widely dif fering in deformity and treatment.
The simplest form is a cleft of the azygos uvula only. The most complicated form pre sents a complete cleft of the soft and hard palate; the vomer is separated from the hard palate; the premaxillary bones are not only separated from the hard palate, but often pro trude far beyond the tip of the nose, with the further complication of double harelip which sometimes, though rarely, extends to the eyes.
The nostrils are abnormally broad and fiat. In cases of single harelip and deft palate, the vomer is nearly always attached to the long side of the palate.
There are six centres of ossification in form ing a palate — two premaxillary, two maxillary and two palatal. These six bone centres carry with them other tissues, the soft parts consist ing of periosteum, mucous membrane, connec tive tissue, etc. All these centres are assembled during the formation of the palate, like a piece of machinery. If nothing interferes with the bones meeting and uniting, the palate will be normal. If, however, from any cause the bones fail to unite, the child will have a cleft palate, accompanied very frequently by harelip.
Cleft palate seriously interferes with degluti tion in a young infant. The child, consequently, is poorly nourished. The open palate makes it difficult for the child to draw its milk, and what little it may get often regurgitates through the nose. A cleft palate nipple used with the bottle, or artificial velum which is employed in conjunction with the breast, will enable the child to swallow its food without difficulty. The English author, Lawson Tait, has stated that the mortality of children who have cleft palate is so great by reason of their failure to secure proper nutrition, that an early operation is desirable.
Etiology of Cleft literature of this subject is voluminous and largely con jectural. Among the causes assigned are heredity, maternal pre-natal impressions, de fective nutrition during the early months of gestation, intervening mucosa in tooth enamel formation, uterine inflammation, venereal diseases and pressure. These causes may be divided into two classes: Predisposing and Exciting.