Cleft – somamani

Introduction

Clefts of the lip and Palate were Considered

As marks of beauty

Supernatural Ability

Major life threatening abnormalities

The Patients With clefts Presents a Complex biologic, Sociologic and Psychologic Problem,

One Whose best Management Involves Several Disciplines.

AIM OF REHABILITATION OF CLEFT PALATE PATIENTS IS TO ENABLE HANDICAPPED

INDIVIDUALS TO ASSUME AN EFFECTIVE POSITION IN SOCIETY

What is Cleft Lip/Cleft Palate

In early Pregnancy different parts of the Baby’s face develops SEPARATELY

And then joins together. SOMETIMES THE PARTS DO NOT JOIN PROPERLY, Hence the baby is born with a CLEFT.

A cleft lip/and cleft palate are the most common craniofacial [ face and skull ]

Abnormalities which babies can be born with.

VEAU’S CLASSIFICATION:

TYPE 1: Defect of red portion of the lip ( Vermilion )

TYPE 2 : Clefts which include vermilion and a portion of the lip musculature Upto the nostril on Affected side but not including the floor of the nostril.

TYPE 3: Unilateral complete clefts involving the full thickness of the lip typically accompanied by a marked deformity of the nose.

TYPE 4: Bilateral clefts of the lip either partial, complete or in combination.

What are the causes of this condition

Exact causes of cleft are unknown

Research indicates two factors, namely

Genetic [ inherited from the family ] and Environmental

Factors [ events that happen just before or durning a pregnancy].

Factors affecting Cleft lip/and Cleft Palate

Genetically, it is family related which can either be inherited by siblings or can be a single

Occurrence.

Environmental factors include lack of knowledge, lack of adequate and immediate medical

Facilities, malnutrition, Lack of vitamin B and folic acid, Maternal illness, Tetatrogens in the

Work place, smoking, use of drugs and alcohol as well as infections in early pregnancy are

all factors that affect the above conditions.

Conditions and Syndromes

Around 15-30% of Clefts are caused by syndromes and additional medical condition.

A condition called PRS [ Pierre Robin Sequence ] is associate with Clefts. This is a rare

Congenital birth defect Where the baby has an underdeveloped jaw, backward displaced

Tongue and obstructive upper airways.

Edwards Syndrome is related to a chromosomal abnormality the affects many parts of the body abnormally.

Patau Syndrome is related to an extra chromosome T13 which is either in all the cells of the body or in just a few, hence the deformation of the body part.

Stickler Syndrome is a connective tissue disorder like the eyes [ cataracts, myopia and retinal detachment ] then there is hearing loss, early onset of degenerative joint disorders etc.

Common problems faced by the affected Population.

Cosmetic abnormality which affects the patient’s self esteem Difficulties with feeding the new born baby and eating solids later.

Ear Infections [ Repeated ] and hearing loss

Speech and Language delay

Dental Problems like, lack of , misplaced or extra teeth.

Coping With the Challenges of this medical condition.

Population with syndromes or condition are faced with further difficulties like

Congenital heart disease [ 1.4% ]

Treatments available

Ideal treatment is 3-6 months for cleft lip patients and 9-18 months for cleft palate Patients.

Surgical treatment called palatoplasty and Cheiloplasty are carried out on babies from the age of 3 month to 12 months [ Uk ], 6-14 month [ USA ], EU 3-17 Months and India 3-18 Months.

Success rate 68.8-70%

Average surgical costs between E2,419 -E4,032 in India , Uk – NHS based E150, USA – Insurance claim , EU $10,000-E-$13000 [ State health Insurance ].

CLEFT MANAGEMENT TEAM

Surgical Treatment

Demographics

1:700 babies are born with a clefts around the world, that is 1200 babies every year.

1:770 babies are born in India with clefts that’s around 35000 children [ populous]. It is more common in west India then East India.

Most high risk Incidences occur in Asian, Native American and Hispanic descent. Yemen and India have the highest rate of cleft and underweight patients.

Thia condition is less common in African and American Populations

Condition more prevalent in the male [ 64%] then in female [ 36%] Gender.