Cleft Lip & Palate

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Cleft Lip & Palate Treatment Surgery in India
An overview by India Dental Clinic and listing information of cleft lip & palate treatment surgery centers in India and maxillofacial dental surgery hospitals performing cleft lip palate surgery in India. Affordable cost of cleft lip palate surgery in India encourages patients to go in for treatment. Cleft Lips and Palate is one of the most common of birth (genetic) defects in which tissues of mouth or lips don't form properly during fetal development. The lip and palate openings are normally present in early fetal development. The lip usually closes by 5 to 6 weeks after conception and the palate by 10 weeks. These defects can happen as cleft lip with or without cleft palate, or an isolated cleft palate. Cleft lip or cleft palate, which means the two halves of the palate or lip didn’t join up properly, leaving an open space or ‘cleft’. Other areas of the mouth that may fail to properly join include the soft palate, which is located at the back of the roof of the mouth, and the nostril. The cleft can occur on one side of the face only (unilateral) or on both sides (bilateral). Clefts are sometimes associated with other types of birth defects. There is estimated prevalence of 1 child in 700-800 birth range with this defect. These estimates, however, vary widely according to gender and ethnicity. However, gender seems to play a role in the etiology of oral clefts as well, since males predominate by a 2:1 ratio for Cleft Lip/Palate and females predominate by a ratio of 3:2 for Cleft Palate.

The understanding you get at dental clinics in India that the causes for genetic disorder of clefts have not yet been conclusively understood, though much progress has already been made in its surgical correction by an oral & maxillofacial surgeon. It is important to distinguish between syndromic and nonsyndromic oral clefts. Syndromic cases are due to unknown causes, genetic abnormalities, or teratogenic effects. Most nonsyndromic oral clefts, however, are due to a complex interaction of genes and environmental factors. Despite decades of research, the genes and environmental factors proposed to be involved in oral clefts causation are still a matter of controversy and discussion. No single gene or environmental factor has yet proven unequivocally to cause nonsyndromic oral clefts. There are no specific guidelines which define nonsyndromic oral clefts, although there is sufficient agreement among clinicians to state that nonsyndromic oral clefts are those which are associated with no or one major anomaly or those clefts associated with two or fewer minor anomalies.

Complications Related to Oral Clefting
There are a number of problems that a child with a cleft lip or palate may encounter.  The child may be more susceptible to speech defect, hearing loss and colds, besides dental problems like malformed or displaced teeth, and missing or even extra teeth being common. Many children with clefts are especially vulnerable to ear infections because their Eustachian tubes don't drain fluid properly from the middle ear into the throat. For this reason, a child with cleft lip or palate may have special tubes surgically inserted into his or her ears at the time of the first reconstructive surgery. The most immediate problem caused by a cleft lip or palate is likely to be difficulty with feeding. Many babies with a cleft lip can breastfeed. A cleft lip can make it more difficult for a child to suck on a nipple, while a cleft palate may cause formula or breast milk to be accidentally taken up into the nasal cavity. Special nipples and other devices can help make feeding easier. There are bottles and teats designed especially for use by babies with cleft conditions. In some cases, however, such a child may need to wear a prosthetic palate called an obturator to help him or her eat properly. Occasionally, cleft palate may also affect the growth of the jaw and the development of the teeth.

Treating Clefts
With advancements in the various medical fields, the treatment of oral clefting has also seen much progress. Today, reconstructive surgery can repair cleft lips and palates, and in severe cases, plastic surgery can address specific appearance-related concerns. A team of specialists treats the child with clefting condition. A craniofacial team members of a child's cleft lip and palate treatment usually include an oral surgeon; an orthodontist; a pediatric dentist; a geneticist; a plastic surgeon; an ENT physician (otolaryngology); a speech pathologist (often called a speech therapist); an audiologist; a nurse coordinator; a social worker and/or psychologist. The team specialists will evaluate your child's progress regularly, examining your child's hearing, speech, nutrition, teeth, and emotional state. They will share their recommendations with you, and can forward their evaluation to your child's school, and any speech therapists that your child may be working with.

Cleft Lip & Palate Surgery India
The surgery for cleft lip and/or palate is usually performed 12-18 months of birth by oral & maxillofacial surgeon. If the hemoglobin is very good, the surgery may be performed as early as 3 months for cleft lip and 6 months for cleft palate. The surgery is mostly performed in hospital setting under general anesthesia. Cleft lip often requires only one reconstructive surgery, especially if the cleft is unilateral. The oral surgeon will make an incision on each side of the cleft from the lip to the nostril. The two sides of the lip are then sutured together. Bilateral cleft lips may be repaired in two surgeries, about a month apart, and usually requires a short hospital stay.

Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It requires 2-5 nights in the hospital, with the first night spent in the intensive care unit. The initial surgery is intended to create a functional palate, reduce the chances that fluid will develop in the middle ears, and help the child's teeth and facial bones develop properly. In addition, this functional palate will help your child's speech development and feeding abilities. Some children with a cleft palate require more surgeries to help improve their speech. Additional surgeries, each at least 6 months apart, may also improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. A plastic surgeon may be involved in the final repairs of the scars left by the initial surgery. However, it may not be performed until adolescence, when facial structure is more fully developed. Surgery is designed to aid in normalizing function and cosmetic appearance so that the child will have as few difficulties as possible. If there is a gap in the gum, a bone graft may be used to fill it at around 10 years of age.

Dental Care and Orthodontia India for Cleft Lip & Palate
The dental care needs for a cleft lip & palate child are no different from the normal child. The need for dental treatment and/or orthodontic care may be necessary to help align the teeth and take care of any gaps that exist because of the cleft. Healthy gums and teeth are critical for a child with clefting because they're needed for proper speech. The oral hygiene is equally important, for which the dentist may recommend a toothette, a soft sponge that contains mouthwash, rather than a toothbrush. As your child grows, you may be able to switch to a soft children's toothbrush.

In the growing stage, orthopalatal expansion may be required in which the upper dental arch is rounded out and the width of the upper jaw is increased. A device called an expander is placed inside the child's mouth. The widening of the jaw may be followed by a bone graft in the alveolus. In few of the cases the upper jaw growth does not keep up with the lower jaw growth. If this occurs, your child may need orthognathic surgery to align the teeth and help the upper jaw to develop; an operation called an osteotomy on the upper jaw may be needed to move the upper jaw both forward and down. This usually requires another bone graft for stability. If any extractions have been involved in the course of treatment, dental implants may be considered after child has fully grown up.

Speech, Emotional and Social Issues
After the surgery has fixed the clefting problem, a child may still have trouble speaking; the clefting can make the voice nasal and difficult to understand. A speech therapist/pathologist will analyze and help determine what, if any, speech exercises your child needs. Besides advice from psychiatric and emotional support personnel, encourage your child to develop friendships with people from diverse backgrounds. The best way to do this is you lead by example and help the child to be open to all people.

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