Free Facial Deformities and Cleft Palate Lip Surgeries
- Identifies children with facial deformities such as cleft palate, cleft lip through our mobilization camps in Taluks and villages
- Screens and treats them with a team of specialized doctors and surgeons in reputed hospitals in Bangalore, India
- The treated children will be followed up for prognosis and other need based treatments such as speech therapy.
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Prof. Dr.N. Srinath
BDS, MDS, FDSRCS (ENG), AAAM, IBOMS
Oral Maxillo Facial Surgeon
Dr. N. Srinath is a consultant Faciomaxillary surgeon of Trinity Care Foundation, Bangalore, India.
His area of expertise includes treatment of facial trauma, tumours, dental implants, birth defects like cleft lip and palate, growth abnormalities (orthognathic surgery), cosmetic surgery for age related changes, sleep apnea and TMJ disorders. Has been actively involved in cleft and facial plastic surgery for past 20 years and has treated more than 8000 cases.
Dr. N. Srinath is currently involved in postgraduate training and has various national and international publications to his credit. He acquired his masters in Oral and Maxillofacial surgery from Mangalore University and Fellowship from Royal College of surgeons, U.K., He has undergone training in UK, US and Germany for various facial reconstructive and aesthetic procedures.he has been an active clinician and academician for the past 20 years.
Cleft Lip and Cleft Palate Treatment
Cleft lip (split of the upper lip) and Cleft palate (split of the roof of the mouth) are common congenital deformity. It occurs when the separate areas of the face that develop individually and then join together, do not join properly. Cleft lip is a separation of the two sides of the lip and often includes the bones of the maxilla and/or the upper gum. Cleft palate is an opening in the roof of the mouth. It occurs when the two sides of the palate do not fuse as the unborn baby develops.
A unilateral cleft lip occurs on one side of the upper lip. A bilateral cleft lip occurs on both sides of the upper lip. In its most severe form, the cleft may extend through the base of the nose.
According to the studies every Year 35,000 cleft children are born in India (that is 1:800 births). Cleft Lip and palate is a disorder affecting millions of children around the world. It affects a child’s appearance, speech, teeth, eating, hearing and their ability to develop socially. Each of these issues may be noted at different ages, i.e., difficulty feeding and middle ear dysfunction are infant and early childhood issues. Children with cleft lip and palate cannot be breast-fed. This is because the oral and nasal areas are joined together due to the cleft palate. While eating, food comes out through the nose again as soon as the child swallows. Speech difficulties present themselves when the child reaches approximately two years of age. Repair of these problems is not only important medically, but also cosmetically and emotionally, since the child’s speech and physical appearance is impaired, which may lead to social isolation.
Cleft deformities often occur without any previous family history. Whether the defect is inherited is still under investigation. The cause can also be malnutrition, genetic and environmental factors. Among the factors that are known to increase the risk of a child’s developing CLP are smoking or drinking by the mother during pregnancy. On the other hand, the mother’s intake of folic acid and vitamin B6 are believed to reduce the risk of CLP. It is possible to diagnose CLP by ultrasound examination late in the first trimester or early in the second trimester of pregnancy.
Ideally, children with cleft lip and palate should be treated by a multidisciplinary specialist “cleft team” that may include surgeons, speech and language therapists, audiologists (hearing experts), dentists, orthodontists, psychologists, geneticists and specialist cleft nurses. Care and support of your child and the family should last from birth until your child stops growing at about age 18. The timing of surgery varies, but usually an operation to close the gap in the lip will be done about three months after the baby is born. Surgery to close the gap in the palate is usually done at about six months. As your child grows older, further surgery may be needed to improve the appearance of the lip and nose and the function of the palate. If there is a gap in the gum, a bone graft will normally be done when your child is between 9 and 12 years old. This will help their second teeth to anchor properly into the gum. Bone is usually taken from the hip or shin and grafted into the gap in the gum.
For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 3month old). This will be decided by your child’s surgeon. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 6 to 18 months. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child’s physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.
If you have had a child with a cleft lip or palate, you may be offered genetic counseling to find out the chances of your next child being affected. However, in most cases the most sensible approach is simply to aim to have a healthy pregnancy. Smoking and drinking alcohol have been shown to increase the risk of babies being affected, and can cause other birth defects.
There are different types of facial deformities
- Hearing Restoration
- Cleft Lip/Cleft Palate
- Facial Palsy
- Hemifacial Microsomia
Microtia means a small, abnormally shaped or absent external ear. It can occur on one side of the head (unilateral) or on both sides bilateral). The unilateral form is much more common, occurring in approximately 90 percent of patients, mostly males, and on the right side more often than on the left. Microtia occurs once in every 4,500 births in the general population; bilateral Microtia occurs once in every 18,000 birth.
The causes of Microtia are difficult to define. Some theories point toward a decrease in blood supply to the developing ear in utero. Others involve certain medications taken by the mother during pregnancy, such as Accutane, Thalidomide, and retinoic acid. Environmental factors have also been considered.
Children born with ear deformities often suffer hearing loss due to the absence of their ear canals and/or middle ear structures. The impact of hearing loss on the child’s speech and language development has been well documented. Children born with both ears deformed need immediate attention and hearing rehabilitation in order to avoid the devastating effects of early deafness on their growth and development. They are immediately fitted with a bone-conduction hearing aid until they are of age to undergo more-definitive therapy. Children born with one normal ear and one deformed ear are rehabilitated from age five and on. The need of both ears in sound localization and better speech understanding in noise is well proven. While children with one good ear may do well with preferential seating in school, restoring and recovering hearing from both ears is far superior.
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A child with facial palsy cannot smile or laugh, or express any facial movement. The act of facial motion starts in the brain and travels through the facial nerves to the muscles in the face. The coordinated activity of this nerve and these muscles cause motions such as smiling, blinking, frowning, and a full range of normal facial motions. The absence of these will make him expressionless.
Diseases of injuries affecting the brain, the facial nerve, or the muscles of the face can cause facial palsy. Facial paralysis can be caused in children by the failure of the brainstem nuclei to develop a trauma to the nucleus of the facial nerve, and tumors or trauma to the facial nerve.
Hemifacial microsomia (HFM) is a condition that affects bone, muscle, fat and nerves of the face. The deformities in HFM are on a spectrum from a mild presentation with slight asymmetry to severe with absence of facial structures. This condition is progressive and becomes more apparent as the individual grows.
HFM is the second most common facial deformity. It occurs in approximately 1 in every 5600 births. The cause is unknown.
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The word craniofacial is derived from the word cranio, referring to the skull or cranium, and facial, referring to the face. Anomaly is the medical term meaning “irregularity” or “different from normal.” Craniofacial anomalies are a group of deformities involving the growth of the head and facial bones. These anomalies are congenital (present at birth) and vary
in type and severity.
Experts agree that many factors contribute to the development of craniofacial anomalies. Some craniofacial anomalies are a result of genetic mutations (multiple genes are inherited from both parents). Other craniofacial anomalies may be a result of environmental factors, which scientists do not completely understand.Research studies continue to focus on the normal gene and how a genetic mutation results in different anomalies. New methods of gene therapy are currently being developed.
Over the past several years, plastic and craniofacial surgeons have developed new surgical techniques and interventions for the care of the child with a craniofacial anomaly. Children with craniofacial anomalies often have multiple problems that require the expertise of a multidisciplinary team. The multidisciplinary team provides for the medical, physical, and
psychosocial needs of the child and the family.
What causes craniofacial anomalies?
Most medical professionals agree that there is no single factor that causes these types of abnormalities. Instead, there are many factors that may contribute to their development, including the following:
- Combination of genes
A child may receive a particular combination of gene(s) from one or both parents, or there may be a change in the genes at the time of conception, which results in a craniofacial anomaly.
There is no data that shows a direct correlation between any specific drug or chemical exposure causing a craniofacial anomaly.However, any prenatal exposure should be evaluated.
- Folic acid deficiency
Folic acid is a B vitamin found in orange juice, fortified breakfast cereals, enriched grain products, and green, leafy vegetables. Studies have shown that women who do not take sufficient folic acid during pregnancy, or have a diet lacking in folic acid, may have a higher risk of having a baby with certain congenital anomalies, including cleft lip and/or cleft palate.