CLEFT LIP AND PALATE

A cleft lip and or palate is a birth defect (congenital) generally of the upper part of the mouth. A cleft lip creates an opening in the upper lip between the mouth and nose and a cleft palate occurs when the roof of the mouth has not joined completely.
In sumatra, 1 of 300 children is born with cleft lip and or palate. children of Sumatra, a NGO created in 2002, has coordinated until now 60 operations in hospital and rehabilitation units in Medan, beneficiating from the special intervention of a western plastic surgeon for most severe cleft lip and or palate cases. In September 2007, 42 operations have been realized.

Causes
Causes of cleft lip and or palate are not well identified; nevertherless a combination of genetic and environmental factors may favor appearance of this congenital defect:

• Family history of facial clefts
• Alcohol and drugs abuse during first weeks of pregnancy.
• Vitamins lack (especially folic acid) during the first week of pregnancy
• Mothers with diabetes

Diagnosis
Because clefting causes specific physical manifestastions, it is to diagnose. for an accurate diagnosis and classification, check :

• The harelip localis status in detail,
• The nature of the clefting; lip, palate or both
• Cleft extensivities; complete (a cleft extended through the entire affected mouth structure), gnatho (gums), or incomplete (limited disruption, ususally the gnatho is still complete),
• Cleft location: unilateral (one side) or bilateral (both side),
• Alveolar and gums segment; is there a gap or not? is the gap wide or narrow? Does it collapse or not?

Clefts may occur alone or with other abnormalities (hidden or obvious) in the saliva glands, genital area, fingers and extremitas and may be combined with mental retardation, or hearth and other facial anomalies, so newborns with clefts should be carefully examined by a specialized physician soon after birth.

Cleft palate's patient normally also have tuba Eustachian function disorder and are more likely to suffer from otitis media which can have repercussions on earring functions and speaking learning process. In such case, a consultation with THT specialit (otolaryngologist) is needed.

Treatment
Due to the physical appearence modification, untreated cleft lip (in most cases because of treatment costs) can have repercussion on children self-esteem increased by social acceptance dificulties, generating educational problems.

A cleft lip and or palate can be repaired with corrective surgery :
Labioplasty or cheiloplasty is the plastic surgery of the lip. The recomended age for the surgery follow the 10 s rule :

• Age > 10 weeks (3 months)
• Weight > 10 pounds (5 kg)
• Hb > 10 g/dl

Process :
The edges of the cleft between the lip and nose are cut. The bottom of the nostril is formed with suture. The upper part of the lip tissue is closed and the stitches are extended down to close entirely.

Palatoplaty (platic reconstruction of the palate) is ideally practiced between 18-24 months on healthy children and before speech abilities are developed. to prevent speech dysfunction it is recommended to consult a speech therapist 3 to 6 months after palatoplaty.

Sources : WHO, Young, Greg, M. D (1998). Cleft Lip and Palate January 28 1998, UTMB Dept. of Otolaryngology Grand Rounds, RSU Zainoel Abidin, Plastic surgery specialist, Dr. BJ. Bismedi.