23 February 2013

Nigeria: Cleft Lip/Palate - Fourth Most Common Birth Defect

The exact cause of cleft lip/palate is not known, but most believe it could happen as a result of inherited characteristics (gene) or environmental factors or genetic syndromes. Research has shown this syndrome is the fourth common birth defects in the world, apart from being a part of over 400 syndromes, including Down, Waardenburg and Pierre Robin syndromes that affect children. RALIAT AHMED-YUSUF writes on this traumatizing syndrome that affects about three in 700 children born annually.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate occurs when there is a direct opening between the palate, or roof of the mouth and the floor of the nose. During pregnancy, the baby's upper jaw fails to close as it should, leaving a gap. A cleft palate is a more serious condition than a cleft lip, although both require surgery in order to be corrected.

Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both a cleft lip and a cleft palate together.

The emotional trauma of a cleft lip/palate can have a lot of negative impact on sufferers, not only as a result of the physical pain, but also as a result of the disabilities associated with the disfiguration.

There are various complications associated with cleft palate. Very prominent is dental problems. Because the cleft involves the gums and jaw, it affects proper growth and formation of teeth. Also breathing problems could result when jaw and palate are malformed. Feeding problems are common in children with this syndrome because of difficulties encountered during swallowing and feeding.

Any malfunction in the airway could result in hearing problem, because it affects the Eustachian tube which increases persistent fluid retention in the middle ear, which is a primary cause of repeated infections. Cleft lip/palate can cause a delay in speech and language. Normal development of lip and palate are essential for proper speech and sound development.

This condition statistically affects one in every 2,500 babies in Nigeria, and is caused by the failure of the two sides of the face to unite properly while the baby is in the womb. Although no one knows exactly why clefts happen, they have a tendency to run in families. Hormonal imbalances, nutritional deficiencies and certain drugs when used during pregnancy are possible causes as well.

In advanced countries like the United States of America, one in every 700 babies is affected, and the condition is more common among Latino, Asian and Native American babies than Caucasian. It is believed that compared with girls, twice as many boys have a cleft lip, both with and without a cleft palate. However, compared with boys, twice as many girls have a cleft palate without a cleft lip.

The condition is prevalent all over the world. In other parts of the world, it is a condition that is majorly corrected by surgery when the baby is just a few days old. In Nigeria, you can still find a few adults with the condition, especially in particular parts of the country. These few missed corrective surgery, majorly because their parents could not afford it or were ignorant of the solution, probably because they lived in rural or poor areas.

The sad thing is that some of those afflicted can now be found in major cities across the country, using the condition to beg for alms. Some even say they need the money for the corrective surgery, which they never get round to having, for obvious reasons. It's just a ruse to extract money from sympathisers.

Some of the difficulties the child with a cleft lip or palate is confronted with are eating, breathing, speech and psychological problems, which can be very harrowing for a child. To correct the condition, one would most likely work with a team, involving a plastic surgeon, maxillofacial surgeon, otolaryngologist (ear, nose and throat specialist), general dentist, orthodontist and oral surgeon.

Dr. Salamat Aliu, a surgeon at the National Hospital, Abuja, says, "Cleft lip or palate is caused by various factors. One of such factors is the familial factor, where the condition runs in some families. Having one child with a cleft lip/palate increases the chance of having another child with the same condition.

"Another factor that could result in cleft lip/palate is taking antiepileptic drugs during pregnancy, which have been associated with increased genetic syndromes like Treacher Collins Syndrome - all associated with these malformations. The condition is common in Nigeria, but there is no record of how many babies are affected. While the condition can be reduced by avoiding the use of antiepileptic drugs during pregnancy, in familial cases, it is not preventable."

She further adds that she has seen and operated on many sufferers and they have a good cosmetic outcome following surgery.

"Depending on the severity of the cleft palate, multiple surgeries may be required over an extended period of time. A plastic and/or maxillofacial surgeon performs corrective surgery on the face, while a general dentist, oral surgeon, otolaryngologist and/or orthodontist make appliances to correct any defects," she says.

Aliu noted that due to the way clefts affect the child's facial features or speech, he or she may feel insecure and develop an inferiority complex. "It is important to give assurance, support and encouragement to the child to prevent this," she advised.

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