FREE ESSAY ON CLEFT LIP

CLEFT LIP

Prehistoric art tells historians that people once thought congenital diseases, or birth
defects, werebad omens or the displeasing of the gods. In one instance, it was thought
that cleft lip was caused by themother of the baby being startled by a rabbit. Odd as it
may seem, at that time it was the most logicalexplanation for that particular birth
defect. However, now we know that a cleft lip is not caused by amother being startled by
a rabbit, but by the environment the mother is in, the ethnicity, race, genetics,sex, and
so on. Cleft lip is the fourth most frequent congenital disease in the United States. On
average,one of every 700 newborns is affected by this disease, which means that
approximently 5,000 babies areborn with cleft lip every year. This very common defect
goes along with many other defects as well. Affected babies go through surgery to sew the
lip around 1 to 2 months of age, later dental/orthodonticcare, ear care, and speech
therapy. Although a lot of cleft lip cases accommodate some mental situations,a lot of
cases do not. First of all, the prefix "cleft" means "split," so knowing this, a cleft
lip is a separation, or split, in the upper lip. The cleft might only be on one side of
the lip making a small notch,or it could go all the way to the base of the nose. This
type of a cleft lip is called a unilateral. A secondtype of a cleft lip is called a
bi-lateral where there is one cleft on each side of the lip. The separation isusually an
opening where the upper lip failed to grow together. The failing to grow together can
varyfrom a small notch at the top of the lip to a complete separation stretching to the
nose. How this defecthappens goes back to genetics. Every child inherits 100,000 genes,
50,000 from each parent. There are anumber of inherited genes that combine together to
form the face, palate, or lip, and that can cause aproblem. In most cases, cleft lip
happens because of a combination of genes and some unknown environmentalthings. For this,
a cleft lip is described as a multifactorial condition. Though the child is born with
thisdeformity, it is not a deformity that can not be made normal by surgery. A baby born
with a cleft lip usually has an operation to close the lip at 1 to 2 months of age.
Cheiloplasty, or cleft lip repair, closes the opening in the lip caused by this birth
defect. If the cleft isbi-lateral, closing it can be done on both sides simultaneously or
the surgeon may repair the lip one side ata time in separate surgeries. Sometimes, in a
bad case of cleft lip, a preliminary operation to bring thetwo sides of the separation
closer will probably be needed. This operation can be either a lip adhesion,which means
to sew the edges together without aligning the lip, or to put something in the mouth
tomechanically align the lip and gums. Cleft lip repair is typically done in a hospital
with the patient underanesthesia. There are two common surgical approaches. There is the
rotation-advancement lip repair,where the surgeon makes an incision on both sides of the
nostrils, going from the lip into the nostrils.Working through the incision, the surgeon
opens the lip completely, rotates the pink outer part downward,and advances skin from the
cheek into the cut part to get rid of the cleft. The second way is referred to
astriangular flap repair. This means that the surgeon makes incisions to make small skin
flaps between thelip and nose. These flaps overlap to close the cleft, restore muscle
function, and form the normal lipshape. Usually, the nostril is also deformed when a
child has a cleft lip. So the nostril can also be fixed atthe time of the lip operation
or in a later surgery. If someone wants to get an operation to fix the nasalonly, this
operation usually occurs when the child has reached adolescence. The results depend on
howbad the deformity is, the absence of infection, and the surgeon's skill. When surgery
is done by a qualified plastic surgeon with experience in repairing cleft lip, theresults
can make an outstanding difference. However, as with any operation, there are risks with
surgery. In cleft lip surgery, the most common problem is asymmetry, which is when one
side of the mouth andnose does not match the other side. The goal of cleft lip surgery is
to close the separation in the child'supper lip, creating a normal look with normal
functions. Though incisions and scars are necessary toaccomplish these goals, surgeons
attempt to keep scars to a minimum and to place them in locationswhere they will not be
as obvious. After all surgeries, there must be a healing time. After the surgery, the
child might be restless but the doctor can prescribe medication to relieve any
discomfort. Elbow restraints are probably going to be necessary for a few weeksto keep
the baby from rubbing the stitched area. If dressings have been used, they will be taken
off withina day or two, and the stitches will either dissolve or be removed within five
days. The doctor will show theparent how to feed the child during the first few weeks
after surgery. It's normal for the surgical scar toappear to get bigger and redder for a
few weeks after surgery. Although the redness will slowly fade, thescar will never
totally disappear. In many children it's not very noticeable because of the shadows by
thenose and upper lip. Even though all the physical features have been almost totally
restored, some internaldifficulties may begin to occur as well. Although the surgeon may
be successful in closing the cleft, it is possible that difficulties withhearing might
develop. Since a child born with a cleft lip usually has problems with the nasal cavity,
theyusually experience recurring ear infections and hearing loss. This is the result of
chronic fluid in themiddle ear, or ear infections, which result from reduced ventilation
through the Eustachian tube. TheEustachian tube, a tube that connects the ear to the
throat, is opened by muscles in the palate, allowing airinto the middle ear space by
yawning or swallowing. Typically, when a child is born with a cleft lip, theopening of
this tube is impaired. The pressure in the middle ear causes fluid to build-up, and since
thetube will not open, the clearance of this fluid is reduced. The fluid thickens and
begins to partially block the sound coming into the ear which reduces the ability to
hear. This problem is treated by taking out the fluid from the ear, and putting a
pressure equalization tube in theeardrum to bypass the Eustachian tube and keep the
ventilation process going. Hearing problems areusually the most common difficulty that is
associated with a cleft lip. However, sometimes it is possiblethat difficulties with
speech may develop as well. Although speech problems are not as common as ear infections
and/or hearing loss, it may benecessary for a speech pathologist to give the child some
tests to determine the child's speech skills. Based on the findings the pathologist
receives, he or she can recommend surgery and/or therapy for thechild. Check-ups should
be made habit every 6 to 12 months so the pathologist can monitorimprovement.
Compensatory speech can develop and be very difficult for adults to understand. For
this,the child probably will not want to speak with adults and other children because he
or she is ashamed ofnot being understood. Also, the child could face even worse emotional
problems. If he or she is veryself-conscious about their cleft scar or their speech
differences, he or she could become very shy and theirself esteem also could go down.
Children who were born with clefts will feel different from the peoplethey are around
with every day, when being different is the worst thing that could happen to a child.
Professional counseling will probably be needed to help the child figure out his or her
strengths andpretend the cleft scar is not even there. The difficulties do not even stop
here. The upper gums of thechild also accommodate this disease. In some cases of a cleft
lip, the upper gums may be involved. When this happens, dentalproblems are sure to occur.
Some primary and permanent teeth may be missing, abnormally shaped, orout of position
around the cleft. These problems can be treated with ongoing care by a team of
dentalexperts such as a pediatric dentist, an orthodontist, and an oral surgeon. The
pediatric dentist would befor routine care of the teeth, the orthodontist would be to
reposition the teeth using braces, and an oralsurgeon would be to reposition parts of the
upper jaw, to improve the function and appearance, and torepair the cleft of the gum.
Brushing teeth might not seem that important in comparison to othertreatments the child
is getting, but actually it's very important. For the child with cleft lip/palate,
goodmaintenance of teeth is essential not only for dental development, but also for
speech. With all thesedifficulties, many people wonder why there is not some type of cure
or prevention for cleft lip. Thoughscientists are researching this disease, there still
is not much known about why cleft lip forms let alonehow to prevent it. Little is known
about how to prevent clefts, however, a recent study shows that takingmultivitamins
containing folio acid before conception and during the first two months of pregnancy
canhelp prevent cleft lip. Other studies have shown that fetuses with a certain gene can
be at higher risk of developing cleft lip if their mothers smoke. Also, other things such
as alcohol abuse, diabetes, and some types of medications, such as some drugsused to
treat epilepsy, have been thought to increase the risk of cleft lip. Some things to do to
preventcleft lip would be to avoid alcohol and tobacco, to use medications that were
prescribed by a doctor only,and to get early and regular prenatal care. Families with a
history of cleft lip might want to considerdiscussing the chances of their child getting
cleft lip with a genetic counselor. As strange as it may be,while taking all these extra
precautions, your baby might be even better off because of your ethnicity, sex,or race.
Through recent studies, it has been discovered that the race and or ethnicity has
something to dowith the risk of giving birth to a child with cleft lip. Cleft lip occurs
at the lowest frequency for blacks atabout 1 in every 2,500 births while Caucasians have
a frequency of 1 in every 1,000 births. With aslightly higher cleft lip rate, Asians have
about 2 in every 1,000 births while American Indians hold thehighest frequency at about 4
in every 1,000 births. Not only does the ethnicity and or race have to do withanything,
but the sex has to do with the risk of cleft lip too. If the mother smokes or chews
tobacco,drinks alcohol or is taking any illegal substances, the baby has a higher risk to
be born with a cleft lip. Also, of course, if there has been people in the family who
have had cleft lip, the child's risk is alsogreatly increased. The cleft lip has come a
long way in history. From prehistoric times when they thought it wasthe fault of a mother
getting startled by a rabbit, to now, where we know maybe just a little more. Thoughcleft
lip is the 4th leading congenital disease in the United States, it does not mean that it
is the 4th mostun-repairable disease there is either. Surgeries can be done to make the
child's face look normal withnormal functions, speech pathologists can help the child to
speak more clearly and with betterpronunciation, and doctor's can insert tubes in the
ears of the diseases children to rid them of thedeafening fluid inside their ears. So
many things can be done to help the children with cleft lip and somuch is being done to
find a cure for this disease. In the mean time, everyone can relax to know thateverything
is going to be alright.