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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.
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