What is this problem & how common is it?

This is a congenital or birth defect.It is the most common birth defect in the face.

We estimate that about 1 in every 2000 children in Kenya today, are born with this defect.More than 500 babies are born with this problem every year in Kenya.

What is the cause of this problem?

The cause is not known for sure but is related to;

· Genetics –It runs in some families due to a defective gene.·         Poor nutrition and especially where folic acid is lacking.

·  Alcohol & cigarette smoking by the mother during pregnancy. Fortunately many Kenyan mothers do not smoke.

· Drugs taken during pregnancy for one reason or another e.g. a mother taking anticonvulsants may become pregnant – Epanutin/phenytoin sodium is known to cause the problem if taken during pregnancy.

·  Infections during pregnancy and especially in the first trimester.

·  Radiation exposure during pregnancy.

Due to lack of awareness of the cause, different communities have guessed the possible causes but research has shown the above to be the causes.

It is not caused by witchcraft and neither is it a bad omen but is a disease like any other and the known causes are as above. In some communities these babies are killed soon after birth or if allowed to live, they are hidden at home which is cruel and not right.

This should not happen now as there is treatment available and these individuals can grow to become useful members of our communities just like those born without defects.

CLEFT LIP (CALLED MDOMO SUNGURA IN KISWAHILI)

Definition/Describe the deformity

Upper lip birth defectVaries from a small notch/dimple to a complete cleft lip.The more severe defects are associated with Nose deformities and also abnormally positioned front teeth.Sometimes both the left and right side of lip are affected (Bilateral Cleft Lip)

In some cases, either the unilateral or bilateral Cleft Lip is associated with Cleft Palate.

Diagnosis/How do you tell a baby has this problem?

The defect is obvious immediately after birth and medical personnel (Midwives etc) notice it and advice parents accordingly.Some parents also take their babies to hospital following home deliveries.It can also be diagnosed by Ultra-Sound done during Antenatal Clinic (ANC).

Cleft lip is an aesthetic/cosmetic problem and has minimal effect on function. (Sucking/breastfeeding, eating, speaking). The individual will not look good and therefore may lack confidence and in a complete Cleft Lip, there maybe mal-alignment of the upper front teeth.

Treatment/How do you treat this problem?

Surgery is the only definitive treatment.Generally, babies are operated on from the age of 3 months but Surgeon and Anesthetists may decide to operate early if parents are very distressed and provided the baby is of good weight/health.

The surgery takes 45 minutes to 1 hour and the complications are few.Possible complications are: wound dehiscence, wound infection, scar hypertrophy.

CLEFT PALATE (KAAKAA LA KINYWA LENYE MPASUKO) 

May occur in isolation or together with Cleft Lip.Severity varies from a small gap at the back of the roof of the mouth to a long and wide gap extending to the front teeth.It has more serious effects/repercussions than Cleft Lip and surgery is more hazardous and difficult. 

 

It may result in the following:

Inability to breast feed & therefore the baby does not put on weight (Failure-To-Thrive: FTT).T

The child will also get frequent ear infections (Otitis Media) due to the abnormally positioned muscles of the soft palate.

These muscles are involved in speech and also control the function of the Eustachian tube which is a small tube connecting the back of the mouth and the ear.Later the child with an un-repaired cleft palate is unable to speak properly – the child or individual will be unable to pronounce some words properly and will have incoherent speech. They are unable to pronounce ‘M’, ‘N; ‘NG’ ,‘B’ , ‘P’ ,‘F’ & ‘S’..

Diagnosis

Look into the roof of the mouth - many parents miss it until later.When it is diagnosed early, the parents are counseled on child care and especially feeding using a cup and spoon and a bottle whose opening has been widened.

These children take longer than normal children to feed and parents/caretakers should be patient and feed babies frequently and slowly.

Most of cleft palate children have to be weaned on food very early due to their inability to breast feed because they are unable to create the negative intra-oral pressure required for suckling.Treatment is surgery and it is best done from the age of 11 months or at least before the child starts talking.

Some devices (obturators) can be used to block the opening as the child awaits surgery to facilitate feeding.Any ear infections should be treated as soon as possible to prevent loss of hearing (deafness). 

The service is being offered FREE since January 2007 as a result of partnership and sponsorship by the Metropolitan Hospital and an American (USA) charitable organization called ‘The Smile Train’.

Children or adults below age 50years should be brought or come to the hospital for review by the surgeon on Wednesdays from 2pm to 6pm and Saturdays from 10am to 4pm.

They will be admitted if found fit for surgery. Consultation, Clinic,  Surgery, Medication and Admission are free of charge.

You should go to Metropolitan Hospital if you have this condition or know anyone with the problem.

Compiled by:

Dr. Kimani Wanjeri

GENERAL AND RECONSTRUCTIVE SURGEON