Photo credit: Cleft lip and palate care Nepal
As a baby develops during pregnancy, body tissue and special cells from each side of the head grow toward the center of the face and join together to make the face. Between the sixth and ninth weeks of pregnancy, the palate (the roof of the mouth) develops. When the tissue that makes up the roof of the mouth does not come together completely during pregnancy, a cleft palate develops. For some babies, both the front and back parts of the palate are open. For other babies, only part of the palate is open. Similarly, the lip forms between the fourth and seventh weeks of pregnancy and if the tissues fail to come together gives rise to a cleft lip.
Causes and Risk Factors
The causes of most infants’ orofacial clefts are unknown but for some, it can be a result of changes in their genes. These congenital defects are thought to be caused by a combination of genes and other factors, such as what the mother comes in touch with in her environment, what she eats or drinks, and specific medications she takes during pregnancy.
Diagnosis
A regular ultrasound by an expert can detect orofacial clefts during pregnancy, particularly cleft lips with or without a cleft palate. However, cleft palate, in particular, can be diagnosed only after the infant is born. Certain kinds of cleft palate, such as the submucous cleft palate and bifid uvula, are frequently not identified until much later in life.
Treatment
A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old. Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The initial surgery to restore the palate is usually performed between the ages of 6 and 12 months. The initial operation establishes a functional palate, minimizes the risk of fluid accumulation in the middle ear, and aids in the appropriate development of the teeth and facial bones.
When children with a cleft palate are around 8 years old, they may need a bone graft to fill in the upper gum line so that permanent teeth can be supported and the upper jaw can be stabilized. About 20% of children with a cleft palate require further surgeries to help improve their speech.
Once the permanent teeth grow in, braces are often needed to straighten the teeth. Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help to breathe and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence when the facial structure is more fully developed.
Who Treats Children With Cleft Lip and/or Palate?
Due to the number of oral health and medical problems associated with a cleft lip or cleft palate, a team of doctors and other specialists is usually involved in the care of these children. Members of a cleft lip and palate team typically include:
- Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
- An otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
- An oral surgeon to reposition segments of the upper jaw when needed, to improve function and appearance, and to repair the cleft of the gum
- An orthodontist to straighten and reposition teeth
- A dentist to perform routine dental care
- A prosthodontist makes artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
- A pediatrician to screen for other associated defects and to monitor growth and development
- A speech pathologist to assess speech and feeding problems
- A speech therapist to work with the child to improve their speech
- An audiologist (a specialist in communication disorders stemming from a hearing impairment); to assess and monitor hearing
- A nurse coordinator to provide ongoing supervision of the child’s health
- A social worker/psychologist to support the family and assess any adjustment problems
- A geneticist to help parents and adult patients understand the chances of having more children with these conditions
The health care team works together to develop a plan of care to meet the individual needs of each patient. Treatment usually begins in infancy and often continues through early adulthood.
Here is a list of hospitals/health centers in Nepal where the cleft palate is treated. Please note that this is not an exhaustive list and there could be more hospitals that treat cleft palate, if you have any further suggestions please email us at info@yomanepal.com
List of hospitals that treat cleft palate for FREE:
| S.N | Name of Hospital | Contact Number | Location |
| 1 | B and B Hospital | 01-5531933 | Gwarko |
| 2 | Sushma Koirala Memorial Trust | 01-4450826 | Sankhu |
| 3 | BPKIHS | 025-525555 | Dharan |
| S.N | Name of Hospital | Contact Number | Location |
| 1 | Nepal Cleft and Burn Center | 01-4330660 | Kirtipur |
| 2 | Kanti Children’s Hospital | 01-4411550/4413398 | Maharajgunj |
| 4 | Kathmandu Model Hospital | 01-4240805 | Bhrikutimandap |
| 5 | Aanandaban Hospital | 01-6218398 | Tikabhairav, Lalitpur |
| 6 | Himalayan Health Home | 01-5193315 | Thasikhel, Lalitpur |
| 7 | International Friendship Children’s Hospital | 01-4511134 | Maharajgunj |
| 8 | Star Hospital | 01-5450197 | Sanepa |
| 9 | Civil Service Hospital of Nepal | 01-4107000 | Minbhabhawan |
| 10 | National Medicare Hospital and Research Center. | 01-4467067 | Chabahil Chowk |
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