Labio-palatal fissure

Fissure or cleft is an opening or separation which can affect the lip (fissured lip or hare lip), the palate (fissured palate or cleft palate) or both (lip and palate fissure), it is a congenital malformation (innate) which occurs during the first 3 months of pregnancy when the face of the fetus is being formed. It is caused by the lack of union of the growth centers which will form it.

Its cause is not known but the most probable is a combination of multiple factors, some are hereditary (genes) and others are environmental (use of medication, tobacco or drugs during pregnancy, malnutrition or stress in the mother).

IMPLICATIONS INHERENT TO LABIO-PALATAL FISSURES

As with all malformations this has several implications which can be grouped as follows:

a. Esthetic aspect: The physical and anatomic appearance of affected organs is altered. The most common are the lateral flattening of the face and a protrusion of the upper jaw.

b. Functional aspect:

* Nutritional difficulties: Difficulties for nursing/suckling in the baby added to the lack of orientation in the parents;

* Reduced mastication (chewing) efficiency;

* Auditory and odontological problems- reduction in hearing sharpness in 50% of fissured children;

* Disturbances in speech and voice.

c.Emotional aspect: Since the environment of the fissured child is saturated with strong emotions due to the impact caused by the malformation on parents, inhibition is characteristic added to a high degree of dissatisfaction and anxiety.

Children with fissure must undergo one or more surgical operations and rehabilitation treatments in order to achieve their integral development. This means a high financial cost for the family apart from the physical and emotional wear.

In Peru, the rate of children born with fissure is of 2 per a thousand newborns, and it is one of the highest in Latin America. Every year around 800 children are born with some type of oral fissure.

Among the different catalogued fissures, we find that labio-palatal fissure is the most frequent (53.38%), followed by lip fissure (34.72%) and cleft palate (7.11%).

* Integral evaluation by a team of professional specialists in order to plan adequate treatment.

* A balanced, including milk, vegetables and fruit.

* Oral hygiene is very important from birth. After first teething, the child’s teeth must be brushed after each meal especially before bedtime.

* Following the application and attendance of the prescribed therapies for rehabilitation.

* Correct speech, avoiding doing so in front of strangers so that the child will not feel inhibited.

* When the child attends school, she/he should be seated close to the teacher so as to avoid hearing problems and be able to have better performance.

* Daily concern about the child’s advances where each achievement should be highly valued.

* Both parent and teachers should provide support and should keep informed about progress made in the rehabilitation program.

* Above all, THE CHILD MUST BE LOVED. The manifestation of love should be through concern but not through overprotection. Accepting their situation not denying it, will help towards reconciliation and harmony in their life with other people, their surroundings and with God.

IS IT NECESSARY TO OPERATE IMMEDIATELY ALTER BIRTH?

No. Becauese these fissures do not endanger the child’s life, although the new born may have difficulting in breathing and feeding with patience and helping htem adopt the right posture, they manage to do so.

It is better to wait and allow them time to develop and prepare them to face surgery in the best possible condiitons . Any surgery on newborns implies higher risk of complications including death.

WHAT IS NEEDED BEFORE SURGERY?

Several tests and medical exams are needed. First of all a pediatric exam, because when a baby is born with fissure there is more likelihood of other abnormalities which can be hidden since they affect internal body organs (heart, kidneys, etc.). In addition lab tests, surgical risk factors and other tests are needed according to each case. During this preparation time, patients and their families require guidance, understanding, love and help to relieve their anxieties and to prepare them for the plastic surgery and other treatments that may be needed.

WHAT’S THE BEST TIME TO OPERATE A FISSURE?

For lip surgery the best time is from 3 months old, because it is the safest moment and the esthetic and functional results are better that in operations done at an earlier age. The baby should be at least 5 kilos in weight more than 10% hemoglobine, well nurtured and in good health.

For the palate, it is best to wait until 9 months of age and for the baby to weigh 8 kilos, more than 12% hemoglobine, in healthy condition and well nurtured. In some cases it may be necessary to delay the surgery, because special treatments may be needed to prepare the palate and facilitate the surgery.

IS THE PROBLEM OVER AFTER SURGERY?

No. Because the operation closes the fissure, reestablishes normal functions and fixes the appearance of the baby, but frequently, other problems persist which affect hearing, the teeth, feeding, breathing and psychology. These problems must b identified and treated at the right time by other specialists.

HOW LONG IS THE TREATMENT AND WHO PARTICIPATES?

Treatment begins after birth and ends during adolescence, specialists from several disciplines participate as a team, among them:

* PEDIATRICIAN

* ODONTOLOGIST

* ORTHODONCIST

* OTRORRINOLARINGOLOGIT (Ear-Mouth-Throat specialist)

* GENETICIST

* SPEECH, VOICE, LANGUAGE THERAPIST

* PHYSICAL THERAPIST

* NUTRITIONIST

* PSYCHOLOGIST

* NEUROLOGIST

* PLASTIC SURGEONPEDIATRA

WHY IS IT URGENT TO HELP PARENTS AND FAMILY OF PATIENTS WITH FISSURES?

Because the birth of a child with lip or palate fissure is a difficult emotional experience for parents who were expecting a child without any problems and quite frequently, their anxiety is intensified due to misleading information they get from family, friends or even doctors who are not familiar with the problem. That is why it is urgent to explain the problem, answer all questions, calm the family down and suggest to them a reasonable treatment program. We in ARMONIZAR can help them in these difficult times- we can guide them, support them and keep them company throughout the treatment.