TRANSFORMING FACES.. TRANSFORMING LIVES!
The human face is a corridor of emotions, a gateway to verbal and nonverbal communication, and a criterion for social acceptance and mate selection.1
It is a key, which generate a note and leaves a very long lasting impression in the minds of concerned parties. It automatically becomes a reference point for description and identification of individuals. The pleasant facial appearance awakens positive feelings and reactions in the family and other people, but altered facial appearance and speech are also immediately observable by others.2 The aesthetics of facial structures are used by humans to determine, not only a person’s beauty but his or her personality, intelligence, social class, trustworthiness, social skill, popularity and overall goodness.3
I joined Charles pinto Center for cleft lip palate and Craniofacial anomalies at Jubilee Mission Medical college Thrissur, Kerala, India in year 2016.It has been a wonderful journey to see the transformation of these cleft babies as well as to see the smile and relief of their parents .I consider myself truly blessed to be part of this divine mission to transform their lives.
While sitting in outpatient clinic last day an adolescent girl came for review; after the initial introduction she confided in me her only prayer now to God is she wants her nose to be corrected. She was born with complete cleft lip and palate; we had corrected her lip and palate deformity and now it’s time for correction of her cleft nose deformity. Many children born with cleft deformities their parents and children have these silent prayers; they are often side lined from the mainstream society and as clinicians it’s our collective responsibility to lead them back to normal life4.
Treatment for cleft lip and palate is multidisciplinary by nature and takes place mainly during the first 20 years of life. Ideal treatment objectives are improved aesthetics, good speech, good function and positive self-image5.
The most promising happening in cleft care in the last decade include:-
· Antenatal diagnosis & Neonatal counselling
More accurate diagnosis and effective counselling is now possible with the advent of 3D and 4D scanning, this also helps in reducing the anxiety of parents.
· Presurgical orthopaedics
Infant orthopaedics like nasoalveolar moulding is usually performed in the first few weeks of life to realign the cleft segments.
· Primary surgery & modern anaesthesia care
With the latest advances in anaesthesia care, quality of surgical care has improved in leaps and bounds. The aim of cleft lip surgery is to create an aesthetic and functional result with minimal scarring. The muscles of the lip and floor of the nose are reconstructed during the operation and In palate repair the surgeon aims to both close the cleft, and more importantly anatomically reconstruct the muscular ‘sling’ of the soft palate so that velopharyngeal closure can be achieved. This is required for the development of speech. The timing of surgery in cleft deformity remains controversial, but every case represents a compromise between function, development and appearance versus scarring, and its effect on growth.
· Speech and language therapy
Even after cleft palate repair, speech is still vulnerable to disorders of resonance and articulation which can affect intelligibility. This requires a coordinated approach between specialist and speech pathologist trained in this field.
· Hearing
There is a well-recognized association between cleft palate and middle ear disease that is related to failure of the ventilatory function of the eustachian tube. ENT surgeons have an active role in tackling this issue
· Psychology
The psychological care of the cleft patient and their parents begins at the time of diagnosis. The importance of psychologists involvement in the cleft team is becoming increasingly apparent.
· Dental health
The aim of the paediatric dentists is to try to prevent decay, minimize restorative necessity, prevent infection and prevent tooth loss with its associated alveolar bone loss, as this could complicate future cleft surgery.
· Alveolar bone grafting & Cone beam CT
Clefts of the alveolus lead to significant displacement of adjacent teeth and hinder their orthodontic alignment. The increasing availability of cone beam CT is allowing detailed assessment of the cleft site pre-bone grafting. This allows accurate positioning of any supernumerary teeth as well as any permanent teeth adjacent to the cleft site. It is also enables production of three-dimensional stereolithographic models.
· Orthodontics
The orthodontist monitors tooth eruption and growth throughout childhood as well as aligning the dentition and preparing the cleft site for alveolar bone grafting. They also have an active role in correction of dental and skeletal deformities.
· Orthognathic surgery & Distraction Ontogenesis
Cleft children with the need for multiple surgeries at various stages in life are bound to have dental and skeletal growth disturbances, both these treatment modalities are used in providing better functional and aesthetic appearance.
· Electronic patient record & Digitisation
A great advance for clinicians involved in cleft care is the use of digitisation and maintenance of electronic patient records. This spans traditional organization boundaries and allows access to all clinicians working with the patient. At birth each patient can be registered and their records including radiographs, photographs and correspondence stored electronically. Items such as protocols and audit sheets for different specialities can be included.
· The future…
1. With the identification of various genetic and environmental factors involved in causing cleft deformities, let’s hope for a day that we work of preventing these deformities!
2. Techniques to reduce scar formation after surgery on a cellular level.
3. Speech after cleft palate surgery always and enigma, lets strive in giving them perfect intelligible speech.
Let’s hope, pray and together work in providing these children a better life!!
Reference
1. Evolutionary Psychology – ISSN 1474-7049 – Volume 8(1). 2010
2. Soc Personal Psychol Compass. 2008 May 1; 2(3): 1497.
3. Philos Trans R Soc Lond B Biol Sci. 2011 Jun 12; 366(1571): 1638–1659.
4. Menon varun ; DentCare Magazine ‘The Myth and Reality of Orofacial cleft ‘ Part 1 pg 48-50
5. Dental Nursing August 2010 Vol 6 No 8
Comments