Experts: Cleft Palate Requires Early Detection, Treatment

Experts are urging the Lagos State government to implement policies that will pro­mote the early detection and treatment of cleft lip and palate, a congenital disorder to reduce trauma, and complications in af­fected families and ensure that no child lives with a cleft.

The need for early detection of cleft lip and palate and teaching mothers whose babies are born with the condition how to feed them was one the major focus of the recent Smile Train Cleft Nu­trition Training in Ikeja, Lagos.

Miriam Nabie, a clinical nutri­tionist from Kenya explained why early detection and treatment of palate in newborns is crucial.

The Clinical Nutritionist with SmileTrain who spoke to Inde­pendent Newspapers at Ikeja, during Training for Nutritionists said she works to support the families on how to feed their children with palate so that they are ready to have surgery at an early age.

Nabie noted that a Cleft Lip is visible as a hole on the lip, while the Cleft Palate requires looking into the roof or palate of the mouth for a hole. Mothers often hide their children due to this condition.

However, mothers can be taught to identify a cleft palate by observing difficulties during breastfeeding, such as milk coming out of the child’s nose or struggling to attach to the breast.

Nabie is also a Nutrition Ad­viser for the East Africa region supporting partner hospitals, In­ter-Christian Fellowship Evangel­ical Mission, ICFEM Dream Land Missions Hospital which provides care to children born with Cleft lip/palate.

According to her, coughing while feeding or swallowing is another indication, as it suggests milk entering the airway instead of the esophagus. Severe cases can lead to choking or aspiration, posing significant risks. Prompt medical attention is crucial to prevent potentially life-threaten­ing complications. These signs indicate the presence of cleft lip/palate conditions.

Cleft lip/palate prevents affect­ed children from feeding well and some mothers do not know how to feed their children. So, we support the mothers to feed their children so they can have the right weight for surgery, Nabie also said.

The nutrition trainer also trains other healthcare provid­ers to be able to identify the feed­ing challenges that mothers have with children with Cleft so that they can comfortably feed their babies and have them gain weight so that they can have sur­geries.

Dr. Kole Doye, Senior Registrar in Orthodontist, Lagos Univer­sity Teaching Hospital (LUTH) Idiaraba, Lagos said, “Cleft care involves various specialities. It is a multi-disciplinary team that takes care of patients with cleft. We have oral Maxillofacial surgeons, orthodontists, plastic surgeons, social workers, nurses, Periodontists, and paediatricians.

“Basically, what we do is to see various categories in patients’ newborn babies that come with cleft of either the lip that is al­veolar or sometimes involving a palate.

“When they present, we do pre­surgical infants auto physics for them. This is to prepare them for surgery. The Presurgical infants’ auto physics involves lip-taping sometimes we also use appliances such as this Nasoalveolar mold­ing appliance or NAM appliance.

“Nasoalveolar moulding (NAM) is a pre-surgical, custom-made orthopaedic appliance that brings together the two sides of a cleft lip or palate and narrows a wide cleft. It also forms and shapes the nose and facial structures to provide a more symmetrical ap­pearance.

“Before babies with cleft have their surgery done they come to the Orthodontist at this stage we use either the lip – taping to accords the lip together and this helps to reduce the cleft width just before surgery.”

“One of the major things we noticed here is that some of the mothers with babies having cleft when they come for the first time have very little awareness about this condition,” stated Dr Uche Egbunah, OMF Surgeon, and Dr Chinedu Uwadoka. So many re­late it to spiritual and non-natural reasons, and there is a lot of cul­tural stigmatisation surrounding the disorder.

The experts who both work in LUTH said, “Usually, we strive to educate our patients, particularly those who are unaware of the subject, about potential factors that may contribute to the disease. These factors can include environmental influences during pregnancy. However, it is import­ant to note that the presence of these factors does not necessar­ily imply fault on the part of the mother. Additionally, the condi­tion can be inherited from either the mother or the father. She stressed the need for aware­ness that children born with cleft palate or lips are not evil. They do not need to live with cleft palate or lips. They deserve to live a normal life after a successful surgery, she added.

Uwadoka highlighted the on­going collaboration with Smi­leTrain, which has resulted in a continuous clinic where var­ious specialists, including sur­geons, plastic surgeons, speech therapists, orthodontists, and nutritionists, come together to provide comprehensive care for patients.

“The great work we are doing with SmileTrain as you can see is a nonstop clinic where we have the surgeons, plastic surgeons, the speech therapist, orthodontist, and nutritionist they all converge here to take care of these patients. Those who require surgery we put in for surgery.

“Depending on the specific deformities and stages involved, different treatment approaches are taken. Some patients may have cleft lip only, while others may have both cleft lip and pal­ate, as well as alveolar defects. Each of these conditions requires different stages of referral and treatment. For instance, cleft lip surgery is typically performed around three months, cleft palate surgery around one year, and al­veolar defect treatment around seven years. It is important to note that SmileTrain generous­ly sponsors all aspects of these treatments, including the initial presentation, surgeries, tests, and ongoing care, completely free of charge. This partnership has prov­en to be highly beneficial and im­pactful.”

“Aside from that you can even have a sporadic mutation that means the mother did everything correctly there’s no genetic or in­heritance of any kind but it still comes up, so it can happen.”

Both Egbunah and Uwadoka emphasized the importance of educating mothers about the condition. They highlighted that it is not a one-time occurrence but can be associated with other anomalies that may require sur­gery or treatment. In such cases, a comprehensive assessment of the patient’s entire body is conducted, involving different doctors, and the treatment is planned accord­ingly. It is crucial to encourage patients to continue visiting the hospital and not give up. They commended Smile Train for the support it provides which helps alleviate financial burdens for pa­tients. All mothers and parents need to do is present their babies with cleft early to the hospital and the rest will be taken care of.

Dr Adebayo Adekunle, Oral and Maxillofacial surgeon as well as Cleft surgeon, LUTH said, the response is better now than be­fore because of the little aware­ness campaigns that we have done to places like maternity homes, traditional birth attendants, and communities. So, parents, mostly, mothers tend to present their ba­bies earlier now as compared to about a decade ago.

According to Victoria Awazie, the Senior Programme Manager of West Af­rica for Smile Train, “Our goal in Smile Train is to make sure that every child born with cleft lip and palate gets treated and has a healthy life in their communities.

SOURCE: Inde­pendent Newspapers