subject: Therapy for the Correction of Cleft Lip and Palate [print this page] Therapy for the Correction of Cleft Lip and Palate
There may be a link between a popular seizure medication and birth defects such as cleft lip and cleft palate. According to the National Institute of Dental and Craniofacial Research, there were an annual number of clip lip with or without cleft palate case of 4,209 for the years 1999 to 2001. There has been an abundance of research done on clp.
One interesting study is called, "The syndrome of ankyloblepharon, ectodermal defects and cleft lip and palate: an autosomal dominant condition" by R.J. HAY, R.S. WELLS
British Journal of Dermatology - Volume 94, Issue 3, pages 277289, March 1976. Here is an excerpt: "Seven patients from four families are reported who had an inherited condition of which the main features were ankyloblepharon, ectodermal defects and cleft lip and palate. The ectodermal defects were partial or complete hair loss, absent or dystrophic nails, pointed widely spaced teeth and partial anhidrosis. Associated anomalies included lacrimal duct atresia, supernumerary nipples, syndactyly and auricular deformities. The inheritance of this abnormality was consistent with that of an autosomal dominant trait. The relationship between this and similar syndromes is discussed."
Another interesting study is called, "Presurgical Nasoalveolar Molding in Infants with Cleft Lip and Palate" by Barry H. Grayson, D.D.S.a, Pedro E. Santiago, D.M.D.b, Lawrence E. Brecht, D.D.S.c, and Court B. Cutting, M.D.d - The Cleft Palate-Craniofacial Journal: November 1999, Vol. 36, No. 6, pp. 486-498. Here is an excerpt: "Abstract - Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach falled to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center."
Another study is called, "Primary Correction of the Unilateral Cleft Lip Nose: A 15-Year Experience" Plastic & Reconstructive Surgery - April 1986 - Volume 77 - Issue 4. Here is an excerpt: "Abstract - This paper reviews a 15-year personal experience based on 400 unilateral cleft nasal deformities that were reconstructed using a method that repositions the alar cartilage by freeing it from the skin and lining and shifts it to a new position. The rotation-advancement lip procedure facilitates the exposure and approach to the nasal reconstruction. The nasal soft tissues are transected from the skeletal base, reshaped, repositioned, and secured by using temporary stent sutures that readapt the alar cartilage, skin, and lining. The nasal floor is closed and the ala base is positioned to match the normal side. Good subsequent growth with maintenance of the reconstruction has been noted in this series. The repair does not directly expose or suture the alar cartilage. Improvement in the cleft nasal deformity is noted in 80 percent of the cases. Twenty percent require additional techniques to achieve the desired symmetry. This method has been used by the author as his primary unilateral cleft nasal repair and has been taught to residents and fellows under his direction with good results. This technique eliminates the severe cleft nasal deformity seen in many secondary cases."
We all owe a debt of gratitude to these researchers for their fine work and dedication. For more information, please read the studies in their entirety.
