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Cleft Lip and Palate Problem in the Philippines

An Overview and Proposed Solution

 

Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg

June, 2002

 

What is a cleft lip? What is a cleft palate?

 

A cleft lip is a congenital anomaly that presents as cleft on the lip that results from a failure of one or both sides of the upper lip to fuse.  The cleft lip may be unilateral or bilateral and can range from a slight notch to a complete cleft extending up and into the nose.

 

A cleft palate is a congenital anomaly that presents as cleft on the palate or roof of the mouth that results from a failure of one or both sides of roof of the mouth to fuse.  The cleft palate may be partial or complete extending up to the soft palate and front part of the upper gum.

 

Cleft lip and cleft palate may be present concomitantly.

 

Oral cleft is an encompassing for clefts in the oral cavity.  It includes both cleft lip and cleft palate.

 

How does oral clefts affect the health of the children?

 

Oral clefts affect the biopsychosocial well-being of the children.

 

A cleft lip may cause feeding and or speech/language problems if they are not treated.

Cleft palate primarily impacts speech development. If surgical repair is not performed early enough, a child with cleft palate may have difficulty with proper pronunciation and articulation. Cleft palate can also cause dental and middle ear problems.

What are the more common types of cleft lip and cleft palate?

Cleft lip may be complete or incomplete.  It may be unilateral or bilateral.

Cleft palate may be complete or incomplete.

What are the common causes of cleft lip and cleft palate?

 Cleft lip and palate are congenital anomalies that result basically from a genetic defect .  The causes of the genetic defect are hypothesized to be environment and nutrition related.  The exact genetic defect and exact mechanisms causing the defect are NOT yet known.

Diagnosis of cleft lip and palate

Diagnosis is simply by inspection.

 

Presence of an unusual and abnormal cleft in lip and palate is the diagnostic sign of cleft lip and palate.

 

After seeing the cleft, the next thing to determine is the extent of the cleft, which may be complete or incomplete, and laterality of the cleft, which may be unilateral or bilateral.

 

Magnitude of the cleft lip and palate problem in the world

 

It is more common in developing countries than in developed countries.

 

a) Highest in Asian populations
b) Intermediate in Caucasian populations
c) Lowest in African populations

 

Magnitude of the cleft lip and palate problem in the Philippines

 

National statistics:

1-2/1,000 live births with cleft lip being more common than cleft palate

 

Computations for annual load:

Birth Rate = 27.85 births/1,000population       

Population = 81,159,644

Birth/annum = 2,260,296

New CLP cases/annum = 2,260

 

Combined cleft lip and palate being not as common than single structure involvement.

           

Source: Murray J.C. et al. Clinical and Epidemiological Studies on Cleft lip and Palate in the Philippines. Cleft palate Craniofac J, 1997; 34: 7-11

 

Practically, every region has its share of cleft lip and palate.

 

In the 1966-2000 statistics of the Philippine General Hospital, in terms of residence of patients, the City of Manila topped the list.

 

Preventive Measures in the Philippines:

 

There are no known effective measures at present because the exact mechanisms on the production of genetic defect are NOT yet known. 

At present, there is an ongoing plan to do a research in the Philippines by Dr. Ronald Munger to evaluate the efficacy of maternal periconceptional vitamin supplementation with pyridoxine (B-6) or folic acid or both for the prevention of recurrences of oral clefts among births to high risk women.

 

           

Proposed Solutions of the Cleft Lip and Palate Problem in the Philippines

 

Foreign Missions

 

At present, the solution to the present cleft lip and palate problem in the Philippines is being initiated by foreigners through missions, such as Operation Smile, Operation Hope, Operation Rainbow, and Operation Smile Train.

 

These foreign missions are performing about 2000 operations per year.

 

How come there are a lot of foreign missions in the Philippines?  They come here to help the indigent Filipino patients with cleft lip and palate. 

 

They feel:

“In many developing countries, millions of people are desperately poor and do not have access to skilled medical help. They are typically rejected by their communities and have little hope of attending school, making friends, or ever enjoying a normal life.

“Many patients endure a lifetime of suffering simply because they have no access to the reconstructive surgical care that would help them regain functional mobility or improve their physical appearance.

“Many people in developing countries never receive corrective surgery.”

 Most of the time, the foreign surgeons come here to perform the reconstructive surgeries on the indigent patients.  At times, they try to empower the Filipino surgeons to serve their own countrymen.

 

How should and can the Filipino physicians and surgeons contribute to the solution of the cleft lip and palate problem in the Philippines?

 

Can’t the local surgeons do the operations?  Can’t the Filipino surgeons help their own countrymen?

 

There are a lot of head and neck surgeons who can do repair of cleft lip and palate.  There are enough  general surgeons (head and neck surgeons), plastic and reconstructive surgeons, and otorhinolaryngologist-head and neck surgeons who can do the operations.

 

If there are NOT enough Filipino surgeons who can do repair of cleft lip and palate, then more Filipino surgeons should be trained.  If there are NOT enough Filipino surgeons in the provinces, then Filipino surgeons Metro Manila and Metro Cebu can do outreach missions just as the foreign surgeons do outreach missions in the Philippines.

 

The Department of Health and the Philippine Medical Association and the various concerned specialty societies like the Philippine College of Surgeons, Philippine Society of Plastic, Reconstructive, and Aesthetic Surgery,  Philippine Society of Otolaryngology - Head and Neck Surgery, and Philippine Academy of Head and Neck Surgery  have yet to come out with comprehensive long-term plan in solving (reducing, if not annihilate) the cleft lip and palate problems in the country.

 

What is the role of general surgeons in the solution of the cleft lip and palate problem in the Philippines?

 

Since there are few certified plastic and reconstructive surgeons and otorhinolaryngologist-head and neck surgeons and there are general surgeons-head and neck surgeons distributed throughout the country, the general surgeons can play a big role in the solution of the cleft lip and palate problem in the Philippines.

 

There are about 60 fellows of the Philippine Society of Plastic, Reconstructive, and Aethetic Surgery and 9  accredited residency training programs in plastic surgery  in the entire country.

There are about 300 fellows of the Philippine Society of Otolaryngology and 22 accredited residency training programs in ENT in the entire country.

There are about 1000 fellows of the Philippine Society of General Surgery and 63 accredited residency training program in general surgery.

 

The number and their distritubtion of general surgeons put them in the best position to help in the solution of the cleft lip and palate problem in the Philippines.

 

How can Department of Surgery of Ospital ng Maynila Medical Center (OMMC) help in solving the cleft lip and palate problem in the Philippines?

 

With its Operasyon Pinoy program launched in September, 2001, a regular surgical mission for indigent Filipino patients done by Filipino surgeons, with its community perspective, and with its Healthy Urban Poor – Health for All Filipino Movement, the Department of Surgery of OMMC can and will do the following:

 

Spearhead the development of a project to solve the cleft lip and palate problem in the Philippines.

Provide quality surgical services to patients with cleft lip and palate, initially in Metro Manila  and later extending to the provinces.

Provide training of general surgeons who will perform repair of cleft lip and palate in the place of their practice.

Perform research on how to reduce the cleft lip and palate problem in the Philippines.

 

It will establish network with other organizations, both locally and internationally to solve the cleft lip and palate problem in the Philippines.

 

It will be launching its Operasyon Pinoy: Operasyon Bingot at Ngongo or Operasyon Pinoy: Operasyon Ngiti in June, 2002.  See primer for details.

 

 

 

References:

Murray J.C. et al. Clinical and Epidemiological Studies on Cleft lip and Palate in the Philippines. Cleft palate Craniofac J, 1997; 34: 7-11

 

 

 

For more information:

 

rjoson@maniladoctors.com.ph

rjoson2001@yahoo.com