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.
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.
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
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.
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
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