An orofacial cleft involves the lip, the palate, the tooth bearing part of the upper jaw. It affects the nose, the ear and the midface. It also affects the person’s appearance, speech, swallowing, hearing and causes intense physical and psychological suffering for the child and the family. How does this happen? We know that the orofacial cleft happens due to failure of fusion of parts of the embryo in the 4th week of intrauterine life. Often the damage is already done even before the mother realises, she is pregnant. However, what we do not know is to tell for sure how it happens – leave alone predict it or reliably prevent it, though there are several suspect genetic and environmental factors. Our best bet yet seems to be to treat the baby once it’s born since all the deformities are eminently correctable.
Unfortunately, in India like in many other parts of the developing world the quality of care varies widely. Several children have their lips and palates repaired and are never followed up. Even these operations are sometimes done inexpertly by Surgeons who either had no interest in doing this delicate surgery or just did not have the necessary expertise. Because of this, we get patients from all over the country who had primary lip and palate repair and little else at other centres. So, we went one step ahead and developed a unique protocol to suit our situation to deal with these deformities.
These are clefts of the face and facial bones resulting into major deformities of face. Some of these defects may involve the eyelids and child may not able to cover the eyes completely resulting into loss of vision. And therefore, it is very essential to reconstruct these deformities immediately after the birth to preserve the vision.
Due to arrest of growth of certain part of skull, it gets deformed leading to various shape and size of head. It can either put pressure on the orbit leading to protrusion of eyeballs and/or increase pressure on the brain compromising the growth of the brain. Some of these children will have less developed brain by birth. The craniosynostosis should be operated ideally by the age of 9-12 months. These surgeries are done either to improve the appearance or release the pressure on brain or both.
Any child having speech problem in spite of palate repair and speech therapy may need second surgery to improve the speech and reduce the nasality.
The orbit is the bone surrounding the eyeball. Abnormal growth of the skull can displace the orbits either outwardly with more space between the two eyes or rarely vice versa. The correction of malpositioned orbits needs major craniofacial surgery and often more than one surgery.
Facial asymmetry, a noticeable difference in features from one side of the face to the other. This happens due to less growth of bones (especially lower jaw), muscles and other soft tissue. Often this is associated with ear deformities, malposition of orbits and facial nerve paralysis. The treatment is planned according to the severity of the deformities. However, the latest technique of distraction osteogenesis has shown good results for these deformities.
Various ear deformities are associated with craniofacial anomalies. The extent can vary from slightly smaller size to total absent of ear. When one ear is deformed, most often hearing is near-normal. However, hearing check should be done in all children with ear deformities. Children with bilateral involvement may need hearing aids. Ear reconstruction is usually done at age of 8-10 years depending on the growth of child. Minor deformities of ear can be corrected in early childhood.
Abnormal jaw and facial development can be genetic or acquired due to disease or injury. This results in facial deformities, unattractive jaw or teeth protrusion, difficulty with chewing, speech, and jaw function. “Orthognathic” means “straight jaws”, and orthognathic surgery corrects these jaw and facial deformities. Distraction Osteogenesis is another latest technique to correct these deformities. Most of these patients will need preoperative and postoperative orthodontic treatment.
Fusion of the one of joint of the lower jaws following unnoticed trauma or infection in early childhood lead to this problem. This is commonly found in developing countries and effect is disastrous. Child does not able to open mouth and the facial bones do not grow properly. These children will need multiple surgeries, first to open mouth and later to correct the facial deformities.
Advancements in craniofacial surgery now permit the surgeon to correctly repair facial fractures. The best time to correct facial bone fractures is within the first few days of the injury. Old fractures, which are misaligned, can be improved by craniofacial techniques. Craniofacial surgical technique also helps to treat the tumors and vascular malformation of the face.