Friday, July 16, 2010

My blog is about cleft palate and lip. It explains what a cleft actally is and how they are repaired. It explains what all is involved in repairing a cleft and treatment the patient might go through the rest of their lives. It has some very helpful and interesting information that is related to a cleft. Even though a cleft is a problem in the nose and mouth it can affect other parts of the body. It explains how someone with a cleft has to eat in order to actually get food into their bodies. It explains a variey of information related to a cleft palate or cleft lip.
3 Learning objectives:
1- What other health problems are associated with having a cleft?
2- Who is part of a cleft palate repair team?
3- What can cause a cleft?

Wednesday, July 7, 2010

"Profile of Patients with Cleft Palate Fitted with Hearing Aids" Review


Cleft palates may also cause hearing loss in patients due to reoccurring otitis meadia. There is a large debate over how this should be treated. The options that different doctors suggest include prescriptions, ventilation tube, otorhinolaryngological and audiological assistance, or hearing rehabilitation with the use of a hearing aid. Cleft palate and lip patients encounter middle ear problems due to movement of the Eustachian tube caused by an incomplete insertion of the palate tensor and elevator muscles; this causes pressure in the middle ear which leads to otitis media. 52% of cleft palate patients have a history of otitis media. It is concluded that hearing aids can help these cleft patients once the ventilation tube has been removed. It is a non-invasive way to treat hearing loss due to chronic otitis media.
Zambonato, Ticiana Cristina de Freitas. "Profile of Patients with Cleft Palate Fitted with Hearing Aids". Brazilian Journal of Otorhinolaryngology. 75.6(2009). ScifloBrazil.7 July 2010.


"One Stage Palate Repair Improves Speech Outcome and Early Maxillary Growth in Patients with Cleft Lip and Palate" Review


A study was done comparing how a one stage cleft repair affects a child's speech and how a two step cleft repair affects a child's speech. The study used the Muhler classification system to assess the participants' speech. The Muhler classification system assesses a person's resonance, nasal escape, compensatory articulation, facial grimace, and spontaneous speech. The classifications run from 0-3 or 4 with 0 being normal speech and 3 or 4 being severe speech problems. The results showed that a one stage repair has the best benefits for a cleft patient. It also makes a difference when the surgery is done and it seems to be most beneficial when the surgery is done between 9 and 12 months. Children who had their cleft repaired after 2 years had more severe speech problems. If a repair is delayed past 2 years the speech mechanisms have already formed so more speech problems are likely to appear. The advantages to a child have a one step repair is that there is only one hospitalization, less scaring in the palate region, better speech development, and no dissection in scarred tissue of the soft palate. There are some disadvantages though including larger wound site, increased blood loss, and airway obstruction. Not only does a one step repair done between 9-12 months benefit speech but it also benefits maxillary growth. For these reasons a one stage palate repair is preferred over a two step procedure.

Pradel, W. "One-Stage Palate Repair Improves Speech Outcome and Early Maxillary Growth in Patients with Cleft Lip and Palate". Journal of Physiology and Pharmacology. 60.8 (2009): 37-41. Jpp.krakow.pl. 7 July 2010.

Monday, July 5, 2010

EMedicine








A cleft palate is the most common form of a congenital deformity. It develops when embryonic parts do not reach each other in time and a space between them persists. Cleft palates can be diagnosed at the seventeenth week of gestation. The palate begins forming at the fifth week of gestation. There are more than 400 syndromes that are associated with a cleft palate. 30% of clefts are associated with other syndromes. Along with obvious problems of eating a cleft can cause problems with breathing because the tongue can enter the nasal cavity as well as the posterior oropharynx. Otitis media occurs in more then 50% of cleft children. It can also cause conductive hearing loss. A person who has a cleft will have hyper nasal speech. 20% of people with a cleft that undergo repairs have complex speech disorders. Clefts occur in 1 out of 1,000 births. 3.6 cases out of 1,000 occur in American Indians. 0.3 out of 1,000 occur in African Americans. Cardiac, limb, or other system defects can be associated with a cleft. There is no agreed upon management algorithm.

In 500 AD the first recorded operation was performed for inflammation of the uvula. 1552 it was proposed that cleft edges be sutured together. The use of obturators began in 1564. The first successful repair of a cleft velum was performed in 1764. In 1839 the first closure of the hard and soft palates was performed. In 1861 a clefts started being closed with the use of mucopenosteal flaps. Doctors began closing clefts in young children in 1944. In the 1950s clefts started being repaired in a staged fashion. Doctors also started lengthening the velum and creating a functioning levator muscle sling in 1986.


This website was not very useful. I liked how they presented information about the developments of the treatment for clefts, but other than that it did not provide much information. The website was somewhat helpful, but not as much as I would have liked it to be. It did have a lot of links which was helpful. I also liked that it provided information on places for where you can find more information about clefts. Overall it was not one of my favorite cites about clefts. It did provide some information, but I felt like it should have provided more. I also felt like it should have presented it in a different way. I would not recommend this website to anyone that wanted to learn more about clefts.




Medline Plus

Cleft Palate:

Cleft Lip:






Cleft palate is a condition that occurs most commonly in Asians. In the Asian population a cleft occurs in 1 out of 800 cases. From 1999-2001 a cleft palate without a cleft lip occurred in 2,567 Americans and a cleft lip with or without a cleft palate occurred in 4,209 Americans. A cleft palate is a very complex birth defect and requires many different types of treatments. A cleft palate can be part of many different syndromes so genetic testing needs to be done when a baby is born with a cleft. Heart genetics are strongly linked to genetics of the palate so a large portion of children born with a cleft are also born with heart problems. Only genetic testing can determine what other health problems the cleft is linked to.

The biggest concern of a child born with a cleft is eating and growing. With a cleft palate there is an opening from the oral cavity to the nasal cavity so anything the baby takes in will come out of their nose. Special precautions need to be taken so that they are able to eat. There is a plastic plate that can be added to close the two cavities temporarily. There are also special bottles a baby with a cleft can use since they are unable to suck due to the cleft. Eating is the first problem that must be overcome with a palate so that the child is able to survive.

There are several factors that put an unborn child at risk for a cleft lip or a cleft palate. These factors include exposure to certain things in utero, family history, race, sex, and maternal obesity. Being exposed to cigarette smoke, alcohol, and drugs in utero increases a baby's chance of being born with a cleft. A cleft occurs most commmon in American Indian and Asian children. Black children are least likely to have a cleft. Males are twice as likely to have a cleft lip without a cleft palate. A cleft palate without a cleft lip are more common in females. All of these factors can cause a cleft palate or a cleft lip in a child.

A cleft causes different complications. These complications include feeding problems, ear infections and hearing loss, dental problems, speech problems, and psychological problems. Feeding problems occur because the oral cavity directly opens to the nasal cavity so anything that goes into the mouth comes out of the nose. Dental problems occur because the teeth are rearranged due to the split in the gums. A child will most likely also encounter psychological problems including social, emotional, and behavioral problems due to everything they will have to go through to repair their cleft. All of these issues need to be adressed when treating a cleft of any kind.

This website also provided information about current research that is being done. The current studies being conducted include articulation and phonology in children with unilateral cleft and lip palate, Cleft Orthognathic surgery versus Distraction Osteogenesis, 3D imaging of hard and soft tissue in Orthognathic surgery, relational development in children with cleft lips and palates: influence of the waiting period prior to the first surgical intervention and the parent's physchological perception of the abnormality, genetic analysis of hereditary non-syndromic oral clefts, and sleep and behavior in children with cleft palates. All of these studies will give greater incite into children with clefts. The website also provides information about treatment, nutrition including breastfeeding, how to cope with a cleft, disease management and dental care, specific conditions, questions about scars, pictures, financial problems, clinical trials for cleft lip and cleft palate, genetics, journal articles, organizations that help, and statistics. They break down their information into differenet sections that are targeted towards children, teenagers, adults, and patients with a cleft. The organizations that help with clefts include Easter Seals, March of Dimes, The Grottoes of North America, and the National Association for the Craniofacially Handicapped.

Overall this website was very helpful. It provided information that was known and also informs people about what is being researched. The information was provided in a very useful way. I would recommed this website for people to learn more about clefts. I really liked how the information was broken down for different types of people and age groups. I have not found another website that provided as much information as this one did. The only thing that I did not like about this website was that it did not mention Operation Smile. I personally know that Operation Smile is a major help for people who have clefts so I was very suprised that they did not mention Operation Smile. Other than not talking about Operation Smile I really enjoyed this website.


Thursday, July 1, 2010

Famous People who had clefts







Peyton Manning- American Football Player
Tutankhamun- Egyptian Pharoah
Cheech Marin- Comedian
Doc Holliday
Rita MacNeil- Country and Folk Singer
Wendy Harmer- Comedian
Tad Lincoln- Son of Abraham Lincoln
Thomas Malthus
Carmit Bachar- Dancer, Singer, Actress
Jesse Jackson- Civil Rights Activist
Richard Hawley- Guitarist, Singer, Songwriter, Producer
Micheal Helm- Writer
Jurgen Habermas- German Philosopher
Stacy Keach- Actor
Tim Lott-British Author
Ljubo Milicevic- Australian Football Player
Nikki Payne- Comedian and Actress
Geoff Plant- Lawyer and Politician
Lee Raymond- Chairman of Exxon Mobile
Louis Wain- Artist
Joaquin Rafael Phoenix- Actor

http://www.disabled-world.com/artman/publish/famous-cleft.shtml

Kids Health



You tube video:
http://www.youtube.com/watch?v=_5XBTiE3xuc

A cleft palate is a birth defect in which the tissues of the mouth and lip do not form properly during fetal development. A cleft palate occurs in 1 out of 700-1,000 children. It is more likely to occur in children of Asian, Latino, or Native American decent. A child who is having a cleft repaired has surgery within the first 12-18 months. A cleft lip appears as an opening in the skin of the upper lip that extends all the way to the base of the nose. A cleft palate is an opening from the roof of the mouth to the nasal cavity. Some extend through the front and rear part of the palate and others appear as partial clefts. There are three common kinds of clefts: cleft lip without cleft palate, cleft palate without cleft lip, and a cleft lip along with a cleft palate. More boys have a cleft lip and more girls have a cleft palate without a cleft lip. A cleft palate can be seen in a prenatal ultrasound. The cause is unknown, but believed to have genetic and environmental factors.

Kids with clefts are more prone to middle ear fluid collections, hearing loss, and speech defects. Special nipples for bottles have been created in order to help babies with cleft plates. There is a prosthetic plate called an obturator which aids children with clefts during eating. A child who has a cleft palate has to work with a team of specialists including: a geneticist, a plastic surgeon, an ear nose and throat doctor, an oral surgeon, an orthodontist, a dentist, a speech and language pathologist, an audiologist, a nurse coordinator, a social worker, and possibly even a psychiatrist. Normally surgeries are performed during the first 3-6 months for a cleft lip and the first 9-14 months for a cleft palate.

I really enjoyed this website. It was very informative. It provided a lot of helpful information. They sited their sources and had their information peer reviewed which makes the information even more trustworthy. The site was set up so that it was user friendly. It provided helpful information for anyone who could encounter someone who has a cleft, or just anyone who is interested in clefts. I would recommend this website to anyone. Even though the website provided a lot of information it did not present it in a way that was confusing. The website did a great job of laying out the information. It provided great pictures. I learned a lot from this website and highly suggest it to anyone who wants to learn anything about a cleft lip or cleft palate.

http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html