Page 25 - Sphere No.24 (Mar 2009)

that offers not only free surgery but also transportation, hous-
ing, food, speech rehabilitation guidance and comprehensive
assistance to the patient and family.
In addition, Shantou University Medical College is investi-
gating the genetic basis of cleft lips and palates and is building a
comprehensive database on China’s cleft lip population to gain
better insight into the causes of the disease and explore more
effective prevention and treatment solutions.
While medical science points to a variety of factors that contrib-
ute to the occurrence of cleft lips and palates, the exact cause is not
known. Orofacial clefting is, to an extent, a hereditary condition: if
a parent was born with a cleft the chances that his or her child will
also have a cleft rise to one in 14, given no other factors.
On the other hand, genetics only answers some of the ques-
tions. Environmental factors like exposure to pesticides or lead,
extra stress, the mother’s vitamin deficiency, and the use of drugs,
alcohol and cigarettes can interact with a genetic predisposition.
The condition manifests itself within the first two months of
pregnancy, when the two plates of an embryo’s skull are not
joined during fetal development. This results in a gap in the
lips, palate, gums and nose cavity, ranging from a small gap to
something much more severe.
Occurrence rates are about 1.65 to 1.8 births per 1,000 in
China, a number that is consistent with worldwide rates, al-
though it may be rising due to as yet unknown reasons, accord-
ing to Dr Chen Renji, the head of surgery at Beijing Stomato-
logical Hospital, Capital Medical University.
Surgery for cleft lips can be simple, lasting as little as 45 min-
utes. However, babies withmore severe deformities may require
years of surgery, dental work, speech therapy and even counsel-
ling. Most hospitals in China only provide the surgery, and only
a few specialist hospitals in the country have the resources to
treat the patient using a holistic approach.
At the Beijing Stomatological Hospital, Dr Chen has person-
ally treated over 3,000 cleft lip and palate patients during his 20
years in the field. “When there isn’t a charity helping with the
cost of the treatment, the notes some families bring are dirty
and wrinkled. You can tell that they haven’t lived well for years,
that they have been saving forever.”
Dr Chen said that before surgery, his patients have trouble at
school and are made fun of by other students. Even teachers may
avoid communicating with the student
because of their speech difficulties.
“Often, even if society accepts the
child, he or she won’t have the confi-
dence to enter society,” said Dr Chen,
who not only performs surgery but
also does research into speech ther-
apy and other cleft lip and palate
treatments. “They feel the pressure
in their hearts and some, though
definitely not all, may develop psy-
chological problems.”
Sphere 23
Some students, like Liu Yingying, 18, and her twin sister Liu
Jiawei, both recipients of the free treatment from Project New
Life, began school late as a result of their cleft palates. They are
now in their third year of junior high (ninth grade).
Yingying, who was waiting alone for her surgery in the
sunny hospital room she shared with six other younger pa-
tients and their parents, speaks in a fast, self-conscious clip,
often shrugging to make her point. Her speech is devoid of
the guttural stops and H sounds, like
the one at the beginning of her native
province, Hebei.
Her parents are originally farm-
ers, but have worked in Beijing for
years. She and her sister live with their
grandmother. Their surgeries have
been delayed until now because the
family lacked the funds to treat them.
When asked about her upcoming sur-
gery, Yingying smiled nervously but
widely. “I’m happy. Really happy.”
How the Trouble Starts
Unilateral incomplete
In the case of cleft lips, there is an indenta-
tion or gap in the lip that does not extend
to the nasal cavity. In the case of cleft pal-
ates, there is a hole or fissure in the pal-
ate. Simple surgery is required to sew the
two sides of the fissure together. Babies with cleft lips and
palates can also have hearing problems and constant ear
infections.
Unilateral complete
The fissure in the lips and palate extends, in
the case of the cleft palate through the gums,
to the nasal cavity, linking the oral and the
nasal cavity. Depending on the severity of the
clefting, the patient may require multiple sur-
geries of the lip, palate, gums, and nasal cavity.Years of orth-
odontic work and speech therapy may follow.
Bilateral complete
The most severe category of the birth
defect.The fissure splits off in two direc-
tions and extends through the lip and
gums on two sides to both nostrils, the
lip tissue in between the two fissures flip
upwards. The deformity may extend to the jaw and re-
quire bone grafting.
Here are three
main types of
cleft lip and
palate conditions
Lip
Alveolus (gum)
Hard Palate
Soft palate
Uvula