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Cleft Lip/Palate more prevalent in Asians

Scientists still don't know what causes birth defects such as cleft lip and palate but Fernando Burnstein, M.D., medical director at the Center for Craniofacial Disorders, Children's Healthcare in Atlanta, said the prevailing amount of evidence points to genetic as well as environmental factors.

By Jorge E. Bañales

Scientists still don't know what causes birth defects such as cleft lip and palate but Fernando Burstein, M.D., medical director at the Center for Craniofacial Disorders, Children's Healthcare in Atlanta, said the prevailing amount of evidence points to genetic as well as environmental factors.

According to Dr. Burstein, one out of every 800 children born among Asian-Americans will likely have a birth defect known as cleft lip/palate.

Nearly one in 33 babies, or about 120,000, is born each year in the United States with a birth defect, and birth defects are the leading cause of death in the first year of life. One of the most common of these, cleft lip/palate, affects about 6,800 babies each year. A cleft lip and palate occurs when there is an opening in the lip or roof of the mouth or in both.

Asian father with infant.Dr. Burstein said that among Caucasians or other children of European descent, the incidence is about one in 1,000, and among African-Americans it is one in 1,200. He said the number for Hispanics, are "pretty close to that of Caucasians, it's not too much different," adding that "American Indians also have a fairly high incidence."

Usually, the presence of this birth defect is detected when the child is born, but sometimes it can be diagnosed prior to childbirth.

"If the mother has had access, and this is important in the minority context, to very advanced perinatal care , there is a high probability that through high resolution ultrasonography defects can by identified, Dr. Burstein said. "Not all, but most of the time," Dr.Burstein added.

What happens to my baby with cleft lip/palate?

When a baby with a cleft lip/palate, or both, is born, the priority is to look at the feeding issues the baby might have, said Fernando Burstein, M.D., medical director at the Center for Craniofacial Disorders Children's Healthcare in Atlanta.

"Sometimes, when babies have clefts, it's hard for them to eat, so we provide them with special nipples and bottles to help them to eat," he explained.

Dr. Burstein, who specializes in cleft lip and palate, craniofacial deformities, hemangiomas, perinatal consultation and dentofacial anomalies, said that when a baby is taken to the craniofacial surgery center, he or she is evaluated by a team. The team, includes specialists such as speech therapist, dentists, surgeons, as well as social worker, "to make sure we can get this all lined up for them."

One in 33 babies, or about 120,000, is born each year in the United States with a birth defect, and birth defects are the leading cause of death in the first year of life. One of the most common of these, cleft lip/palate, affects about 6,800 babies each year. A cleft lip and palate occurs when there is an opening in the lip or roof of the mouth or in both.

"When these babies are 12 weeks old, surgeons repair the lip and the baby has to stay for one or two days in the hospital. When they're about six months old doctors perform the palate surgery, and once again, they are in the hospital for one or two days", Burstein said. Then his team follows the child's progress on a yearly basis.

"So there's actually a regimen of follow-up visits as the child grows up, where we address not only the initial problem, which is the lip and the palate, but we also look at their dental health, their speech and other problems that can come up along the way," Dr. Burstein said.


What is the Latham appliance?

When a baby is born with a cleft lip or palate, an opening in the lip or roof the mouth or both, and there is a large gap in the gum doctors may place a device inside the child's mouth called the Latham appliance in order to facilitate surgery.

Then, the parents have to adjust the device at night by turning a screw on it, helping to make the gap in the gums smaller. "Not completely, but enough that it makes it easier to close the lip and the palate," said Fernando Burstein, M.D., medical director, at the Center for Craniofacial Disorders, Children's Healthcare of Atlanta.

Dr. Burstein specializes in cleft lip and palate, craniofacial deformities, hemangiomas, perinatal consultation and dentofacial anomalies.

One in 33 babies, or about 120,000, is born each year in the United States with a birth defect, and birth defects are the leading cause of death in the first year of life. One of the most common of these, cleft lip/palate, affects about 6,800 babies each year. A cleft lip and palate occurs when there is an opening in the lip or roof of the mouth or in both.

"It's no so much the bones," he said explaining that a common misconception is that the bones of the palate have to fuse together. "There are two bones, but what's more important is that the soft palate, which has the muscles that are used for speech, is closed. That's the way we speak, and then the bones don't need to be brought together but what we do need to do is to bring the micosa, or the covering, of the bones together, so that we are able to separate the mouth from the nose."

He said that if surgeons are successful then they can prevent food from going into the nose, which can be "unpleasant," and the baby is able to develop the proper speech patterns.

"As long as the nose and mouth are separated we'll have normal function," said Burstein. "It's really the covering that is more important."


Changes in cleft Lip and Palate treatment

Over the last 30 years, a lot has changed since Dr.Fernando Burstein, M.D. started practice in terms of diagnoses, treatment and approach to babies born with a cleft lip and palate. Dr. Burstein is the medical director, at the Center for Craniofacial Disorders, Children's Healthcare of Atlanta.

One in 33 babies, or about 120,000, is born each year in the United States with a birth defect, and birth defects are the leading cause of death in the first year of life. One of the most common of these, cleft lip/palate, affects about 6,800 babies each year. A cleft lip and palate occurs when there is an opening in the lip or roof of the mouth or in both.

"We did not have these appliances that made things easier for us," he says. "Our teams have gotten much better in terms of being able to diagnose and treat. We have better designed bottles and nipples,” said Dr. Bursntesin, who specializes in cleft lip and palate, craniofacial deformities, hemangiomas, perinatal consultation and dentofacial anomalies.

Dr. Burstein said that, babies had to stay in the hospital up to a week following cleft palate repair 20-years- ago, but now, they stay one day. Dr. Burstein said he has also seen more international recognition to an early diagnoses with a "team approach" to treat this birth defect with better results.




Content Last Modified: 3/9/2009 11:31:00 AM
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