The incidence of cleft lip/palate in children is 1 in 2000. The cause is yet unknown. Deficiency of vitamin B complex or C or excess of vitamin of A and E is suspected. The organs of fetus develop in the womb when the fetus is 4 to 8 weeks old. The drug cortisone is also responsible for the formation of cleft lip / palate in the fetus.
When a lady becomes pregnant, it is advisable to take adequate quantities of vitamins, especially folic acid, to avoid drugs like cortisone, abstain from tobacco and alcohol especially during the first 4 to 8 weeks of pregnancy.
Feeding difficulties are observed in children born with cleft lip/ palate. A Plastic surgeon or a Paediatrician, can suitably advise the care givers upon feeding techniques.
Because of the gap in the lip / palate, the child is unable to create a vacuum in the mouth and thus is unable to suck from the mother's breast or feeding bottle. The child can be fed with a spoon or with a plastic feeding bottle with a larger hole in the nipple, so that when the child sucks ,the plastic bottle is squeezed gently and more milk enters the mouth. Along with the milk, the child also swallows large quantities of air. It is important to remember to burp the child after each feed. These children are at a risk for repeated throat and chest infections. It is advised to protect these children from unnecessary exposure to polluted atmosphere.
Cleft lip / palate deformity is fortunately a correctable deformity. This correction has to be done in stages, just like building a house, which is done over a period of time. The cleft lip is closed when the child is about 3 months old. For improving the speech, a surgery has to be done for some children at the back of the throat when the child is 3 to 5 years old. The nose has to be corrected at the time of puberty along with improvement of the lip scar.
In children with cleft lip / palate, the teeth erupt in an irregular manner and the child has to be under the care of dental surgeon and orthodontist (A Dentist who specialises in the alignment of teeth). There is a tube called Eustachian tube, which connects the throat with the middle ear. Usually in a child with cleft lip / palate, the tube dose not function properly and these children develop repeated middle ear infections. If this is not treated properly, the child may become deaf and have improper speech. To prevent this, the child with cleft lip / palate must also be under the regular observation of an ENT Surgeon.
Some of these children might have other birth defects involving the heart, brain etc., and these could be diagnosed by a thorough investigation by a Paediatrician who is a member of the treating team. After the palate surgery, the child and the parents must regularly visit the speech therapist who will help in improving the speech of the child.
Very often, the parents of such children need counseling. The child with the cleft lip / palate, might be teased by their playmates and may need to be counseled.
Management of a cleft lip / palate child involves a multidisciplinary approach. At G.K.N.M. Hospital the child with a cleft lip / palate deformity is examined by a team of specialists who collaborate in the treatment. The parents are involved at every step of the care delivery.
It is advisable to approach centres which offer a multidisciplinary team approach for the correction of cleft lip and palate deformity where the entire planning, treatment and follow up is done under one roof. On correction, majority of these children become well integrated.
It is of paramount importance for parents to understand that the correction and rehabilitation of cleft lip / palate children involve various specialties and intervention has to be done at appropriate times. The parents should fully understand the treatment plan and partner in the treatment .
Diabetic foot disease is a difficult disease to treat. 10% of the population will develop diabetes and out of this 15% will develop diabetic foot disease. The most important thing in diabetic foot disease is prevention.
Preventive measures :
The comprehensive Diabetic Foot Care Centre was inaugurated at GKNM Hospital on 11-10-2006. The service is available on Mondays between 2.00 pm and 4.00 pm at room No.21 of A Block.
Modern methods of treatment like vacuum assisted closure for wounds, usage of growth factors for quick wound healing, revascularisation to improve the blood supply to the foot and skin substitutes for wound cover are regularly performed here.