Cleft lip and cleft palate and Kandholhudhoo (Raa Atoll): Difference between pages

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{{Maldives Island|
{{Infobox_Disease
ImageExists=No|
| Name =ass
islandimage=|
| Image = 13900470 3PREOPERATION0.jpg
island=Kandholhudhoo|
| Caption = Right sided unilateral complete cleft lip
atoll=Raa Atoll|
| DiseasesDB = 29604
location=05° 37' 06" E|
| DiseasesDB_mult = {{DiseasesDB2|29414}}
area=4.4 Hec|
| ICD10 = {{ICD10|Q|35||q|35}}-{{ICD10|Q|37||q|35}}
population=3679|
| ICD9 = {{ICD9|749}}
length=475m|
| ICDO =
width=150m|
| OMIM =
male-distance=175.84[[Kilometre|km]]|
| MedlinePlus =
island_chief=Ahmed Solih|
| eMedicineSubj = ped

| eMedicineTopic = 2679
| MeshID =
}}
}}
:''For other islands see [[Kandholhudhoo]]''
{{wiktionary|cleft lip|cleft lip and palate}}
{{otheruses|Cleft (disambiguation)}}
{{redirect|Hairlip|the South American fish|Hairlip brotula}}
'''Cleft lip''' (cheiloschisis) and '''cleft palate''' (palatoschisis), which can also occur together as '''cleft lip and palate''' are variations of a type of clefting [[congenital deformity]] caused by abnormal facial development during [[gestation]]. This type of deformity is sometimes referred to as a ''cleft''. A '''[[cleft]]''' is a sub-division in the body's natural structure, regularly formed before birth. A cleft lip or palate can be successfully treated with [[surgery]] soon after [[birth]]. Cleft lips or palates occur in somewhere between one in 600-800 births.

The term '''harelip''' is no longer used to describe the condition as it is considered offensive.

==Cleft lip==
If the cleft does not affect the palate structure of the mouth it is referred to as cleft lip. Cleft lip is formed in the top of the lip as either a small gap or an indentation in the lip (partial or incomplete cleft) or continues into the nose (complete cleft). Lip cleft can occur as one sided (unilateral) or two sided (bilateral). It is due to the failure of fusion of the maxillary and medial [[nasal processes]] (formation of the primary palate).

<center>
<gallery>
image:CleftLip1.svg|Unilateral incomplete
Image:Cleftlip2.svg|Unilateral complete
image:CleftLip3.png|Bilateral complete
</gallery>
</center>

A mild form of a cleft lip is a '''microform cleft'''. A microform cleft can appear as small as a little dent in the red part of the lip or look like a scar from the lip up to the nostril. In some cases [[Orbicularis oris muscle|muscle tissue in the lip]] underneath the scar is affected and might require reconstructive surgery. It is advised to have newborn infants with a microform cleft checked with a [[craniofacial team]] as soon as possible to determine the severeness of the cleft.

<center>
<gallery>
Image:Cleftbefore.jpg| 3 month old boy before going into surgery to have his unilateral incomplete cleft lip repaired.
Image:Cleftafter.jpg|The same boy, 1 month after the surgery.
Image:Cleftafter2years.jpg|Again the same boy, age 1.5 years old. Note how the scar gets less visible with age.
</gallery>
</center>

<center>
<gallery>
Image:13900470_3PREOPERATION0.jpg|6 month old girl before going into surgery to have her unilateral complete cleft lip repaired.
Image:10_months.jpg|The same girl, 1 month after the surgery.
Image:66_months.jpg|Again the same girl, age 5.4 years old. Note how the scar gets less visible with age.
</gallery>
</center>

</center> The complete restoration of this Cleft Child girl from above can be seen here.
</center> http://www.pbase.com/stella97king/cleft_lip

== Cleft palate ==
'''Cleft palate''' is a condition in which the two plates of the [[skull]] that form the [[hard palate]] (roof of the mouth) are not completely joined. The [[soft palate]] is in these cases cleft as well. In most cases, cleft lip is also present. Cleft palate occurs in about one in 700 live births worldwide.<ref>{{cite web |url=http://www.wrongdiagnosis.com/c/cleft_palate/stats-country.htm |title=Statistics by country for cleft palate |accessdate=2007-04-24 |work=WrongDiagnosis.com }}</ref>

Palate cleft can occur as complete (soft and hard palate, possibly including a gap in the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate). When cleft palate occurs, the [[Palatine uvula|uvula]] is usually split. It occurs due to the failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine processes (formation of the [[secondary palate]]).

The hole in the roof of the mouth caused by a cleft connects the mouth directly to the [[nasal cavity]].

Note: the next images show the roof of the mouth. The top shows the nose, the lips are colored pink. For clarity the images depict a toothless infant.
<center>
<gallery>
image:Cleftpalate3.png|Incomplete cleft palate
image:Cleftpalate1.png|Unilateral complete lip and palate
image:Cleftpalate2.png|Bilateral complete lip and palate
</gallery>
</center>

A direct result of an open connection between the [[oral cavity]] and [[nasal cavity]] is '''velopharyngeal insufficiency''' ([[velopharyngeal inadequacy|VPI]]). Because of the gap, air leaks into the nasal cavity resulting in a hypernasal [[voice]] [[resonance]] and nasal emissions.<ref name="Sloan">{{cite journal |author=Sloan GM |title=Posterior pharyngeal flap and sphincter pharyngoplasty: the state of the art |journal=Cleft Palate Craniofac. J. |volume=37 |issue=2 |pages=112–22 |year=2000 |pmid=10749049 |doi=}}</ref> Secondary effects of VPI include speech [[articulation]] errors (e.g., [[distortions]], substitutions, and omissions) and compensatory misarticulations (e.g., glottal stops and posterior nasal fricatives).<ref>Hill, J.S. (2001). Velopharyngeal insufficiency: An update on diagnostic and surgical techniques. Current Opinion in Otolaryngology and Head and Neck Surgery, 9, 365-368.</ref>. Possible treatment options include [[speech therapy]], prosthetics, augmentation of the posterior pharyngeal wall, lengthening of the palate, and [[Pharyngeal flap surgery|surgical procedures]].<ref name="Sloan" />

'''Submucous cleft palate''' (SMCP) can also occur, which is an occult cleft of the soft palate with a classic clinical triad of bifid uvula, notching of the hard palate, and zona pellucida.

==Prevalence among ethnic groups==
{{main|Clefting prevalence in different cultures}}
[[Prevalence]] rates reported for live births for Cleft lip with or without Cleft Palate (CL +/- P) and Cleft Palate alone (CPO) varies within different [[Ethnicity|ethnic]] groups.

The highest prevalence [[rates]] for (CL +/- P) are reported for [[Native Americans in the United States|Native Americans]] and [[Asians]]. [[Africans]] have the lowest prevalence rates.<ref>See {{cite web |url=http://www.webmd.com/hw-popup/who-is-affected-by-cleft-lip-and-cleft-palate |title=Who is affected by cleft lip and cleft palate |accessdate=2008-06-20}}</ref>
* Native Americans: 3.74/1000
*[[Japanese people|Japanese]]: 0.82/1000 to 3.36/1000
*[[Han Chinese|Chinese]]: 1.45/1000 to 4.04/1000
*[[Caucasian race|Caucasians]]: 1.43/1000 to 1.86/1000
*[[Latin Americans]]: 1.04/1000
*Africans: 0.18/1000 to 1.67/1000

Rate of occurrence of CPO is similar for Caucasians, Africans, North American natives and Asians.

Prevalence of "cleft [[uvula]]" has varied from .02% to 18.8% with the highest numbers found among [[Chippewa]] and [[Navajo people|Navajo]] and the lowest generally in Africans.{{Fact|date=February 2007}}

==Causes of cleft==
During the first six to eight weeks of pregnancy, the shape of the embryo's head is formed. Five primitive tissue lobes grow:
:'''a)''' one from the top of the head down towards the future upper lip;
:'''b-c)''' two from the cheeks, which meet the first lobe to form the upper lip;
:'''d-e)''' and just below, two additional lobes grow from each side, which form the chin and lower lip;
If these tissues fail to meet, a gap appears where the tissues should have joined (fused). This may happen in any single joining site, or simultaneously in several or all of them. The resulting birth defect reflects the locations and severity of individual fusion failures (e.g., from a small lip or palate fissure up to a completely malformed face).

The upper lip is formed earlier than the palate, from the first three lobes named a to c above. Formation of the palate is the last step in joining the five embryonic facial lobes, and involves the back portions of the lobes b and c. These back portions are called palatal shelves, which grow towards each other until they fuse in the middle.<ref>Dudas et al. (2007): Palatal fusion – Where do the midline cells go? A review on cleft palate, a major human birth defect. Acta Histochemica, Volume 109, Issue 1, 1 March 2007, [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7CW7-4KV3XM1-1&_user=10&_coverDate=03%2F01%2F2007&_rdoc=2&_fmt=full&_orig=browse&_srch=doc-info(%23toc%2318099%232007%23998909998%23643280%23FLA%23display%23Volume)&_cdi=18099&_sort=d&_docanchor=&_ct=9&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=17601b1e25589fa0a31f100e2deef522 Pages 1-14]</ref> This process is very vulnerable to multiple toxic substances, environmental pollutants, and nutritional imbalance. The biologic mechanisms of mutual recognition of the two cabinets, and the way they are glued together, are quite complex and obscure despite intensive scientific research.<ref>{{cite journal |author=Dudas M, Li WY, Kim J, Yang A, Kaartinen V |title=Palatal fusion - where do the midline cells go? A review on cleft palate, a major human birth defect |journal=Acta Histochem. |volume=109 |issue=1 |pages=1–14 |year=2007 |pmid=16962647 |doi=10.1016/j.acthis.2006.05.009}}</ref>

The cause of cleft lip and cleft palate formation can be genetic in nature. A specific gene that increases threefold the occurrence of these deformities has been identified by Zucchero et al in 2004<ref>Zucchero, T.M. et al 2004 Interferon Regulatory Factor 6 (IRF6) Gene Variants and the Risk of Isolated Cleft Lip or Palate ''New England Journal of Medicine'' 351:769-780 [http://content.nejm.org/cgi/content/abstract/351/8/769]</ref> as reported by the BBC.<ref>{{cite web |url=http://news.bbc.co.uk/1/hi/health/3577784.stm |title=BBC NEWS | Health | Cleft palate genetic clue found |accessdate=2007-07-01 |format= |work=}}</ref>

Environmental influences may also cause, or interact with genetics to produce, orofacial clefting. Some environmental factors that have been studied include: seasonal causes (such as pesticide exposure); maternal diet and vitamin intake; retinoids- which are members of the vitamin A family; [[anticonvulsant]] drugs; alcohol; cigarette use; nitrate compounds; organic solvents; parental exposure to lead; and illegal drugs (cocaine, crack cocaine, heroin, etc).

If a person is born with a cleft, the chances of that person having a child with a cleft, given no other obvious factor, rises to 1 in 14. Research continues to investigate the extent to which [[Folic acid]] can reduce the incidence of clefting.

In some cases, cleft palate is caused by syndromes which also cause other problems. [[Stickler's Syndrome]] can cause cleft lip and palate, joint pain, and [[myopia]]. [[Loeys-Dietz syndrome]] can cause cleft palate or [[bifid uvula]], [[hypertelorism]], and [[aortic aneurysm]]. Cleft lip/palate may be present in [[Patau Syndrome]] (trisomy 13). Many clefts run in families, even though there does not seem to be any identifiable syndrome present.

==Treatment==
Cleft lip and palate is very treatable; however, the kind of treatment depends on the type and severity of the cleft.

Most children with a form of clefting are monitored by a ''cleft palate team'' or ''craniofacial team'' through young adulthood. Care can be lifelong. Treatment procedures can vary between craniofacial teams. For example, some teams wait on jaw correction until the child is aged 10 to 12 (argument: growth is less influential as [[deciduous teeth]] are replaced by [[permanent teeth]], thus saving the child from repeated corrective surgeries), while other teams correct the jaw earlier (argument: less speech therapy is needed than at a later age when speech therapy becomes harder). Within teams, treatment can differ between individual cases depending on the type and severity of the cleft.

Pioneering Surgeon Dr. Victor Collins has devised the first non skin graft procedure for the treatment of infantile unilateral incomplete and complete cleft lips. This technique involves the partial circumcision of the foreskin and then being applied to the affected area. This technique has led the way in the the modern day removal of the two most common types of cleft lip.

===Cleft lip treatment===
Within the first 2-3 months after birth, [[surgery]] is performed to close the cleft lip. While surgery to repair a cleft lip can be performed soon after birth, the often preferred age is at approximately 10 weeks of age, following the "rule of 10s" coined by surgeons Wilhelmmesen and Musgrave in 1969 (the child is at least 10 weeks of age; weighs at least 10 pounds, and has at least 10g haemoglobin). If the cleft is bilateral and extensive, two surgeries may be required to close the cleft, one side first, and the second side a few weeks later. The most common procedure to repair a cleft lip is the ''Millard procedure'' pioneered by [[Ralph Millard]].
Dr. Ralph Millard performed the first procedure at a
[[MASH|Mobile Army Surgical Hospital]] unit in Korea.<ref>{{cite web |url=http://calder.med.miami.edu/Ralph_Millard/biography.html |title=Biography and Personal Archive |accessdate=2007-07-01 |format= |work=}} at miami.edu</ref>

Often an incomplete cleft lip requires the same surgery as complete cleft. This is done for two reasons. Firstly the group of [[muscle]]s required to purse the lips run through the upper lip. In order to restore the complete group a full incision must be made. Secondly, to create a less obvious scar the surgeon tries to line up the scar with the natural lines in the upper lip (such as the edges of the [[philtrum]]) and tuck away stitches as far up the nose as possible. Incomplete cleft gives the surgeon more tissue to work with, creating a more supple and natural-looking upper lip.

<center>
<gallery>
image:Millardrepair1.svg|The blue lines indicate incisions.
Image:Millardrepair2.svg|Movement of the flaps; flap A is moved between B and C. C is rotated slightly while B is pushed down.
Image:14046555 HAPPY2.jpg | Pre-operation
Image:17161036 POSTOPT3.jpg| Post-operation, the lip is swollen from surgery and will get a more natural look within a couple of weeks. See photos in the [[#Cleft_lip|section above]].
</gallery>
</center>

===Cleft palate treatment===
[[Image:Repairedcleftpalate.JPG|150px|thumb|right|A repaired cleft palate on a 64-year-old female.]]
Often a cleft palate is temporarily closed using a [[palatal obturator]]. The obturator is a prosthetic device made to fit the roof of the mouth covering the gap.

Cleft palate can also be corrected by [[surgery]], usually performed between 6 and 12 months. Approximately 20-25% only require one palatal surgery to achieve a competent velopharyngeal valve capable of producing normal, non-hypernasal speech. However, combinations of surgical methods and repeated surgeries are often necessary as the child grows. One of the new innovations of cleft lip and cleft palate repair is the [[Latham appliance]]. The Latham is surgically inserted by use of pins during the child's 4th or 5th month. After it is in place, the doctor, or parents, turn a screw daily to bring the cleft together to assist with future lip and/or palate repair.

If the cleft extends into the maxillary alveolar ridge, the gap is usually corrected by filling the gap with bone tissue. The bone tissue can be acquired from the patients own chin, rib or hip.

===Speech and hearing treatments===
A [[tympanostomy tube]] is often inserted into the [[eardrum]] to aerate the [[middle ear]]. This is often beneficial for the hearing ability of the child.
Speech problems are usually treated by a [[speech and language pathology|speech-language pathologist]]. In some cases [[pharyngeal flap surgery]] is performed to regulate the airflow during speech and reduce nasal sounds.

===Sample treatment schedule===
Note that each individual patient's schedule is treated on a case-by-case basis and can vary per hospital. The table below shows a common sample treatment schedule. The colored squares indicate the average timeframe in which the indicated procedure occurs. In some cases this is usually one procedure (for example lip repair) in other cases this it is an ongoing therapy (for example speech therapy).
<center>
{| class="wikitable" width="90%"
|-
| <p align="right">age
| <center>0 m</center>
| <center>3 m</center>
| <center>6 m</center>
| <center>9 m</center>
| <center>1 y&nbsp;</center>
| <center>2 y&nbsp;</center>
| <center>3 y&nbsp;</center>
| <center>4 y&nbsp;</center>
| <center>5 y&nbsp;</center>
| <center>6 y&nbsp;</center>
| <center>7 y&nbsp;</center>
| <center>8 y&nbsp;</center>
| <center>9 y&nbsp;</center>
| <center>10 y</center>
| <center>11 y</center>
| <center>12 y</center>
| <center>13 y</center>
| <center>14 y</center>
| <center>15 y</center>
| <center>16 y</center>
| <center>17 y</center>
| <center>18 y</center>
|-
| [[Palatal obturator]]
| bgColor="#009900" | &nbsp;
| bgColor="#009900" | &nbsp;
| bgColor="#009900" | &nbsp;
| bgColor="#009900" | &nbsp;
| bgColor="#009900" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| Repair cleft lip
| &nbsp;
| bgColor="#ff0000" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| Repair [[soft palate]]
| &nbsp;
| &nbsp;
| &nbsp;
| bgColor="#ff6666" | &nbsp;
| bgColor="#ff6666" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| Repair [[hard palate]]
| &nbsp;
| &nbsp;
| &nbsp;
| bgColor="#9900cc" | &nbsp;
| bgColor="#9900cc" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| [[Tympanostomy tube]]
| &nbsp;
| &nbsp;
| bgColor="#ff0099" | &nbsp;
| bgColor="#ff0099" | &nbsp;
| bgColor="#ff0099" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| [[Speech therapy]]/[[Pharyngeal flap surgery|Pharyngeal surgery]]
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| bgColor="#666699" | &nbsp;
| bgColor="#666699" | &nbsp;
| bgColor="#666699" | &nbsp;
| bgColor="#666699" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| [[Bone grafting]] jaw
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| bgColor="#ff3300" | &nbsp;
| bgColor="#ff3300" | &nbsp;
| bgColor="#ff3300" | &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
|-
| [[Orthodontics]]
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| bgColor="#0000cc" | &nbsp;
| &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
| bgColor="#0000cc" | &nbsp;
|-
| Further cosmetic corrections
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
| &nbsp;
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| &nbsp;
| &nbsp;
| bgColor="#ffff00" | &nbsp;
| bgColor="#ffff00" | &nbsp;
| bgColor="#ffff00" | &nbsp;
| bgColor="#ffff00" | &nbsp;
|}
</center>

=== Craniofacial team ===
{{Main article|Craniofacial team}}
A craniofacial team is routinely used to treat this condition. The majority of hospitals still use craniofacial teams; yet others are making a shift towards dedicated cleft lip and palate programs. While craniofacial teams are widely knowledgeable about all aspects of craniofacial conditions, dedicated cleft lip and palate teams are able to dedicate many of their efforts to being on the cutting edge of new advances in cleft lip and palate care.

Many of the top pediatric hospitals are developing their own CLP clinics in order to provide patients with comprehensive multi-disciplinary care from birth through adolescence. Allowing an entire team to care for a child throughout their cleft lip and palate treatment (which is ongoing) allows for the best outcomes in every aspect of a child's care. While the individual approach can yield significant results, current trends indicate that team based care leads to better outcomes for CLP patients. .<ref>{{cite web |url=http://www.widesmiles.org/cleftlinks/WS-359.html|author=Joanne Green |title=The Importance of a Multi-Disciplinary Approach |accessdate=2007-10-15 |format= |work=}}</ref>

A complete listing of craniofacial teams is available through the [http://www.cleftline.org Cleft Palate Foundation]

==Complications==
[[Image:Cleft Nurser Mead Johnson.jpg|thumb|right|A baby being fed using the Cleft Nurser by Mead Johnson. The upright sitting position allows [[Earth's gravity|gravity]] to help the baby swallow the milk more easily]]
Cleft may cause problems with feeding, ear disease, speech and socialization.

Due to lack of suction, an infant with a cleft may have trouble feeding. An infant with a cleft palate will have greater success feeding in a more upright position. Gravity will help prevent milk from coming through the baby's nose if he/she has cleft palate. Gravity feeding can be accomplished by using specialized equipment, such as the [[Haberman Feeder]], or by using a combination of nipples and bottle inserts like the one shown, is commonly used with other infants. A large hole, crosscut, or slit in the nipple, a protruding nipple and pressure applied to the bottle insert by the caregiver's hand can result in controllable flow to the infant without the stigma caused by specialized equipment.

Individuals with cleft also face many middle ear infections which can eventually lead to total hearing loss. The [[Eustachian]] tubes and external ear canals may be angled or tortuous, leading to food or other contamination of a part of the body that is normally self cleaning.

Because the lips and palate are both used in pronunciation, individuals with cleft usually need the aid of a speech therapist. Bonding with the infant, socializing with family and community may be interrupted by the unexpected appearance, unusual speech and the surgical interventions necessary. Support for the parents as well as for the child can be pivotal.(see Psychosocial issues)
<BR clear=all>

==Psychosocial issues==
Having a cleft palate does not inevitably lead to a psychosocial problem. Most children who have their cleft lips repaired early have a happy youth and a healthy social life. However, it is important to remember that adolescents with cleft palate are at an elevated risk for developing psychosocial problems especially those relating to self concept, peer relationships, and appearance. It is important for parents to be aware of the psychosocial challenges their adolescents may face and to know where to find professional help if problems arise.

A cleft palate may impact an individual’s [[self-esteem]], [[social skills]], and [[behavior]]. There is a large amount of research dedicated to the [[social development|psychosocial development]] of individuals with cleft palate. Self-concept may be adversely affected by the presence of a cleft palate. Research has shown that during the early preschool years (ages 3-5), children with cleft palate tend to have a self-concept that is similar to their peers without a cleft. However, as they grow older and their social interactions with other children increase, children with clefts tend to report more dissatisfaction with peer relationships and higher levels of social anxiety. Experts conclude that this is probably due to the associated stigma of visible deformities and speech abnormalities, if present. Children who are judged as attractive tend to be perceived as more intelligent, exhibit more positive social behaviors, and are treated more positively than children with cleft palate.<ref>Tobiasen, J.M. (1984) Psychosocial correlated of congenital facial clefts: a conceptualization and model. Cleft Palate Journal, 21, 131-139.</ref> Children with clefts tend to report feelings of anger, sadness, fear, and alienation from their peers. Yet these children were similar to their peers in regard to "how well they liked themselves."

The relationship between parental attitudes and a child’s self-concept is crucial during the preschool years. It has been reported that elevated stress levels in mothers correlated with reduced social skills in their children.<ref>{{cite journal |author=Pope AW, Ward J |title=Self-perceived facial appearance and psychosocial adjustment in preadolescents with craniofacial anomalies |journal=Cleft Palate Craniofac. J. |volume=34 |issue=5 |pages=396–401 |year=1997 |pmid=9345606 |doi=}}</ref> Strong parent support networks may help to prevent the development of negative self-concept in children with cleft palate {{Fact|date=June 2008}}. In the later preschool and early elementary years, the development of social skills is no longer only impacted by parental attitudes but is beginning to be shaped by their peers. A cleft palate may affect the behavior of preschoolers. Experts suggest that parents discuss with their children ways to handle negative social situations related to their cleft palate. A child who is entering school should learn the proper (and age-appropriate) terms related to the cleft. The ability to confidently explain the condition to others may limit feelings of awkwardness and embarrassment and reduce negative social experiences.<ref>{{cite web |url=http://cleftline.org |title=Cleft Palate Foundation |accessdate=2007-07-01 |format= |work=}}</ref>

As children reach adolescence, the period of time between age 13 and 19, the dynamics of the parent-child relationship change as peer groups are now the focus of attention. An adolescent with cleft palate will deal with the typical challenges faced by most of their peers including issues related to self esteem, dating, and social acceptance.<ref>{{cite journal |author=Snyder HT, Bilboul MJ, Pope AW |title=Psychosocial adjustment in adolescents with craniofacial anomalies: a comparison of parent and self-reports |journal=Cleft Palate Craniofac. J. |volume=42 |issue=5 |pages=548–55 |year=2005 |pmid=16149838 |doi=10.1597/04-078R.1}}</ref><ref>{{cite journal |author=Endriga MC, Kapp-Simon KA |title=Psychological issues in craniofacial care: state of the art |journal=Cleft Palate Craniofac. J. |volume=36 |issue=1 |pages=3–11 |year=1999 |pmid=10067755 |doi=}}</ref><ref name="PopeSynder">Pope, A.W. & Snyder, H.T. (2004). Psychosocial adjustment in children and adolescents with a craniofacial anomaly: Age and sex patterns. The Cleft Palate-Craniofacial Journal, 42, 4.</ref> Adolescents, however, view appearance as the most important characteristic above intelligence and humor.<ref>Prokohorov, A.V., Perry, C.L., Kelder, S.H., & Klepp, K.I. (1993). Lifestyle values of adolescents: Results from the Minnesota Heart Health Youth Program. Adolescence, 28.</ref> This being the case, adolescents are susceptible to additional problems because they cannot hide their facial differences from their peers. Adolescent boys typically deal with issues relating to withdrawal, attention, thought, and [[internalizing]] problems and may possibly develop anxiousness-depression and aggressive behaviors.<ref name="PopeSynder" /> Adolescent girls are more likely to develop problems relating to self concept and appearance. Individuals with cleft palate often deal with threats to their [[quality of life]] for multiple reasons including: unsuccessful social relationships, deviance in social appearance, and multiple surgeries. Individuals with cleft palate often have lower QOL scores than their peers {{Fact|date=June 2008}}. Psychosocial functioning of individuals with cleft palate often improves after surgery, but does not last due to unrealistic expectations of surgery {{Fact|date=June 2008}}.

==Controversy==
In some countries cleft lip or palate deformities are considered reasons (either generally tolerated or officially sanctioned) to perform [[abortion]] beyond the legal [[fetal]] age limit, even though the [[fetus]] is not in jeopardy of life or limb. Some [[human rights]] activists contend this practice of "cosmetic murder" amounts to [[eugenics]]. A [[United Kingdom|British]] clergywoman, [[Joanna Jepson]], who suffered from a congenital jaw deformity herself (not a cleft lip or palate as is sometimes reported), has started legal action to stop the practice in the [[UK]] as reported by CNN<ref>{{cite web |url=http://www.cnn.com/2003/WORLD/europe/12/01/uk.curate.abortion/index.html |title=CNN.com - Priest challenges late abortion - Dec. 1, 2003 |accessdate=2007-07-01 |format= |work=}}</ref> and the BBC.<ref>{{cite web |url=http://news.bbc.co.uk/1/hi/england/hereford/worcs/3680162.stm |title=BBC NEWS | England | Hereford/Worcs | CPS examines late abortion case |accessdate=2007-07-01 |format= |work=}}</ref> Note that in the UK, an abortion could never be justified under the 1967 Abortion Act on the basis that a cleft lip and palate is not considered a serious handicap.

==Famous people born with a cleft==
===Historical===
<!-- Note: Please cite sources when adding entries to this list, non sourced entries can be removed -->
{| class=wikitable
! width="17%" | Name
! width="65%" | Comments
! width="5%" | Reference
|- valign="top"
| '''[[Tutankhamen]] '''
| Egyptian [[Pharaoh]] who may have had a slightly cleft palate according to diagnostic imaging
|<ref>{{cite web |url=http://news.nationalgeographic.com/news/2005/03/0308_050308_kingtutmurder_2.html |title=King Tut Not Murdered Violently, CT Scans Show |accessdate=2007-07-01 |format= |work=}}</ref>
|- valign="top"
| '''[[Doc Holliday]]'''
| [[Dentist]], [[gambler]] and [[gunfighter]] of the American [[Old West]] frontier
|
|- valign="top"
| '''[[Tad Lincoln]] '''
| Fourth and youngest son of President [[Abraham Lincoln]]
|<ref>{{cite web |url=http://www.historybuff.com/library/reftad.html |title=HistoryBuff.com -- Tad Lincoln: The Not-so-Famous Son of A Most-Famous President |accessdate=2007-07-01 |format= |work=}}</ref>
|- valign="top"
| '''[[Victor Collins]]'''
| Well know surgeon who developed the pioneering technique for harelip removal.
|
|}

===Modern===
<!-- Note: Please cite sources when adding entries to this list, non sourced entries can be removed -->
<!--

DO NOT ADD JOAQUIN PHOENIX TO THE LIST.
Contrary to popular belief he does not have a cleft lip. His condition is described elsewhere in this article.

-->
{| class=wikitable
! width="17%" | Name
! width="65%" | Comments
! width="5%" | Reference
|- valign="top"
| '''[[Carmit Bachar]]'''
| American [[dancer]] and [[singer]]
|<ref>{{cite web |url=http://www.buddytv.com/articles/pussycat-dolls-present-the-search-for-the-next-doll/pussycat-dolls-carmit-bachar-i-12393.aspx |title=Carmit Bachar, smile ambassador |accessdate=2007-10-13 |format= |work=}}</ref><ref>Beverley Lyons, [[October 16]], [[2006]]. [http://www.dailyrecord.co.uk/news/tm_headline=the-razz--carmite-doing-her-bit-for-charity-&method=full&objectid=17937064&siteid=66633-name_page.html Carmite Doing Her Bit For Charity]. ''The Daily Record''</ref>
|-
| '''[[Jürgen Habermas]]'''
| German [[philosopher]] and [[sociologist]]
|
|-
| '''[[Wendy Harmer]]'''
| Australian [[comedian]]
|
|-
| '''[[Richard Hawley]]'''
| English [[guitarist]], [[singer]], [[songwriter]] and [[Record producer|producer]]
|
|-
| '''[[Michael Helm]]'''
| Canadian novelist
|
|-
| '''[[Jesse Jackson]]'''
| American [[politician]], professional [[civil rights]] activist and [[Baptist]] [[Minister (Christianity)|minister]]
|
|-
| '''[[Stacy Keach]]'''
| American [[actor]] and [[narrator]]
|<ref>{{cite web |url=http://www.cleftline.org/story_of_the_month/oct02 |title=Stacy Keach | Cleft Palate Foundation |accessdate=2007-07-01 |format= |work=}}</ref>
|-
| '''[[Tim Lott]]'''
| English novelist
|-
| '''[[Rita MacNeil]]'''
| Canadian [[country]] and [[folk]] [[singer]]
|
|-
| '''[[Cheech Marin]]'''
| American [[actor]] and [[comedian]]
|-
| '''[[Jesse Merz]]'''
| American [[actor]] and [[Film director|director]]
|
|-
| '''[[Ljubo Milicevic]]'''
| Australian [[football (soccer)]] player
|
|-
| '''[[Nikki Payne]]'''
| Canadian [[comedian]] and [[actress]]
|
|-
| '''[[Geoff Plant]]'''
| Canadian [[lawyer]] and [[politician]], Attorney-General of [[British Columbia]]
|
|-
| '''[[Lee Raymond]]'''
| American business executive - former [[CEO]] and [[Chairman]] of [[ExxonMobil]]
|
|-
| '''[[Louis Wain]]'''
| English [[artist]], best known for his drawings featuring [[anthropomorphised]] large-eyed cats<ref>[[Louis Wain]] was famous for his amusing drawings of cats and kittens in human situations: possibly when he was a child he may have compared his own mouth to that of a cat which has a natural cleft, drawing the animals to mock his deformity</ref>
|
|-
| '''[[Tom Brokaw]]'''
| American television journalist and author.
|
|-
|'''[[Barney Frank]]'''
|American Congressmen.
|}


The popular belief that [[Joaquin Phoenix]] has a repaired cleft lip is '''mistaken'''. The mark on his lip is a microform, an almost-cleft that healed itself [[in utero]]. If the tissues join up just enough to create correct bone and muscle tissues, no corrective surgery is required, as was the case with Phoenix.

==Cleft lip and palate in animals==
Cleft lips and palates are occasionally seen in [[cattle]] and [[dog]]s, and rarely in [[sheep]], [[cat]]s, [[horse]]s, [[panda]]s and [[ferret]]s. Most commonly, the defect involves the lip, [[rhinarium]], and [[premaxilla]]. Clefts of the hard and soft palate are sometimes seen with a cleft lip. The cause is usually hereditary. [[Cephalic index|Brachycephalic]] dogs such as [[Boxer (dog)|Boxers]] and [[Boston Terrier]]s are most commonly affected.<ref name=Ettinger_1995>{{cite book|author=Ettinger, Stephen J.;Feldman, Edward C.|title=Textbook of Veterinary Internal Medicine|edition=4th ed.|publisher=W.B. Saunders Company|year=1995|id=ISBN 0-7216-6795-3}}</ref> An inherited disorder with incomplete [[penetrance]] has also been suggested in [[Shih tzu]]s, [[Swiss Sheepdog]]s, [[Bulldog]]s, and [[Pointer (dog breed)|Pointers]].<ref>{{cite web | last = Garcia | first = J.F. Rodriguez | title = Surgery of the Soft and Hard Palate | work = Proceedings of the North American Veterinary Conference | date = 2006 | url = http://www.ivis.org/proceedings/navc/2006/SAE/516.asp?LA=1 | accessdate = 2007-04-28 }}</ref> In horses, it is a rare condition usually involving the caudal soft palate.<ref>{{cite web | last = Semevolos | first = Stacy A. | coauthors = Ducharme, Norm | title = Surgical Repair of Congenital Cleft Palate in Horses: Eight Cases (1979–1997) | work = Proceedings of the American Association of Equine Practitioners | date = 1998 | url = http://www.ivis.org/proceedings/AAEP/1998/Semevolo.pdf | format = PDF | accessdate = 2007-04-28 }}</ref> In [[Charolais cattle]], clefts are seen in combination with [[arthrogryposis]], which is inherited as an [[Recessive allele|autosomal recessive]] trait. It is also inherited as an autosomal recessive trait in [[Texel (sheep)|Texel sheep]]. Other contributing factors may include maternal nutritional deficiencies, exposure ''in utero'' to viral infections, trauma, drugs, or chemicals, or ingestion of toxins by the mother, such as certain [[lupin]]es by cattle during the second or third month of [[gestation]].<ref>{{cite web | title = Mouth | work = The Merck Veterinary Manual | date = 2006 | url = http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/20202.htm | accessdate = 2007-04-28 }}</ref> The use of [[corticosteroid]]s during pregnancy in dogs and the ingestion of ''[[Veratrum californicum]]'' by pregnant sheep have also been associated with cleft formation.<ref>{{cite web|author=Beasley, V.|year=1999|title=Teratogenic Agents|work=Veterinary Toxicology|url=http://www.ivis.org/advances/Beasley/cpt8a/chapter_frm.asp?LA=1&table=1|accessdate=2007-04-28}}</ref>

Difficulty with nursing is the most common problem associated with clefts, but [[aspiration pneumonia]], [[regurgitation]], and [[malnutrition]] are often seen with cleft palate and is a common cause of death. Providing nutrition through a [[feeding tube]] is often necessary, but corrective surgery in dogs can be done by the age of twelve weeks.<ref name=Ettinger_1995/> For cleft palate, there is a high rate of surgical failure resulting in repeated surgeries.<ref>{{cite journal |author=Lee J, Kim Y, Kim M, Lee J, Choi J, Yeom D, Park J, Hong S |title=Application of a temporary palatal prosthesis in a puppy suffering from cleft palate |journal=J. Vet. Sci. |volume=7 |issue=1 |pages=93–5 |year=2006 |pmid=16434860}}</ref> Surgical techniques for cleft palate in dogs include [[prosthesis]], mucosal flaps, and microvascular [[free flap]]s.<ref>{{cite journal |author=Griffiths L, Sullivan M |title=Bilateral overlapping mucosal single-pedicle flaps for correction of soft palate defects |journal=Journal of the American Animal Hospital Association |volume=37 |issue=2 |pages=183–6 |year=2001 |pmid=11300527}}</ref> Affected animals should not be bred due to the hereditary nature of this condition.
<center>
<gallery>
Image:Cleft lip in boxer.JPG|Cleft lip in a Boxer
Image:Cleft lip in boxer 2.JPG|Cleft lip in a Boxer with premaxillary involvement
Image:Cleft lip adult dog.JPG|Same dog as picture on left, one year later
</gallery>
</center>

==References==
{{Reflist|2}} 31. ^ Stella King Cleft Child; http://www.pbase.com/stella97king/cleft_lip

==See also==
===Treatment/aids===
* [[Oral and Maxillofacial Surgery]]
* [[Haberman Feeder]]
* [[Palatal obturator]]
* [[Vomer flap surgery]]
* [[The Latham Device]] [http://www.pbase.com/stella97king/cleft_lip&page=2]

===Syndromes===
* [[Hearing loss with craniofacial syndromes]]
* [[Popliteal pterygium syndrome]]
* [[Van der Woude syndrome]]


'''Kandholhudhoo''' ([[Dhivehi language|Dhivehi]]: ކަނދޮޅުދޫ) is one of the inhabited islands of [[Raa Atoll]]. The island was destroyed during the tsunami of 2004, and the inhabitants of the island currently reside in various other islands of Raa Atoll. An uninhabited island, Raa. Dhuvaafaru, has been proposed to be developed for the residents of Kandholhudhoo.
===General Support Discussion Boards===
*[http://www.cleftadvocate.org/ftfc.html cleftAdvocate's Family-to-Family Connection Listserv]
*[http://www.aboutcleft.com/ aboutcleft - International Discussion Boards]
*[http://www.faceforward.org.uk/ Face Forward - The UK's Number One Discussion Boards]


{{Islands of the Maldives}}
===Organizations===
*[[Cleft lip and palate organisations|List of Cleft lip & palate organizations]]


{{Maldives-geo-stub}}
{{Commonscat|Cleft lip}}
{{Congenital malformations and deformations of digestive system}}
{{Cleft lip and palate}}


{{coord missing|Maldives}}
[[Category:Congenital disorders]]
[[Category:Facial features]]
[[Category:Dog health]]
[[Category:Oral and maxillofacial surgery]]


[[nl:Kandholhudhoo (Raa-atol)]]
[[ar:فلح الشفة والحنك]]
[[gn:Tembevo]]
[[sk:Kandoludú]]
[[da:Læbe-ganespalte]]
[[de:Lippen-Kiefer-Gaumenspalte]]
[[dv:ކްލެފްޓް ޕަލޭޓް]]
[[es:Labio leporino]]
[[eo:Fendlipo]]
[[fa:لب‌شکری]]
[[fr:Fente labiale]]
[[ko:언청이]]
[[it:Labbro leporino]]
[[he:שפה שסועה]]
[[nl:Schisis]]
[[ja:口蓋裂]]
[[no:Hareskår]]
[[pl:Zajęcza warga]]
[[pt:Lábio leporino]]
[[ru:Расщепление нёба]]
[[fi:Halkio]]
[[sv:Läpp-, käk- och gomspalt]]
[[te:గ్రహణం మొర్రి]]
[[vi:Sứt môi]]
[[tr:Dudak damak yarığı]]
[[zh:唇顎裂]]

Revision as of 13:44, 10 October 2008

Template:Maldives Island

For other islands see Kandholhudhoo

Kandholhudhoo (Dhivehi: ކަނދޮޅުދޫ) is one of the inhabited islands of Raa Atoll. The island was destroyed during the tsunami of 2004, and the inhabitants of the island currently reside in various other islands of Raa Atoll. An uninhabited island, Raa. Dhuvaafaru, has been proposed to be developed for the residents of Kandholhudhoo.

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