Dr.David C. Hoffman - Oral & Maxillofacial Surgery School of Dentistry: NY Univ.- College of Dentistry Residency :Oral & Maxillofacial Surgery Univ. Texas Health Science Center Parkland Memorial Hospital
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Cleft Lip/Palate Introduction Male1: You are an oral surgeon, what is an oral surgeon do? Male2: An oral surgeon is a doctor who dominates the surgery on the face, the mouth, and the—most people know oral surgeon to put brace on teeth, treat facial fractures. In my case--- Male1: Okay, but you are too much more than just pull wisdom teeth and maybe in planning something. You are involved in an area that pediatrics is a great detail, cleft palate or lip, is that true? Male2: That is right. One of my major interest is children borne with cleft lip and cleft palates. Male1: First, what is a cleft? Male2: A cleft lip is an opening in the lip and cleft palate is an opening in the palate, the roof of your mouth. Let me show you a picture, let me see if we can focus it on this—you have a baby born with a one-sided cleft known as a unilateral cleft lip and it is an opening through the nose, the lip, the palate and the bone that holds the teeth. Male1: And what happen after all this surgery and correction would end up looking like? Male2: Okay, if you look at the bottom picture that is a baby about two months after the surgery is done. This is before and after. Male1: Do we know what causess our cleft lips and palates? Male2: That is a good question, there is. Sometimes we do know what causes it. The most obvious is there is a family history or family genetics. Male1: So it does run in the family? Male2: Right, that happens. And then there are problems that cause birth defects in general. Let us say, the mother is sick during her first trimester that she does takes hard medications. Male1: Any particular medications as a risk. Male2: There are two known ones that can cause cleft lips. The first one that comes to mind is Dilantin for seizures, there has high incidence of baby’s born—(voice overlap). Male1: So someone who is on that medicine, they will get pregnant, they should have a discussion of the risk benefit? Male2: Yes, unfortunately sometimes do. It is safer that they take the medicine and take your chances if you think about a cleft lip is easily repairable, the chances, what would happen if the mother had multiple seizures during pregnancy? It could cause more damage than just a cleft lip which is very treatable problem. Male1: Is that a complication of the different seizure medicines? Male2: Yes. Male1: What are the other medicines? Male2: Well, the other really common one is not a medicine but it is vitamin B deficiency. Now you would wonder who would be vitamin D deficient but it does happen and not necessarily people in big and urban areas like New York City but in a worldwide setting, there is a lot of—(voice overlap). Male1: So more likely in the third world, very unlikely in the (voice overlap). Male2: But as any doctor knows practicing medicine today even in New York City, we do see an element of people that are malnourished for whatever reason. And it is hard to explain why but it does occur. But the majority of babies born with cleft lips or cleft palates are isolated events and although we do not know why, you are going to see all us the whole amount of research that is developing with the genes and chromosomes, you are going to see that we can pin point a sort of, a little bit more information as to what happened. I do not know that that is going to prevent it but we are going to see a little bit more of an explanation as to saying this is a problem or that is on the gene or chromosome versus just we do not know why. (Audio cut)

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