Abhishek Kumar¹*, Siddhartha KR Shah², Sanchita Khadka³, Bandana Koirala³, Gajendra Birajee³ and Lokraj Shah²

¹College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
²Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
³Department of Pedodontics and Preventive Dentistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

*Corresponding Author:Abhishek Kumar, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

Received: May 04, 2023; Published: May 27, 2023

Abstract

Cleft lip and palate (CLP) are one of the most frequently occurring craniofacial congenital anomalies. A syndromic association is frequently seen in such cases. A feeding obturator is a prosthetic aid that assists a patient in obturating a cleft until surgery is performed. Cleft lip surgery or cheiloplasty is often performed three months after birth, while palate surgery or palatoplasty is typically performed between the ages of six and fourteen months. A 2-day-old newborn presented to the Pediatric Emergency with a complaint of difficulty in feeding. On examination, bilateral cleft of the lip and unilateral cleft of the palate was present. The ultrasonography of the fetus before the birth had revealed non-visualized left kidney, so an ultrasonography (USG) of the abdomen and pelvis was advised which confirmed the finding i.e., left renal agenesis. Electrocardiography (ECG) revealed an arterial septal defect (ASD) of 4.5 mm. Such presentation is commonly seen in cases of isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD). A custom-made feeding obturator was fabricated and delivered to help the baby overcome feeding difficulties. Parents were instructed and well-taught to feed the child with the appliance in place. Apart from giving appropriate instructions regarding feeding and maintenance of the appliance, parents were also informed about the surgical procedures that would be followed at a later date. Also, considering the exceptional psychological situation of the family and the need for a long-standing relationship between the cleft team for a successful outcome, appropriate counseling with reassurance was rendered to the family members.

Keywords: Cleft Lip; Cleft Palate; Palatal Obturators; Unilateral Renal Agenesis

References

1. Ghonmode SW., et al. “Vista of cleft lip and palate in India”. Journal of Evolution of Medical and Dental Sciences6 (2012): 1102-1111.
2. Dvivedi J and Dvivedi S. “A clinical and demographic profile of the cleft lip and palate in Sub-Himalayan India: A hospital-based study”. Indian Journal of Plastic Surgery1 (2012): 115-120.
3. Venkatesh R. “Syndromes and anomalies associated with cleft”. Indian Journal of Plastic SurgeryS 01 (2009): S51-S55.
4. Jugessur A., et al. “The genetics of isolated orofacial clefts: from genotypes to subphenotypes”. Oral Diseases7 (2009): 437-453.
5. Allam E., et al. “Cleft lip and palate: etiology, epidemiology, preventive and intervention strategies”. Anatomy and Physiology: Current Research3 (2014): 1-6.
6. Balasubramanian R and Crowley WF Jr. “Isolated Gonadotropin-Releasing Hormone (GnRH) Deficiency”. 2007 May 23 [updated 2017 Mar 2]. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Mirzaa GM, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2022.
7. Mokosch A., et al. “Kallmann-Syndrom”. Der Hautarzt10 (2011): 728-730.
8. Goldberg WB., et al. “Successful use of a feeding obturator for an infant with a cleft palate”. Special Care in Dentistry 8 (1988): 86-89.
9. Osuji OO. “Preparation of feeding obturators for infants with cleft lip and palate”. Journal of Clinical Pediatric Dentistry 19 (1995): 211-214.
10. Samant A. “A one-visit obturator technique for infants with cleft palate”. Journal of Oral and Maxillofacial Surgery 47 (1989): 539-540.
11. Jones JE., et al. “Use of a feeding obturator for infants with severe cleft lip and palate”. Special Care in Dentistry 2 (1982): 116-120.
12. Choi BH., et al. “Sucking efficiency of early orthopaedic plate and teats in infants with cleft lip and palate”. International Journal of Oral and Maxillofacial Surgery 20 (1991): 167-169.
13. Shprintzen RJ. “The implications of the diagnosis of Robin sequence”. Cleft Palate Craniofacial Journal 29 (1992): 205-209.
14. Saunders ID., et al. “A simplified feeding appliance for the infant with cleft lip and palate”. Quintessence International 20 (1989): 907-910.
15. Rathee M., et al. “Role of feeding plate in cleft palate: Case report and review of literature”. Internet Journal of Otorhinolaryngology1 (2010): 123-128.
16. Alkureishi LWT and Cohen MN. “Cleft Lip and Palate”. In: Thaller, S.R., Panthaki, Z.J. (eds) Tips and Tricks in Plastic Surgery. Springer, Cham (2022).
17. Tollefson TT and Sykes JM. “Unilateral cleft lip”. In: Goudy SG, Tollefson TT, editors. Complete cleft care. New York: Thieme (2014): 37–59.
18. Akhiwu BI., et al. “Congenital Heart Disease in Cleft Lip and Palate Patients: How Common Is the Association?”. Journal of Advanced Oral Research1-2 (2017): 53-56.
19. Kim DW., et al. “Prenatal ultrasonographic diagnosis of cleft lip with or without cleft palate; pitfalls and considerations”. Maxillofacial Plastic and Reconstructive Surgery1 (2015): 24.
20. Nunn DR., et al. “The effect of very early cleft palate closure on the need for ventilation tubes in the first year of life”. Laryngoscope 105 (1995): 905-908.
21. “Cleft lip and palate: Treatment” (2022).
22. Farronato G., et al. “How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? Literature review”. Stomatologija 2 (2014): 53-60.
23. Randag AC., et al. “Surgical impact and speech outcome at 2.5 years after one-or two-stage cleft palate closure”. International Journal of Pediatric Otorhinolaryngology11 (2014): 1903-1907.
24. Pande R., et al. “Pre-surgical Alveolar Molding: An Adjunct to Surgical Repair in Cleft Lip and Palate Rehabilitation”. Journal of Nepalese Association of Pediatric Dentistry1 (2021): 32-35.
25. Wikstad I., et al. “Kidney function in adults born with unilateral renal agenesis or nephrectomized in childhood”. Pediatric Nephrology2 (1988): 177-182.

Citation

Citation: Abhishek Kumar.,et al. “Bilateral Cleft Lip and Unilateral Cleft Palate with Unilateral Renal Agenesis: A Case Report".Acta Scientific Dental Sciences 7.6 (2023): 56-60.

Copyright

Copyright: © 2023 Abhishek Kumar.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.