Annamalai Nadarajan, student of the 2011 MBBS batch at the Amrita School of Medicine recently received the best student paper award at the 7th Biennial World Cleft Lip and Palate Congress at Mahe, Seychelles. Top plastic and oral surgeons from around the globe participated in the conference.

“The formation of the face is a complex process, involving the proper fusion of many diverse components. It is possible for this fusion to be incomplete, and this results in a variety of disorders,” stated Annamalai.

A cleft defect is formed when the tissues of the lip and/or palate of the baby do not fuse, while the baby is still in the mother’s womb.

Annamalai’s paper titled Embryology and Etiology of Cleft Lip sought to examine the cause for the defect, wherein an opening in the upper lip can even extend upto the base of the nostril.

Analyzing types of possible clefts, factors affecting them and the commonly accepted theories of cleft formation, Annamalai traced the normal formation of lips and nose during gestation, beginning at 28- 37 days of pregnancy.

“The lower lip is formed by the two mandibluar processes of the embryo growing medially towards each other and eventually fusing in the midline. As for the upper lip, the two maxillary processes of the embryo grow medially and fuse together with the lateral nasal process first, followed by the medial nasal process. After this fusion the medial and lateral nasal processes also fuse with each other,” he explained.

If this formation is flawed, and the baby has a cleft lip, there will be problems in feeding. The baby is unable to suck properly; moreover, there is the danger of liquid entering the nose from the mouth.

Medically, it is possible to correct this defect. A cleft lip can be repaired surgically.

In his presentation, Annamalai addressed cases of lip and nose formation that went astray. He analyzed four clinical diagnoses that included unilateral and bilateral clefts of the upper lip as well as midline clefts of both upper and lower lips.

“Once the zone of a certain cleft has been identified, all abnormalities in that zone can be corrected. It prevents the need for multiple surgeries to correct a cleft defect. Now 80% of patients undergo a second surgery later in life,” he noted.

The scholar asserted that the use of therapeutic pharmaceutical drugs or substance abuse during pregnancy increases the risk for cleft lip formation in the baby.

His presentation also addressed demographic, life style, environmental and genetic factors that may impact the formation of cleft lips.

July 13, 2012
School of Medicine, Kochi