CHENNAI: Thanks to a rare, successful surgery performed by a leading dental hospital in the city, an 18-month-old Pakistani toddler from Karachi with a ‘congenital mid-facial, bilateral cleft deformity’ has not only regained his vision, but also sports an improved physical appearance now.
“Non-fusion of facial bones, including the bones forming the eye sockets, results in facial clefts,” says Dr S M Balaji of Balaji Dental and Craniofacial Hospital, Teynampet. “Of the nearly 20 major types of facial clefts, those involving orbit are often rare and rehabilitation is complex.”
Data show that the abnormality occurs in one in 100,000 live births. What is more, such children suffer immense difficulties in feeding, breathing, speaking and psychological trauma because of their appearance. One such recent case is that of 18-month-old Noman Arshad from Pakistan, who was born with bilateral Tessier’s facial cleft type-4 defect. Search for a cure for their child’s rare condition took his parents Arshad Ali and Raziya, both farm labourers, to leading Pakistani dental surgeon Dr Asif Arian, who referred the toddler to Chennai-based Dr Balaji.
“It was very tough bringing the Pakistani boy to India,” the renowned craniofacial surgeon said at a press briefing here on Monday.
Not surprising, since the surgeon was grilled by the local cops, wary of the objective of the family’s visit to the city. However, after several rounds of verification, they became supportive. Language was another obstacle, as the parents spoke only Urdu. A local translator assisted in day-to-day communication between them and the medical team.
The boy’s rehabilitation was a medical challenge at several levels. “The defect in itself was complex and required skill and precision, as the main challenge was to salvage some vision for the boy,” Dr Balaji pointed out. A 3D CT scan showed that the little one had a bilateral cleft lip and palate extending to the orbital (eye) floor, resulting in a deformed eye and eyelids. The left eye was congenitally absent. While there was no vision in the left eye, the right one had only 40 per cent vision.
Further, the nasolacrimal ducts were damaged causing ‘epiphora’ or continuous tear flow because of the extensive involvement of the eyes in the cleft defect. The child could not be normally fed and nor was there a chance of good speech formation. The central part of cleft was attached to the upper lip.
“Our plan was to immediately close the lip defect to recreate the mouth to enable the baby to be fed well and to have a reasonable facial profile,” the surgeon said.
“Our foremost concern was to save the baby’s vision in the right eye, prosthetically replace the congenitally missing left eye to improve the appearance for social acceptance and to correct the abnormal tear flow.”
The reconstruction was achieved in a surgery that lasted six hours. Noman has a near normal appearance now and his feeding has improved greatly. No wonder, his parents appeared psychological strengthened seeing their baby’s improved facial appearance and health.
While they are returning to Karachi, they have to bring back their child for minor revisions in the future.
To parents of children born with similar facial deformities, Dr Balaji has a message: There is no cause for despair.
“Sometimes, the babies are murdered or considered inauspicious,” he rued. “This is due to lack of awareness. Corrective methods are available and the surgery is not expensive,” he said.
In Noman’s case too, his poor and illiterate parents were apprehensive about the cost of the surgery. “It was only about `1.5 lakh,” the surgeon pointed out.