WEBVTT - How Cleft Lips and Palates Work 0:00:01.480 --> 0:00:04.280 Welcome to Stuff you Should Know, a production of I 0:00:04.360 --> 0:00:13.800 Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark, 0:00:13.840 --> 0:00:17.560 There's Charles W Chuck Bryant, and Jerry is literally right there, 0:00:18.280 --> 0:00:21.239 and I'm Chuck. I want to start something. I'm going 0:00:21.280 --> 0:00:24.680 to get I actually have a jar at my studio 0:00:24.720 --> 0:00:28.360 at home kind of. But it's a use of the 0:00:28.360 --> 0:00:31.800 word literally jar. I'm trying to break myself of that, 0:00:32.159 --> 0:00:35.720 except when it really truly makes sense, when it literally 0:00:35.800 --> 0:00:39.720 makes sense to use that word, like in this instance, 0:00:39.800 --> 0:00:42.839 Jerry is literally sitting right here. So do you have 0:00:42.880 --> 0:00:44.920 a problem with that, with misusing that word like so 0:00:45.000 --> 0:00:49.760 many Yeah, no, not necessarily. It's overused. That's what bothers me. 0:00:49.920 --> 0:00:52.519 What about Gimmy and she donating to the jar at all? 0:00:52.720 --> 0:00:56.760 Or she just like this literally the dumbest idea. I 0:00:56.800 --> 0:00:59.240 don't think she has an opinion on this one. Okay, Yeah, 0:00:59.520 --> 0:01:03.000 she's just spend some money. Well, I keep the jar 0:01:03.160 --> 0:01:06.000 at home. I'll get money out of it when I 0:01:06.040 --> 0:01:09.520 need to. It's more just the ritual of like punishing myself, 0:01:09.560 --> 0:01:13.080 calling out that's good, I'm doing something stupid. Once a Catholic, 0:01:13.120 --> 0:01:17.880 always a Catholic. So um, oh yeah, this is stuff 0:01:17.920 --> 0:01:21.400 you should know. And uh, we are talking Chuck today. 0:01:21.480 --> 0:01:24.240 How are you doing, by the way, I'm great. Good, 0:01:24.480 --> 0:01:27.360 we're in the same room. It's still a little weird, 0:01:27.920 --> 0:01:29.640 getting used to it still. Yeah. I went to a 0:01:29.640 --> 0:01:32.520 baseball game last night, Oh my god. And that was weird. 0:01:32.840 --> 0:01:35.440 I mean it was great. Uh. And once we get 0:01:35.440 --> 0:01:37.640 on our seats, we were actually i mean they're fully 0:01:37.680 --> 0:01:40.360 just selling seats, but where we bought seats there just 0:01:40.400 --> 0:01:42.199 happened to be no one kind of around us, which 0:01:42.240 --> 0:01:45.600 was good. But yeah, I went to a Braves game. 0:01:45.760 --> 0:01:48.520 But you know, they're supposed to be policing and saying, 0:01:49.280 --> 0:01:51.200 you know, unless you're in your seats, eating and drinking, 0:01:51.200 --> 0:01:53.800 you should be wearing a mash. And so we the 0:01:53.840 --> 0:01:57.360 four of us, wore masks, you know, in and out 0:01:57.360 --> 0:01:59.320 in the bathrooms and the food lines and all that stuff. 0:01:59.360 --> 0:02:02.960 But no, buddy else was well, I mean Atlanta there's 0:02:03.000 --> 0:02:07.000 a lot of jerks, yeah, and Atlanta. Yeah, it just 0:02:07.080 --> 0:02:08.679 it is what it is. We took care of ourselves 0:02:08.680 --> 0:02:13.320 and it's fine. Yeah, it was fun. Um, well, that's good. 0:02:13.360 --> 0:02:16.440 I'm glad. Juddie good walk off, Homer. Oh yeah, the 0:02:16.520 --> 0:02:18.320 bottom of the ninth man. I've only seen like one 0:02:18.320 --> 0:02:20.760 of those in my life. It was amazing, great game. Yeah, 0:02:20.800 --> 0:02:23.480 it was cool. Who we play? We played the Mets 0:02:23.520 --> 0:02:27.640 in our star player Akunya blasted one in the bottom 0:02:27.639 --> 0:02:29.640 of the ninth first pitch. It was just great. I 0:02:29.639 --> 0:02:32.560 thought Freddie Freeman was our star player there. I mean 0:02:33.200 --> 0:02:37.519 they're one and two on any given day. Yeah, I 0:02:37.520 --> 0:02:39.480 wouldn't want to be number two, you know what I'm saying. 0:02:39.520 --> 0:02:43.040 But yes, no, of course not. That's why I'm number two. No, 0:02:43.280 --> 0:02:47.000 that's not true. You meet Jerry all tied for number one. 0:02:48.000 --> 0:02:50.640 But anyway, it was a little just's it's just a 0:02:50.639 --> 0:02:53.320 little jarring to be among a lot of people again. 0:02:53.360 --> 0:02:56.120 And but it also comes back quickly like, oh wait, 0:02:56.160 --> 0:02:58.440 I spent the first forty nine years of my life 0:02:59.000 --> 0:03:02.200 among people. A took a year off, and I'm back 0:03:02.200 --> 0:03:04.840 in this wing. That's good. That's good. I'm hoping to 0:03:04.919 --> 0:03:08.160 get back there myself. At any rate. This is still 0:03:08.160 --> 0:03:12.520 a little weird. So we're talking today about clefts, and 0:03:12.639 --> 0:03:15.000 most people when they think about clefs, they think about 0:03:15.000 --> 0:03:17.560 cleft lips. But there's a lot more to that, or 0:03:17.560 --> 0:03:21.000 trouble cliffs. Sure, that's a little different. There's an extra 0:03:21.280 --> 0:03:23.639 letter in this one that I'm talking about at the end. 0:03:24.280 --> 0:03:27.280 How is that spelled? Is that just trouble cleft? No 0:03:27.560 --> 0:03:31.440 cl ef Oh, there's no t trouble cliff cliff. I 0:03:31.440 --> 0:03:35.080 didn't take piano. That's okay, right, Um, But no, that's 0:03:35.080 --> 0:03:38.040 a cleft. This is a cleft. A cleft in this 0:03:38.120 --> 0:03:41.120 case is um. It's a it's a division, it's a trench, 0:03:41.200 --> 0:03:44.800 it's a void. I guess you could say and that 0:03:44.800 --> 0:03:47.160 that that is what we're talking about. It is a 0:03:48.040 --> 0:03:52.760 it is a very common, actually fairly common birth defect. Um. 0:03:52.800 --> 0:03:55.640 It occurs in the embryonic stage and a child is 0:03:55.680 --> 0:03:59.920 born with part of their lip and or part of 0:04:00.040 --> 0:04:02.480 their palate the roof of their mouth is another way 0:04:02.520 --> 0:04:06.240 to put it right missing, it's just not there, un joined. 0:04:07.080 --> 0:04:10.200 And we should probably say right at the beginning, Uh, 0:04:10.240 --> 0:04:13.960 this is a birth defect. But it is a visual difference, 0:04:14.560 --> 0:04:16.400 is what we call things like this. It is not 0:04:16.480 --> 0:04:19.640 a disability, although there are you know, many complications will 0:04:19.680 --> 0:04:22.200 go over, but it's a visual difference. And it is 0:04:22.279 --> 0:04:26.040 also the term hair lip is not something you should use. 0:04:26.120 --> 0:04:28.920 It was used for many, many years, even by doctors 0:04:29.440 --> 0:04:33.000 to describe this condition, but it is uh not a 0:04:33.040 --> 0:04:36.040 good nice term, so just stop saying it. Yeah, I 0:04:36.080 --> 0:04:37.719 don't know anybody who says that. I don't think so 0:04:37.760 --> 0:04:40.600 any but you know, some people just may not know. Like, well, 0:04:40.600 --> 0:04:43.039 I thought that's what it was called. Uh, And when 0:04:43.080 --> 0:04:46.400 doctors use a term, you can sort of understand, you know, 0:04:46.560 --> 0:04:49.120 like somebody falling into that trap. But it's not a 0:04:49.200 --> 0:04:50.919 term that we use anymore now. And I think that 0:04:51.000 --> 0:04:52.719 was a good thing to say. All right, So that's 0:04:52.760 --> 0:04:55.320 the c I A is finished. So um, like we're saying, 0:04:55.400 --> 0:04:57.040 it is, like you said, it is a birth effect, 0:04:57.040 --> 0:04:59.160 but it is just a visible difference. And there's I mean, 0:04:59.200 --> 0:05:01.880 that's that's it. I mean, it is tied in with 0:05:02.000 --> 0:05:06.200 some syndromes, some genetic syndromes, but plenty of people, I 0:05:06.200 --> 0:05:08.520 think in the United States somewhere between one and every 0:05:08.600 --> 0:05:12.920 seven um comes with some sort of cleft, either a 0:05:12.960 --> 0:05:18.559 cleft lip, a cleft palette, or both UM and there's 0:05:18.640 --> 0:05:21.719 that's it. That can be it. That's the only thing 0:05:21.880 --> 0:05:25.880 that is different about that child. There's no developmental problems, 0:05:25.880 --> 0:05:28.520 there's no and like you said, it's not disability. There's 0:05:28.560 --> 0:05:31.360 nothing else that's it. And what's fascinating to me, I 0:05:31.400 --> 0:05:33.760 had no idea about this, but I never really thought 0:05:33.800 --> 0:05:38.880 about it. Is that the the kid with the cleft 0:05:38.920 --> 0:05:42.840 lip or the cleft palette there, their palette or their 0:05:42.920 --> 0:05:46.640 lip just never finished forming. Yeah, they never You know, 0:05:46.720 --> 0:05:50.240 there's a symmetry generally running down the center of your 0:05:50.640 --> 0:05:55.000 nose and the two sides of the lip. You know, 0:05:55.040 --> 0:05:58.320 the stuff forms when you're in the in the womb 0:05:59.240 --> 0:06:01.359 very early on. It actually for both. I think the 0:06:01.400 --> 0:06:03.840 lip is first and then the palette, but you know 0:06:03.839 --> 0:06:07.520 they joined together, and in this case they just don't join. Yeah, 0:06:07.640 --> 0:06:10.640 you know the little a little bit under your nose, 0:06:11.000 --> 0:06:14.240 the bip joining the uh, the bottom of your nose 0:06:14.240 --> 0:06:18.760 through top lip. Yeah, it's filtraum okay. And that is 0:06:18.800 --> 0:06:23.800 where your lips joined together, your upper lip joins together, right, 0:06:23.839 --> 0:06:27.840 and that is where your mustache can part. Yeah, yeah, 0:06:27.880 --> 0:06:29.719 you got a little mustache part. I have a mustache 0:06:29.760 --> 0:06:31.880 part because mine. But you know, some guys, do you 0:06:31.920 --> 0:06:35.240 shave yours in just for looks or is it it 0:06:35.360 --> 0:06:37.320 just kind of parts? Naturally? Your hair doesn't quite grow 0:06:37.400 --> 0:06:39.560 right there. But you know, if you're like a Burt 0:06:39.600 --> 0:06:43.200 Reynolds type or Wilfred Brimley, you can just grow it 0:06:43.279 --> 0:06:46.520 over the whole. What's it called filtraum fil traum p 0:06:46.720 --> 0:06:49.560 h I l t r U Hiltraum, which would be 0:06:49.600 --> 0:06:54.159 a really great nerdy boy's name film. Yeah, yeah, and 0:06:54.200 --> 0:06:56.760 his brother Baxter. On the second thought, though, don't name 0:06:56.800 --> 0:07:01.160 your son filter so um. When you are in the embryonics, 0:07:01.440 --> 0:07:04.080 like you said, very early on, the lip forms in 0:07:04.240 --> 0:07:07.120 like the fourth to seventh week, and very frequently a 0:07:07.240 --> 0:07:09.440 woman might not even know she's pregnant at that time, 0:07:09.680 --> 0:07:12.720 and that lips forming, yes already. Um. I saw a 0:07:12.800 --> 0:07:18.520 really cool bbc UM Documentaries sequence basically where they took 0:07:19.080 --> 0:07:24.760 three D images of baby in utero and basically turned 0:07:24.760 --> 0:07:29.280 it into a flipbook video showing the face forming. Your 0:07:29.320 --> 0:07:33.200 nostrils are giant when you're when you're forming, and they're 0:07:33.240 --> 0:07:36.080 like on the top of your forehead. They moved down 0:07:36.840 --> 0:07:40.760 and each nostrils part of a tissue plate, and then 0:07:40.800 --> 0:07:43.400 the bottom jaw and your bottom lip are part of 0:07:43.400 --> 0:07:46.080 a third tissue place. So you have three forming and 0:07:46.120 --> 0:07:50.080 coming together. And as they form, new cells form new skin, 0:07:50.160 --> 0:07:52.160 and they just kind of move into place. If you 0:07:52.160 --> 0:07:55.160 have a cleft, flip or a cleft palette. Again, that 0:07:55.160 --> 0:07:59.200 that final meeting in the middle just never happened. Yeah, 0:07:59.240 --> 0:08:00.800 So when you watch something thing like that, are you 0:08:00.840 --> 0:08:04.600 amazed at the miracle of life or are you disgusted 0:08:05.000 --> 0:08:07.760 amazed at the miracle? Okay, yeah for sure, because when 0:08:07.760 --> 0:08:09.440 you think of nostrils on the top of the head, 0:08:10.080 --> 0:08:15.440 it's nothing like that most it did. It's neat, actually 0:08:15.480 --> 0:08:18.320 it is. Yeah, for sure. The miracle of life is 0:08:18.360 --> 0:08:21.160 what I'm going with. So there are different ways this 0:08:21.200 --> 0:08:23.600 can happen. Your your palette on the top of your 0:08:23.600 --> 0:08:26.200 mouth is in a couple of sections. The one closer 0:08:26.200 --> 0:08:27.800 to the front is the hard palette, and the rear 0:08:27.840 --> 0:08:30.920 it's a soft pallet. And if you have a cleft palette, 0:08:30.920 --> 0:08:33.920 it can be in the soft part the hard part. 0:08:34.000 --> 0:08:39.480 It can split both. Yeah, because if you do don't mouth, 0:08:39.600 --> 0:08:43.640 don't do that. The front part is is bony, that's 0:08:43.640 --> 0:08:45.680 your hard palate. If you go further back, it's really 0:08:45.760 --> 0:08:47.800 kind of tough to do, but you can go, well, 0:08:48.320 --> 0:08:50.200 what you gotta stop. You don't like that, No, I 0:08:50.200 --> 0:08:53.360 don't think anyone does. Um, I really you think some 0:08:53.400 --> 0:08:55.640 people like hearing that. I think it's kind of pleasant. 0:08:55.800 --> 0:08:58.520 Anybody who like that shout out. I want to hear you. 0:08:58.559 --> 0:09:00.080 I think there's some kind of a pressure point in 0:09:00.080 --> 0:09:03.440 your soft pallet too. For is it migraines or something 0:09:03.480 --> 0:09:06.439 I remember hearing about, like pressing your thumb into your 0:09:06.440 --> 0:09:10.240 soft pallet to do something that wasn't that it was 0:09:10.280 --> 0:09:15.520 something else. Well, you can cure an ice cream maybe 0:09:15.600 --> 0:09:18.800 multi functional. Anyway, In the very back, you have just 0:09:19.040 --> 0:09:22.880 a muscle like your hard palate, bony with some skin 0:09:23.000 --> 0:09:26.280 covering it. Further back, it's like muscle with skin covering, 0:09:26.280 --> 0:09:28.040 and that's your soft palate. It's like a little rib 0:09:28.080 --> 0:09:30.120 cage up there. And you can have this division, this 0:09:30.240 --> 0:09:34.000 cleft in either part or both. Right, that's correct, That's 0:09:34.000 --> 0:09:37.440 what I said. So, Uh, an incomplete cleft is missing. 0:09:38.960 --> 0:09:41.079 It's a little notch and it's missing from the middle 0:09:41.080 --> 0:09:44.120 of the upper left. A complete cleft is all the 0:09:44.160 --> 0:09:48.080 way through into the nose. And then with the lip, 0:09:48.160 --> 0:09:51.400 it's it's always the upper lip, but it's usually off 0:09:51.440 --> 0:09:53.080 to one side or the other, I think because of 0:09:53.120 --> 0:09:56.319 that symmetry and how it forms. Yes, uh, And it's 0:09:56.360 --> 0:09:59.280 always the upper lip because it only affects the two 0:09:59.360 --> 0:10:02.320 top plates of flesh that are forming that from your 0:10:02.400 --> 0:10:05.280 upper lip in your face and those forehead nostrils that 0:10:05.360 --> 0:10:08.440 come back down to your nostril area. That's right. God, 0:10:08.520 --> 0:10:10.760 it's just like old times. Cherry's literally dropping food out 0:10:10.760 --> 0:10:15.559 of her mouth onto the table. Is amazing. No, but 0:10:15.640 --> 0:10:18.120 it's so funny. I don't know. I think there might 0:10:18.120 --> 0:10:20.120 be a little all day and she chooses to eat 0:10:20.120 --> 0:10:22.839 when she's in here. I think we should take a break. 0:10:23.120 --> 0:10:26.360 I think so too. All right, that's a good opening, Uh, salvo, 0:10:28.040 --> 0:10:52.040 So we'll be back after this. I think I might 0:10:52.080 --> 0:10:55.520 have missed you salvo did I don't think so? Was 0:10:55.559 --> 0:10:58.880 that right? Yeah? I associate that with like a timpani 0:10:59.559 --> 0:11:03.640 or and in going off. Yeah, all right, I think you. 0:11:03.760 --> 0:11:06.439 I think you used it correctly. A cleft that you 0:11:06.520 --> 0:11:10.800 got wrong. Yeah, back to clefts. They are developmental defects, 0:11:10.880 --> 0:11:15.000 like we said, very early, and what causes them, you know, 0:11:16.160 --> 0:11:19.280 genetics can play a part. I think if you're a 0:11:19.400 --> 0:11:23.600 parent you have with a cleft either a palette or lip, 0:11:23.640 --> 0:11:25.240 you have it like a two to eight percent chance 0:11:25.320 --> 0:11:28.120 that your kid may if you have a biological child, 0:11:28.720 --> 0:11:31.120 and then that goes up if you have siblings and 0:11:31.400 --> 0:11:33.480 or if you have your parents and it's sort of 0:11:33.480 --> 0:11:37.560 passed down. I think that number can go up to like, yeah, 0:11:37.720 --> 0:11:40.240 it can if you if your parent has a sibling 0:11:40.320 --> 0:11:43.080 that has a cleft as well, the chance of your 0:11:43.360 --> 0:11:47.560 your kid having ACT is definitely increased. And then um, 0:11:47.640 --> 0:11:49.920 it can keep going up depending on whether or not 0:11:50.120 --> 0:11:54.480 your parent has a genetic syndrome that they're passing along. Um. 0:11:54.520 --> 0:11:57.679 I think there's something like three hundred to four hundred 0:11:57.720 --> 0:12:02.600 different genetic syndromes are associated with cleft lip or cleft 0:12:02.600 --> 0:12:05.440 palette um and together we should say they're both called 0:12:05.440 --> 0:12:07.719 orofacial clefts. Oh yeah, we didn't say that to me. 0:12:07.840 --> 0:12:10.920 And I've also known and I've also seen it abbreviated 0:12:10.960 --> 0:12:16.600 as c l slash p lips slash pallet um. That 0:12:16.640 --> 0:12:18.440 seems to be kind of like the shorthand for it, 0:12:18.480 --> 0:12:21.360 because doctors don't like the right full words and their 0:12:21.400 --> 0:12:24.199 handwriting is just terrible. Um. And then I've also seen 0:12:24.280 --> 0:12:28.520 them called affectionately as cleft eas. Oh that's nice. So 0:12:28.920 --> 0:12:31.720 and you know, we'll talk about the uh, you know, 0:12:31.800 --> 0:12:34.679 acceptance of facial differences if you have a cleft or 0:12:35.040 --> 0:12:37.000 have friends or family members, and that's a big, big 0:12:37.000 --> 0:12:38.960 part of it. And I think something like cleft E's 0:12:39.040 --> 0:12:42.280 might be a way of embracing that s. So there 0:12:42.280 --> 0:12:45.880 are some other things that could be risk factors and 0:12:46.120 --> 0:12:49.400 increase the risk of all kinds of birth effects, certainly 0:12:49.440 --> 0:12:52.079 including clefts. And one of them is if you're smoking 0:12:52.080 --> 0:12:55.800 and drinking booze while you're pregnant. UM. One of the 0:12:55.840 --> 0:12:59.839 reasons alcohol effects UM, any kind of birth effect, is 0:13:00.000 --> 0:13:05.320 because it disrupts the absorption of UH follic acid. And 0:13:05.720 --> 0:13:08.240 that's another reason you might if you don't have enough 0:13:08.240 --> 0:13:11.199 fallic acid. That's why pregnant women take extra It's a 0:13:11.280 --> 0:13:15.680 natural form of B nine. It's a vitamin. And yeah, 0:13:15.720 --> 0:13:18.320 I think. And then late nineties the FDA said you've 0:13:18.320 --> 0:13:21.440 got to start putting extra folic acid in like all 0:13:21.520 --> 0:13:27.199 kinds of common foods. Remember that store your recyclables starting, yeah, 0:13:27.240 --> 0:13:29.480 and and just like put it in bread and pasta 0:13:29.559 --> 0:13:32.320 and grains and cereals and things that people eat a 0:13:32.320 --> 0:13:36.160 lot of. UH. It's naturally found in sunflower seeds and 0:13:36.240 --> 0:13:40.160 fruits and beans and peanuts and stuff like that. So 0:13:40.480 --> 0:13:43.559 you want the follic acid, I think if you're pregnant, 0:13:43.640 --> 0:13:48.080 they recommend you take at least UH six hundred milligrams 0:13:48.080 --> 0:13:51.600 per day. And and if you're just a regular non 0:13:51.640 --> 0:13:55.760 pregnant humans a day, yeah, if you UM are in 0:13:55.960 --> 0:14:00.320 your reproductive stage or age. Right, but you you need 0:14:00.400 --> 0:14:03.720 folic acid anyway, right, why not just as a person? Sure? Yeah, 0:14:03.960 --> 0:14:05.559 I get a lot of bread, I get a lot 0:14:05.600 --> 0:14:08.840 of folic acid. Uh So smoking and drinking is one, 0:14:09.160 --> 0:14:12.400 Diabetes is another. Right, Yeah, that's a really big risk factor. 0:14:12.440 --> 0:14:17.200 Diabetes and obesity both seem to be correlated to increased 0:14:17.320 --> 0:14:20.200 risk of clefts. I'm not sure what the incidences for 0:14:20.600 --> 0:14:23.880 women with diabetes, but it is an increased risk UM. 0:14:24.000 --> 0:14:26.920 And then there's also a couple of epilepsy medications that 0:14:27.000 --> 0:14:30.000 increase your risk. UM. The thing about all this is 0:14:30.880 --> 0:14:36.800 there is no UM definitive understanding your explanation of why 0:14:37.040 --> 0:14:42.960 clefts form of what it is that causes some children's 0:14:43.080 --> 0:14:46.080 um lips just not to join together or their palettes 0:14:46.120 --> 0:14:50.040 that not fuse together at that last final stage. UM. 0:14:50.120 --> 0:14:52.640 It seems to be multi factorial is what they call it, 0:14:52.680 --> 0:14:55.720 where there's just a bunch of different factors. UM. And 0:14:55.760 --> 0:14:58.800 also in addition to genetics, like your parents having one 0:14:58.840 --> 0:15:02.320 of your parents having a sibling with one UM depending 0:15:02.320 --> 0:15:06.880 on your race, actually your your risk is increased. Apparently, 0:15:06.920 --> 0:15:11.440 it's far more common among Asian people, UM and Native Americans. 0:15:11.480 --> 0:15:13.840 I think it's the highest among Native Americans, something like 0:15:13.920 --> 0:15:20.520 three points six out of every uh thousand births. I 0:15:20.560 --> 0:15:26.560 believe um to two among Asian people. It's the lowest 0:15:26.600 --> 0:15:33.280 among African Americans. I think Chinese babies are more commonly diagnosed. 0:15:33.520 --> 0:15:35.960 Is a diagnosis or just what do you even call that? No, 0:15:36.040 --> 0:15:39.480 you're diagnosed, But I mean it's like very easy diagnosis. 0:15:39.480 --> 0:15:42.240 It's like, okay, you're a child has a cleft flip. Right. 0:15:42.560 --> 0:15:45.400 But what's what's interesting, Chuck, is with the cleft palette. 0:15:45.960 --> 0:15:49.360 You can have a cleft palette, but it not be visible. 0:15:49.400 --> 0:15:53.840 It can actually be hidden. That's called the submucosis cleft palette. 0:15:54.280 --> 0:15:57.760 And they might they you might never be diagnosed with 0:15:57.800 --> 0:16:00.480 it because there may be no problem with that or 0:16:00.600 --> 0:16:02.960 that arise from it, like with other cluts, like we'll 0:16:03.000 --> 0:16:05.920 talk about. Yeah, but um, that's kind of rare from 0:16:05.920 --> 0:16:08.720 what I understand, right, And the palette is less visible 0:16:08.800 --> 0:16:12.040 anyway as opposed to the lip. Uh. And you know, 0:16:12.080 --> 0:16:14.520 if you see any kind of photo image of cleft palette, 0:16:14.560 --> 0:16:17.840 is usually the doctor taking a picture of someone with 0:16:17.880 --> 0:16:20.400 their mouth wide open, kind of tilting their head back 0:16:20.440 --> 0:16:23.280 so you can get a good angle on it. Um 0:16:23.840 --> 0:16:28.000 health problems that are associated with clefts are uh, they 0:16:28.000 --> 0:16:31.840 can be numerous. It's it's not you know, it seems 0:16:31.880 --> 0:16:35.760 like everything is something that can be overcome. But they 0:16:35.840 --> 0:16:39.440 are challenges, nonetheless, and they are challenges that especially can 0:16:40.280 --> 0:16:43.360 just make a kid when they're growing up field not 0:16:43.440 --> 0:16:45.600 so great about themselves. So that that's a big, big 0:16:45.640 --> 0:16:49.080 part of overcoming these challenges. But to be sure, there 0:16:49.080 --> 0:16:53.320 are some physical things that happen, like it can interfere 0:16:53.360 --> 0:16:56.200 with how your teeth are forming and growing in Uh. 0:16:56.320 --> 0:16:59.200 Sometimes you might have to get bone graphs on the 0:16:59.280 --> 0:17:02.000 upper portion of your gums, especially if you have a 0:17:02.040 --> 0:17:05.280 cleft lip. Yeah, cleft lips, it seems like it's usually 0:17:05.280 --> 0:17:07.840 where the teeth problems come from. Uh. And then one 0:17:07.880 --> 0:17:11.720 of the first things you know, if you're nursing your baby, 0:17:11.880 --> 0:17:15.159 then if your baby has a cleft lip or and 0:17:15.359 --> 0:17:17.920 or a cleft pallet, they may have trouble latching on 0:17:18.080 --> 0:17:21.520 and getting a good like a good suck is what 0:17:21.560 --> 0:17:24.520 they call it. Yes, And if you luckily, there are 0:17:24.640 --> 0:17:27.960 different um methods for improving that. There are certain types 0:17:28.000 --> 0:17:31.080 of bottles which can help with that. So again that's 0:17:31.119 --> 0:17:34.919 a problem that can be overcome pretty routinely. It's the 0:17:35.040 --> 0:17:38.679 easiest to overcome and to nurse a child with a 0:17:38.760 --> 0:17:42.439 cleft lip because you can set the baby up and 0:17:42.840 --> 0:17:48.200 as usual chuck them in the air um, and you 0:17:48.240 --> 0:17:51.639 can just after they latch on, you just kind of 0:17:51.680 --> 0:17:54.119 put your finger over their cleft flip oh and just 0:17:54.200 --> 0:17:57.280 like close the gap. Basically, it's it's easy as pie. 0:17:57.560 --> 0:17:59.840 With a cleft palette, it can be much more difficult 0:18:00.040 --> 0:18:03.520 because we use our palette to create suction, use your 0:18:03.560 --> 0:18:06.240 tongue and your palate, your soft pallet in particular to 0:18:06.320 --> 0:18:10.919 create suction. So there's specialized bottles for feeding babies with 0:18:11.000 --> 0:18:15.760 cleft pallets. Uh. And in particular, if the baby is 0:18:15.800 --> 0:18:19.880 just not able to latch on for breastfeeding, they still say, well, 0:18:19.920 --> 0:18:22.119 just pump your breast milk and feed your baby the 0:18:22.440 --> 0:18:26.600 bottle milk because unfortunately, because of that gap in their 0:18:26.680 --> 0:18:30.160 their palette, uh, there there's basically a passage into their 0:18:30.200 --> 0:18:33.160 nose and sometimes their ears, so breast milk can get 0:18:33.200 --> 0:18:36.159 in there, and they found it's far less irritating breast 0:18:36.160 --> 0:18:39.679 milk is than um formula when it does get in 0:18:39.760 --> 0:18:43.720 the little baby's ears and nose. That's right. And because 0:18:43.720 --> 0:18:47.159 of that same gap there, I think throughout you know, 0:18:47.200 --> 0:18:50.720 we'll talk about the surgeries, but throughout childhood, babies and 0:18:50.800 --> 0:18:54.879 children with cleft palets and lips have higher incidences of 0:18:54.920 --> 0:19:00.480 ear infections, UM, sometimes chronic Sometimes they might have trouble 0:19:01.359 --> 0:19:04.520 hearing and learning how to talk. But again, these are 0:19:04.560 --> 0:19:08.159 all early challenges that it's such a common birth defect 0:19:08.600 --> 0:19:10.560 that they really really know a lot about how to 0:19:10.600 --> 0:19:14.040 overcome this stuff. That's exactly right. Fortunately, especially in the 0:19:14.080 --> 0:19:17.080 developed world, there's a lot of services available that are 0:19:17.080 --> 0:19:20.160 pretty routine. Yeah, and if you're fortunate enough to live 0:19:20.160 --> 0:19:22.480 in a country with socialized medicine, you get it all 0:19:22.520 --> 0:19:25.560 for free. And if you're not, you're gonna be dropping 0:19:25.560 --> 0:19:28.960 some money on surgery. I think the statistic is two 0:19:29.040 --> 0:19:33.720 hundred thousand dollar average for medical procedures over the course 0:19:33.760 --> 0:19:36.280 of your life. Uh. And I don't know if that's 0:19:37.640 --> 0:19:40.160 figuring in insurance. If that's a two d thousand dollars 0:19:40.160 --> 0:19:42.320 sort of total and you pay a portion of that 0:19:42.359 --> 0:19:45.000 if you're insured, I get that that's out of pocket. 0:19:45.240 --> 0:19:48.240 Oh you think so. I think so interesting. So do 0:19:48.240 --> 0:19:50.760 you want to talk specifically about some of the treatments 0:19:50.800 --> 0:19:57.399 for class. Yeah. So, Um, the diagnosis of cleft often 0:19:57.480 --> 0:20:02.360 happens um through ultrasounds. Uh, so you will know your 0:20:02.359 --> 0:20:04.720 baby is going to be born with a cleft lip 0:20:04.960 --> 0:20:07.800 especially is how you know. But a cleft palates probably 0:20:07.800 --> 0:20:10.960 diagnosed after birth, but shortly after birth, usually upon the 0:20:10.960 --> 0:20:14.440 first examination by the doctor and they'll say, okay, well 0:20:14.480 --> 0:20:17.919 your your child has a cleft pallet. Um, don't panic. 0:20:18.200 --> 0:20:20.560 There's a lot of stuff in place. We know exactly 0:20:20.600 --> 0:20:22.479 what to do, we know exactly when to do it. 0:20:23.359 --> 0:20:25.119 But it's gonna be really tough for you and your 0:20:25.160 --> 0:20:28.639 family because your baby, before your baby turns one year old, 0:20:29.240 --> 0:20:33.240 and as actually as early as maybe three months old, uh, 0:20:33.280 --> 0:20:36.560 they might be they will undergo a surgery, like a 0:20:36.600 --> 0:20:41.439 major surgery where they are given general anesthesia and um, 0:20:41.840 --> 0:20:45.920 basically it's a form of cosmetic surgery to to repair 0:20:46.000 --> 0:20:48.159 is what they call it, um their cleft lip or 0:20:48.200 --> 0:20:51.080 the cleft palette or both. And it's it's basically the 0:20:51.119 --> 0:20:53.720 first in a very long line of surgeries that will 0:20:54.440 --> 0:20:57.880 take up their first eighteen years pretty easily. Yeah, it's 0:20:57.920 --> 0:21:01.040 called the first one is called kylo plasty uh c 0:21:01.480 --> 0:21:06.600 h e I l o plasty, and this is uh 0:21:06.640 --> 0:21:08.840 it can be a few surgeries. Like I said about 0:21:08.880 --> 0:21:12.760 the teeth, it can include bone graphs. And I think 0:21:12.800 --> 0:21:15.040 the cleft palate surgery is a little bit later. That's 0:21:15.080 --> 0:21:17.360 only for cleft lip and cleft pallet though, is still 0:21:17.400 --> 0:21:20.080 before they're eighteen months old. And you know, even though 0:21:20.080 --> 0:21:22.440 it's routine, it is like you said, it's it's stressful 0:21:22.480 --> 0:21:25.840 for a parent too to see that little baby go 0:21:25.920 --> 0:21:28.520 under general anesthesia and go under the knife. Yeah, and 0:21:28.560 --> 0:21:31.679 when they come out, I mean, you know, they're in pain, 0:21:31.800 --> 0:21:36.919 they're not very happy, they're pretty uncomfortable. It's no fun. Fortunately, um, 0:21:36.960 --> 0:21:42.360 they've actually come up with a procedure called nasoalveolar molding 0:21:42.880 --> 0:21:47.919 or any um, thank god uh where this reduces the 0:21:48.000 --> 0:21:50.520 number of follow up surgeries because they don't always get 0:21:50.520 --> 0:21:52.959 it on the first surgery. They might just kind of 0:21:52.960 --> 0:21:55.160 be like, well, this is the first step, and we're 0:21:55.160 --> 0:21:57.280 gonna let this heal and kind of fuse a little 0:21:57.280 --> 0:21:59.359 more closer together, and then we're gonna try it again 0:21:59.400 --> 0:22:01.640 and again, and we'll finally get there after a couple 0:22:01.680 --> 0:22:05.480 of surgeries. Are a few Uh an a yum kind 0:22:05.480 --> 0:22:08.880 of does that follow up surgery ahead of time by 0:22:08.960 --> 0:22:14.880 molding the little baby's astoundingly malleable features ahead of time 0:22:14.920 --> 0:22:19.399 before the surgery. Yeah, it almost sounded like braces for 0:22:19.600 --> 0:22:24.880 your faces. That's right. Uh. It's a clear plastic retainer 0:22:25.040 --> 0:22:27.920 inside the mouth, and like you said, it helps mold 0:22:27.960 --> 0:22:31.159 it as they grow, and then like braces, they adjust 0:22:31.240 --> 0:22:34.119 it as they grow and maybe like tighten it down. 0:22:34.280 --> 0:22:37.399 I think for cleff lips um they add a little 0:22:37.440 --> 0:22:39.480 if it's a small one, they add a little plastic 0:22:39.560 --> 0:22:43.280 post that's up in the nose to lift that up 0:22:43.600 --> 0:22:45.800 because it can also affect the shape of your nose 0:22:45.840 --> 0:22:48.119 early on too. I'm not sure if we mentioned that. 0:22:48.200 --> 0:22:51.840 So it's all sort of tied in together developmentally, and 0:22:51.920 --> 0:22:56.280 it sounds like this nam retainer device sort of just limits, 0:22:56.320 --> 0:22:58.600