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Medical Edge Newspaper Column from Mayo Clinic
SURGERY, THERAPY COULD RELIEVE CHILD’S TORMENT OVER ‘HARELIP’
DEAR MAYO CLINIC: My grandson is 6 years old and suffers terribly
from teasing now that he’s at school, and frustration because he talks
funny. His problem is that he was born with a harelip and my daughter
hasn’t done anything about it. Can’t they fix that so his looks and his
talking are more normal? — West Virginia
ANSWER: “Cleft lip” is now the preferred term for the malformation you
describe. It can occur by itself as a split in the upper lip, or in conjunction
with a cleft, or split, in the roof of the mouth. This combined condition
is known as “cleft palate.”
In this condition, the lip or palate doesn’t fuse properly during fetal
development. The cleft can range from a small indentation in the upper
lip (hence the older term “harelip,” likening the appearance to that of
a rabbit’s natural upper lip shape) to a segment missing from the upper
lip.
The crevice can extend into the nose and the roof of the mouth, causing
problems with breathing and eating. If the malformation is severe, other
medical problems can occur — from problems with feeding and weight gain
in infants, to delayed speech development and chronic ear infections,
to self-consciousness about cosmetic flaws.
From your description, it sounds as if your grandson is suffering from
speech impairment and cosmetic concerns. Both can be remedied with the
help of skilled medical professionals: surgeons who specialize in head
and face reconstruction, and speech therapists who can teach the child
to control his tongue, mouth and air passages to make the common sounds
of speech.
For a mild malformation, a single surgery may be sufficient. More severe
malformations usually require multiple surgeries over several years.
Encourage your daughter to seek an evaluation from an experienced medical/surgical/speech-therapy
team. It can make a profound difference in how your grandson feels about
himself and how others respond to him — especially during these early
years, when the foundations of self-esteem are being built.
Oren Friedman, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment of
Cleft Lip
Appointment
Information
More
Information on Cleft Lip
DEAR MAYO CLINIC: I have been devastated several times in my life
by deaths of friends to malignant melanoma. Now I just learned a woman
I work with has it, and it has spread to the brain. The doctors here say
there’s nothing to be done. She has two toddlers, and I can’t stand to
sit by and just watch her die. Isn’t there some surgery or something that
could be tried? — East Peoria, Ill.
ANSWER: Patients who have malignant melanoma that has spread to
the brain have a poor prognosis, and treatment can be difficult because
the disease progresses so quickly. However, a review of the medical literature
and our experience confirms that if the spread involves only one tumor
location, surgery might be beneficial — especially if the cancer is not
spreading throughout the body. Because we don’t know the details of your
friend’s condition, we can’t say definitively if this is an option for
her.
Stereotactic radiosurgery is another choice when the spread is confined
to one or a few sites. This is an advanced, noninvasive therapy that uses
various devices to deliver a precise, high dose of radiation to a defined
target. Because it is an outpatient procedure done under local anesthesia,
it requires no recovery time. Stereotactic radiosurgery is both safe and
effective, and an attractive option for select patients.
External beam whole-brain radiation therapy may be another option for
your friend. While this form of radiation can relieve symptoms, it is
unlikely to completely eradicate melanoma that has spread to the brain.
Cancer-killing drugs — chemotherapy — are another possibility. New therapeutic
agents may enable drugs to work directly on cancer cells in the brain.
In the future, the most effective treatment approach to this highly lethal
cancer will likely involve a combination of several effective therapies.
Because there is so much research activity focused on this form of cancer,
we encourage you to continue to help your friend search for treatment
options.
Robert McWilliams, M.D., and Svetomir Markovic, M.D., Ph.D., Oncology
and Hematology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment of Melanoma
Appointment
Information
More
Information on Melanoma
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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