جراحات إصلاح العيوب الخلقية

It is considered one of the very important surgeries in the treatment of deformities and congenital defects in children, which helps them to live normally in all the following stages of their life, especially with the interest of cosmetic medicine in this incision, and the great development that occurred at the level of techniques, and modern methods to reach the situation; To the situation closest to normal so that this problem does not cause any health or psychological crises for the child, in the future, but what are congenital defects, the most common types of them, their causes, risk factors related to them, and how to deal with them in an optimal way? This is what will be discussed in detail in the future.

What are birth defects؟

Congenital defects mean abnormal increase or decrease in a member of the body. This structural defect begins at the beginning of fetal life, and the main cause is the exposure of the cell to some abnormal factors completely far from the normal development of the fetus; To produce those deformities that fall into the simple ones that do not affect the life of the fetus; To acute, which may lead to death, and which mostly affects (outward appearance, organ function, physical or mental development).

It should be noted that a disabled child is scientifically different from a child with a birth defect; The first is the child who is born, or suffers after birth with a mental or motor disability, such as cases of polio. As for the child with a congenital defect, he is not disabled at all, but he can live his life normally after treating the birth defect.

Causes of congenital malformations and their complications

There are many reasons that lead to birth defects in children, some of which are genetic and environmental, including the following:

• heredity, by passing on the genes of the father and the mother, abnormalities of the child; Because of a defect in those genes, due to a mutation, or a specific defect in the family history of one of the parents.
• Wrong behaviors such as excessive smoking, alcohol, and drugs, these things cause severe fetal abnormalities.
• Taking some disfiguring drugs, or exposure to radiation, and chemicals.
• Infection of the mother with infections or some diseases such as syphilis and German measles, especially in poor countries.
• Decreased intake of some important nutrients such as folic acid; It increases the possibility of birth defects.
• There are also some risk factors that increase the possibility of fetal abnormalities, such as inbreeding, or the mother's pregnancy after the age of 35 years.
• Other unknown causes, and the rate is about 50%.

As for the complications of congenital malformations, although they are rare, sometimes infection, bleeding or blockages may occur in some parts of the body.

How are birth defects diagnosed?

Chorionic villus sampling, and amniocentesis (sampling of the fluid surrounding the fetus), in view of the examination of chromosomal abnormalities.

As for after childbirth, it must be started early, in the presence of a pediatrician during childbirth; To examine the newborn immediately after its birth, to ensure its safety, and to treat any defect as soon as possible, especially since the delay in dealing with birth defects; It may lead to death, or serious complications that destroy the future of the child, and here lies the importance of clinical examination, detection of blood disorders, ensuring the safety of vital processes such as hormone production, metabolism, etc. 

Types of birth defects

Birth defects in children generally include two types, namely:

• Structural birth defects:
• The child suffers through it, by losing a part of the body, or the presence of deformation in this part, and the most common types of skeletal defects (heart defects, cleft lip, cleft palate, spina bifida, clubfoot or club feet).

Functional birth defects:

It means a defect in the function of one of the body's organs; As a result of a problem with the chemical composition of the body, this type of birth defect affects the nervous, metabolic, or immune systems, and the most common type is Down syndrome.

Birth defects treatment

Treatment methods for congenital defects vary depending on the situation. There are cases that can be corrected or improved during pregnancy, and there are other cases that need drug treatment from birth or emergency surgeries to save their lives. Among the most common types of birth defects, which are treated surgically are the following:

· إصلاح الشفة الأرنبية المفردة والمزدوجة

The abnormalities of the rabbit lip, whether their occurrence is associated with abnormalities of the palate or not, occupy the fourth place among the most common birth defects, and they mean the occurrence of a separation in the upper lip, and openings appear on it similar to the rabbit's lip, and this separation often extends to the upper gums, and the area behind the nose, and upper jaw bones. The cleft lip may be partial or complete, and it may occur on one side (single), on both sides (double), or in the middle, and it is one of the very rare cases. 

How is the cleft lip, and the most important causes?

The lip begins to form in the fetus between the fourth and seventh week of pregnancy, as cells and facial tissues grow from each side of the head towards the center of the face, forming it. When the lip tissues are not completely joined together before birth; Cleft lip or cleft lip occurs, which has many forms, it may be a small or large opening, and it may extend into the nose, and the child may suffer from the cleft lip and cleft palate together, and the palate here is the roof of the mouth, the separator between the oral cavity and the nasal cavity. The main causes of the cleft lip are as follows:

• The genetic factor may be a reason for the presence of the cleft lip.
• The mother takes some medications, especially the first 3 months of pregnancy.
• Smoking and alcohol consumption by either the mother or the father.
• Fetal abnormalities may be caused by a deficiency of folic acid.
• The pregnant woman has been exposed to radiation, or harmful chemicals.
• Infection of the mother with infections, diseases or some types of viruses during pregnancy.
• The appearance of the cleft lip was also observed in cases of consanguineous marriages.
• Other unknown reasons.

كيفية علاج الشفة الأرنبية؟

The cleft lip is treated through plastic surgeries, the number of which varies; Depending on the severity of the oral cleft. Although these surgeries are not difficult, they require a plastic surgeon who has a lot of skill, craftsmanship, and accuracy, especially when dealing with soft tissues, such as children’s tissues. The stages of cleft lip treatment are as follows according to each case:

• The surgery to close the cleft lip, and this operation is at the age of 3 months, and the shape of the gums and jaws are modified, and the nostrils are symmetrical.
• The second operation is after 6 months, which is the roof of the throat surgery.
• A dentist follows up, the child then; To make orthodontic teeth, and ensure their growth naturally.
• A final plastic surgery to remove any scars or wounds from the previous operations, and it is preferable to perform it when the child reaches 16 to ensure his full growth.

These operations mainly aim to improve the child's appearance, and thus enhance his confidence in himself, but also aim to improve functional processes, such as breathing, hearing, speech, swallowing, and language development. 

cleft palate repair

This deformity causes a defect in many physiological functions of the body, such as speech, swallowing, articulation and chewing, and negatively affects the normal development of the upper jaw, nose, etc. It is a cleft in the roof of the mouth, it may be in the hard palate, located behind the teeth, or in the soft palate, located behind the hard palate towards the larynx. The degree of cleft palate deformity varies, from a small crack to complete detachment.

Urgent intervention is necessary to surgically repair the cleft palate; Because this deformity causes complications such as middle ear infections, speech and speech problems, as well as a defect in the formation of teeth.

Cleft palate repair surgery can be performed from 6 months of age; If the child’s health condition permits this, several things are aimed at:

• Close the opening between the oral cavity and the nose.
• Prevent food and fluids from entering the nose.
• Improving the child's pronunciation and speech.
• Make the outward appearance of the child's face natural.

Steps of cleft palate repair surgery

Before surgery, attention must be paid to the child’s nutrition, health, and preparation for surgery. He must also be presented to more than one doctor in several specialties; To reach the best result in surgery, these specialties are (plastic surgeon, otolaryngologist, dentist, and speech therapist), and the surgery is performed as follows:

1. The child is placed under complete anaesthesia.
2. The surgeon makes incisions on both sides of the incision; To reach the separated muscles of the throat.
3. Arranging, and repairing the muscles of the soft part, this step helps a lot in improving pronunciation.
4. Sew the outer layer along the midline of the roof of the pommel.
5. The child may need other cosmetic operations in the future; To improve some problems, and hide visible scars.

The operation takes from 2 to 3 hours, and the child can go home within a day or two of the surgery. As for the stitches, they will dissolve on their own, and the doctor will set an appointment to follow up on the results of the surgery.

Hypospadias repair of various types

The urethra is the tube inside the penis that carries urine from the bladder; There are many congenital defects that cause urine to come out of its place, or obstruction in the urethra, or obstruction of its flow, which leads to serious complications of diseases such as urinary tract infection, or great pressures on the bladder and kidneys, And causing harm to them over time. As for the types of congenital defects facing the urethra, they are as follows:

• partial blockage.
• It is in the wrong position.
• Protruding outside its opening (urethral prolapse).
• Double urethra (there are two instead of one), which is a rare case, and in most cases only one of them is connected to the bladder.

يتم تشخيص حالات العيوب الخلقية للإحليل عبر الفحص السريري للطفل، ومن الممكن أن تتطلب الحالة إجراء بعض الفحوصات، والأشعة. كافة أنواع العيوب الخلقية الإحليل البولي يتم معالجتها بالجراحات التجميلية لتصحيح وضعيته، والتخلص من أي عيب.

Repairing birth defects in various parts of the body

Congenital defects may include any organ of the body, and here comes the role of plastic surgery in repairing these defects, and bringing them to the closest level to the natural form. Congenital defects include the following:

• Muscles, joints, and bones.
• the heart.
• brain, and spinal cord.
• genitals.

There may be more common birth defects than others, and some of them are simple, and others are very dangerous, causing death in infants, and although the reason behind the appearance of birth defects is not known, studies have confirmed the presence of some genetic and environmental factors that increase Chances of congenital malformations, such as exposure of the mother to radiation, taking certain medications, nutritional deficiencies, infection, drinking alcohol or smoking.

As for diagnosing birth defects, there are cases that can be diagnosed before birth through (magnetic resonance imaging, blood tests, amniocentesis, chorionic villus sampling).

This diagnosis is preferably made for certain cases of women (those who are over 35 years old, had repeated miscarriages, had children who were suffering from birth defects, and died without clear causes).

As for diagnosing congenital defects after birth, it is through careful examination of the newborn child (skin, head, neck, heart, lung, abdomen, organs, nervous system, and its reflexes).

Plastic surgery is very useful in solving and correcting the problems of congenital defects throughout the body. Surgery can also be used with medications; To adjust for symptoms caused by other birth defects.