Topamax, a pharmaceutical drug used to treat migraines and epilepsy, has been shown to cause birth defects, like cleft lip or cleft palate, in children, which may call for surgery, when taken by mothers during pregnancy.
Surgery is often a last resort for many health professionals who would rather see a patient heal naturally. However, when necessary, surgery can be advantageous, as long as it is handled with great caution. The surgery for a cleft lip or palate is no exception when it comes to taking precautionary measures. After your consultation with your doctor, he/she may recommend surgery to repair your child’s birth defect.
Potential Side Effects of Cleft Lip Surgery
Your doctor will take your personal circumstance into deep consideration and will advise you of the great benefits that are possible from surgery, along with the potential risks and side effects. The advantages of surgery are obvious in helping the child’s dentition, oral health, and your child’s ability to lead a “normal” life. However, when making this important decision, you, as the parent, need to be aware of the potentially harmful effects.
Prior to surgery, some common side risks are bleeding, infection, poor healing of incisions, risks of anesthesia (a heavy drug that is used to reduce sensation and pain during the procedure), allergies, and damage to other, possibly more internal, structures. When a young child goes under anesthesia, he or she is susceptible to unwanted reactions. Furthermore, there are additional effects that can lead to a need for more surgeries. In some cases, after surgery, bones in the face do not continue to grow, meaning that the structure and growth of the face has been disrupted by the repair of the cleft lip, causing more facial damage. Also, the space between the lips and nose is a difficult one to duplicate for many surgeons. It is possible that the cleft lip repair may cause the face to look abnormal by having an unusual amount of space between the lip and nose. These negative effects do not necessarily always occur, but it is important to be aware of them before making this important decision. Your physician will know what is best for your child’s health.
Birth Defects Lawyers in New Jersey and Philadelphia
If your child was born with a birth defect that you believe can be attributed to your use of Topamax during pregnancy, you probably have some questions. Please contact the Mininno Law Office for a free case evaluation, or call for a free consultation at (856) 833-0600 in New Jersey, or (215) 567-2380 in Philadelphia.
Cleft lip occurs in about one out of seven hundred births, meaning there are people who are ready to help your child live a normal life. This team consists of professionals like a plastic/craniofacial surgeon, pediatrician, orthodontist, pediatric dentist, speech language pathologist, ear nose and throat specialist, an audiologist, genetic counselor, nurse team coordinator, and a social worker. Each of these individuals will provide a form of support and strength to your baby and family. These professionals are trained to treat your baby’s needs and answer any questions you may have. Beyond providing healthcare for your baby, counselors and social workers are designated to help your child cope with the psychological aspects that may accompany a cleft lip/palate. A child with a cleft lip will face many health problems, but the deeper, emotional problems can be just as significant. These counselors will introduce you to organizations for certain birth defects, as well as support groups of other families just like yours. Despite the fear of the unknown, it is crucial to be an advocate for your child and to utilize all possible resources.
Diagnostic screenings will be needed in order to avoid reactions from the medications that will be given to your new baby for the surgery. The first phase of the surgery is the anesthesia. The anesthesia will be administered to your baby to put him or her in a “sleep like coma” to avoid pain. The sedation can be given generally or intravenously, and will be chosen depending on your doctor’s recommendations. Next, an incision will be made on either side of the cleft. This flap will then be sewn together to close the cleft. If the incision is successful the surgery is complete and your baby will wake up when the sedation wears off. Once your child is awake, it is important to closely follow the surgeon’s suggestions on caring for the wound. Certain medications may be taken orally or applied directly to the incision to aid in preventing infection and strengthening the new formation. There will be specific feeding restrictions for your child which your doctor will suggest for you. Following surgery, you may find your baby restrained to keep him or her from touching the surgical site until it heals. This surgery is the first of the process to correct clefts, and depending on the outcome of this surgery and your child’s individual case, he or she may need to undergo follow up procedures for health or cosmetic reasons.
Most children with these birth defects require a first, initial surgery as early as 3 months. These surgeries are often invasive and require tedious work on behalf of the plastic surgeon. This initial surgery is crucial to preventing disease from forming in the exposed region of the cleft lip, and to providing a healthier dentition. This preliminary surgery helps restore the actual structure of the face. 
When a cleft does not affect the mouth’s palate structure it is referred to as cleft lip. Cleft lips can occur on one or both sides of the lip which are generally referred to as unilateral or bilateral clefts. The first category of cleft lip is known as an incomplete cleft. An incomplete, or partial, cleft lip occurs at the top of the lip. The cleft appears as a small gap or indentation that does not reach the nose.
Psychosocial problems are not a definite side effect of birth defects and generally, when children have their cleft lip operated upon soon after birth they will have a strong recovery and a healthy social life. The risk in adolescents is far greater when they suffer from birth defects and this may lead to self-esteem, social, and behavioral issues. As children grow older, dealing with a cleft lip may lead to issues relating to self concept, relationships with their peers, and worries with their appearance. During the preschool years, ages three through five, children who have a cleft lip or cleft palate tend to be on par with peers without any oral malformations with regards to self-concept. As children grow older however, they may feel increased pressure and face more social issues. As children have increased interaction with other kids, children who have clefts tend to have more dissatisfaction with relationships with peers and have an increased level of social anxiety. With age, children will generally experience increased social anxiety and pressures with regards to their cleft. These visible deformities may yield a stigma and it is best to have birth defects treated as soon as possible in order to limit the social issues children face as they age.
This trained professional is a source of assistance and alternatives to every day needs. For instance, if your child has a cleft lip he or she will likely have difficulty producing plosives, which include “p”, “b”, “k”, “g”, “t”, and “d”. These plosives are formed by the sealing of the lips and releasing of pressure. Without a full seal of the lips, these words will be problematic in every day speech. A speech language pathologist will work one on one with your child and your family to help develop a stronger labial seal and alternatives to producing these sounds, in order to help your child efficiently communicate. Speech therapy will help your child work on articulation inaccuracies, plosive sounds, and audible speech.
A newborn baby with a cleft lip will have trouble sealing the lips and nasal cavity, preventing efficient sucking. The orbicularis oris, the muscle of the lips, has been affected due to the cleft lip , which prevents the muscles from properly functioning to provide a strong labial seal. If the cleft lip is specific to one area of the lip (i.e. the right or left side) it may help to breastfeed your baby at an angle towards the side of the lip without the malformation. By repositioning yourself, you can help your baby create a stronger labial seal, allowing him or her to suck more efficiently.
Shoulder dystocia occurs when a baby’s shoulder gets stuck behind a mother’s pubic bone. In order to avoid injury, certain changes must be made during delivery. Birth injuries arising from the improper delivery of a baby with shoulder dystocia can be permanent. In the case of the Virginia boy, it was shown that the nerve damage caused him permanent disablement of his right arm. He may need assistance for simple tasks for the rest of life, and may not be able to do many of the typical activities of childhood due to the birth injury he received.