G.Ayanga: One small tooth decay can make children handicapped

Trans. by B.DULGUUN 

Many people born with a cleft lip or palate live discontentedly as adults because their parents didn’t have the condition treated when they were young. In most cases, these people live hidden from others and isolate themselves from society. Many parents spend money and time searching for foreign hospitals because they don’t trust Mongolian doctors or aren’t aware that cleft lip and palate can be treated in Mongolia.

The only Mongolian team specialized in this field operates at the Maxillofacial Surgery Department of the National Center for Maternal and Child Health (NCMCH) of Mongolia.

The following is an interview with G.Ayanga, the Head of Maxillofacial Surgery Department and President of the Mongolian Cleft Lip and Palate Association, about this issue.

G.Ayanga published 15 academic journals on comprehensive diagnosis and surgical treatment for orofacial clefts on renowned international scholarly journals, held six presentations at international conferences and seminars, and acquired intellectual property rights for 11 treatment methods that he introduced in Mongolia. He has been recognized by the state and awarded with the Order of Polar Star and Altan Chagnuur (Gold Stethoscope), an award granted to the top doctors of Mongolia. 

Can you briefly tell us about the operations of the Maxillofacial Surgery Department? How many children are suffering from cleft lip and palate in Mongolia? 

Our department was established in 1992. I’ve been working here since 1993. Approximately 1,800 children are hospitalized every year. Around 97 to 98 percent of them undergo surgeries, and 60 percent of these surgeries are emergency and the rest are scheduled surgeries. Emergency surgeries are required for dental decay and abscess around the face and jaw caused by dental decay.

Dental decay has become very common among children. The decay develops into complications. We’re doing emergency surgeries every day. Parents disregard children’s tooth decay and cavities. Yet, three to four children on average undergo corrective jaw surgery and have it cut off partially or entirely every year. It’s truly unfortunate that parents make their children handicapped after giving birth to a healthy child because of one small tooth decay. Other maxillofacial injuries also require emergency surgeries. Congenital cleft lip and palate take up the majority of scheduled surgeries. According to a survey made in 2012, one in every 1,000 births in Mongolia has this facial deformity.

Experts and nonprofessionals are saying that children suffering from cleft lip and cleft palate, or both a cleft lip and cleft palate, commonly known as orofacial clefts, are increasing and reaching dangerous levels. I disagree with this.

According to the survey we did, the number of children with this deformity per 1,000 children hasn’t increased. More children with this birth defect are being diagnosed in relation to increasing birth rate. Professionals should say things that have been researched and proved on public media. Otherwise, anxiety is spreading among the public. How would this impact newlyweds and pregnant women? Researchers determined that psychological stress and shock can impact negatively on pregnant women and becomes a reason for delivering children with birth defects. I believe that doctors should be cautious on this. 

Why are children born with orofacial clefts? 

The current medical science hasn’t completely determined the causes of birth defects. Many research works have been conducted. Some were denied and only few were approved. Cleft lip and palate occur when a baby’s lip or mouth do not form properly during pregnancy. Specifically, the lip forms between the fourth and sixth weeks of pregnancy while the roof of the mouth (palate) is formed between the eighth and 12th weeks of pregnancy. A baby’s fetal organ can stop developing due to internal and external factors that impact the mother. Many scientists across the world have agreed that this causes orofacial clefts.

We’ve researched many internal and external factors that can cause birth defect. Second-hand smoking, hazardous working conditions, viral infection, use of certain medicines, environment, and even the age of couples can  have an impact. Scientists of other countries have also studied the causes of birth defects. Many research works were conducted on mothers that smoke. The chances of a baby being affected with orofacial clefts or other defects increases by 50 percent when pregnant women smoke more than 10 cigarettes a day. This risk can increase up to 70 to 75 percent if they smoke 20 or more cigarettes a day. American doctors covered a wide range of people in this study.


The Maxillofacial Surgery Department of the NCMCH treats orofacial clefts at a national scale. How is the viability of children born with orofacial clefts?


The Children’s Hospital of the NCMCH has seven surgical wards, including general, ophthalmology, and ear, nose and throat etc.The most important field of work for surgeons is operating on and fixing children’s birth defect. All birth defect have to be treated during childhood, according to standards. Our department was in a stage of development in around 2000. Therefore, we aimed to have the knowledge and skills of our professional personnel internationally recognized and bring healthcare services close as to the public. Within this framework, we developed foreign relations and started working with doctors from highly developed countries. Three to four professional surgeon teams have been sent every year to provinces since 1999 because people living in provinces and rural settlements are financially incapable of coming to the capital and receive treatment or healthcare services. We’re still having surgeons go to provinces to do surgeries.

In the past, our department organized over 60 trips to provinces and conducted surgeries, as well as other necessary treatments for some 2,000 children. Our surgeons are capable of performing difficult and simple defect surgeries.

Heart defect is most common while orofacial cleft is listed third or fourth. Compared to other birth defects, 80 percent of children affected with orofacial clefts are fully matured and have fully developed their organ systems. In other words, they have good viability. The remaining percentage has additional defects of the heart, upper limb or neurologic abnormalities. This isn’t a common occurrence but it will be difficult for the child to live. 

Is it possible for children to recover without scars or having to feel embarrassed from others? 

A child with orofacial cleft will not instantly become “beautiful” after a surgery. Surgeries are done in stages for appropriate age groups. Therapy for correcting speech disorder is provided at the same time. 90 percent of children with cleft palate suffer from ear inflammation. Maternal-fetal medicine physicians, psychologists, and doctors for ear, nose and throat, and dental defect have to provide comprehensive treatment together.

Cleft lip and cleft palate can occur in various ways. They can occur individually or together. One or both sides of the lip can get a slit. Depending on these conditions, treatments are chosen. According to standards, the first surgery for fixing cleft lip has to be done when the baby is three months old and the first surgery for cleft palate has to be done when they’re one or one year and three months old. These children are under our medical supervision since they are checked up until they are 16 to 18 years old. If they don’t skip treatment and therapy, they can live normally both mentally and organ-wise.  For instance, I notice that some Hollywood actors and actresses have had cleft lip before. 

How did you get into the international doctors’ team? How does the organization select its members? 

[Our department] has been cooperating with Operation Smile, a nonprofit medical service organization, for over two years. The organization is based in Virginia Beach, Virginia, and the section in charge of Asia is based in Singapore. Organization Smile selects doctors from different countries and sends them to developing countries to provide free surgeries to repair cleft lip, cleft palate and other facial deformities for children around the globe.

High criteria are set for selecting doctors. The number of surgeries a doctor performs, his surgical skills, and even the time he takes to complete a surgery are evaluated. In addition, doctors have to give tests.

I went to Myanmar in 2013 and two doctors from our department went in 2014. Myanmar has many patients. So I guess the number of patients is high as their population is 60 million. In 2013, our team of some 50 people operated on over 130 Myanmar children. Four doctors from America, Canada, Singapore and Mongolia did six to seven surgeries a day simultaneously.

This year, I’ll be going to Indonesia with our anesthesiologist. Examination and diagnosis are made on the first day, and in the remaining six days, I’ll be operating on children with two to three other doctors. I hear that 60 to 70 patients will be received. 

What is the current direction of maxillofacial surgery? 

The International Association of Oral and Maxillofacial Surgeons determines maxillofacial surgery direction. Corrective jaw surgery has been the main focus of the last 10 to 20 years. To keep up with this trend, Mongolia has been sending doctors abroad to receive higher education in this field. Surgeons in our department are fully capable of doing standard surgeries. 

Source:  mongolnews.mn/1ji8


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Posted by on Apr 28 2015. Filed under Prime Interview. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.

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