How AI Helps Children With Cleft Lip And Palate

The birth of a child with a cleft lip or palate, or both, can be very upsetting, especially as not all families can afford the high treatment costs. Now, Swiss researchers have developed a low-cost and risk-free way to simplify the medical procedures, offering relief for families in poor countries.

With academic background in Journalism (Master Degree in Journalism and Media Wuhan University, Bachelor Degree in Communication and Media Research University of Zurich), Ying began her career as an investigative reporter and freelancer in Peking before joining swissinfo.ch in 2015, with particular interest in job & career, healthcare system, tourism and trends in modern workplace.

When doctor Andreas Müller at the University Hospital of Basel receives smartphone images of a new-born with a cleft lip and palate taken by a doctor from India, he puts them through special software on his computer to automatically create a digital model of the palate. He then sends the model back to doctors in India who can use a 3D printer to print out presurgical palate plates for infant patients.

In a workflow that would otherwise take weeks, a few clicks of a button create a personalised palate plate that can be fitted in newborns with facial birth deformities and prevent multiple expensive surgeries. The digital process developed by Müller, head of the Cleft Lip and Palate Treatment Centre at the University of Basel, and scientists at the Department of Computer Science at the federal technology institute ETH Zurich is now being tested in Indian and Polish clinics and could make better treatment possible, especially in low-income countries.

Cleft lip and palate are much more common than you might think: about one in 700 babies worldwide is born with a cleft lip and/or cleft palate, according to the non-profit organisation smile trainexternal link , which provides corrective surgery to children in 87 countries. This makes it one of the most common birth defects. The most frequent form is the cleft lip, where the upper lip does not form properly, leaving a gap. A cleft palate occurs when the palate (also called roof of the mouth) does not grow together during the foetal development.

But the complications of a cleft lip and palate go beyond the cosmetic. Children with untreated clefts can struggle with lifelong difficulties, including breathing, sucking, swallowing, and dental and speech problems. According to a studyexternal link published in the JAMA Pediatrics journal, individuals born with a cleft palate also tend to have more severe learning difficulties, anxiety disorders, autism spectrum disorders, and even a higher risk of mortality.

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There's no doubt that repair surgeries can significantly alleviate these difficulties. Since the middle of the 20th century, significant progress has been made in repairing clefts. However, children born with cleft lip and palate still have to undergo between two and four surgical procedures throughout their childhood and early adulthood.

The cost of repair surgeries varies based on the type of cleft and the kind of treatment required. In Switzerland and the United States, it typically costs $5,000-10,000 (CHF4,700-9,400) per surgery, says Müller. In India similar surgeries and treatment cost $2,300-3,500. While this may seem relatively affordable compared to the cost of treatment in wealthy nations, for many families in low- and middle-income countries, it is far beyond their means. Although cleft lip and palate can occur in all ethnic groups, they are more common in people of Asian descent (approximately 1 in 500 births), followed by new-borns of Native American and Hispanic descent, according to the nationwide childrenexternal link 's hospitalexternal link in the US.

Some doctors prefer to reduce the surgical intervention of closing the malformation of lip and palate from multiple steps to one. However, as Müller says, this can only be accomplished in collaboration with a multidisciplinary team. A paediatric dentist, a surgeon and an anaesthesiologist take the impression of a baby's palate shortly after birth to create a plaster mould. An experienced dental technician handcrafts an individualised plastic plate based on the mould, then a qualified orthodontist implants the plate into the baby's mouth and frequently adjusts it over several months. The plate closes the palate, which is open to the nose, making it easier for the baby to drink. After six to eight months, the baby's cleft will have become narrower and the tongue's position corrected enough to perform a single surgery to close it.

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