Int J Ayu Pharm Chem - OAJI

Int J Ayu Pharm ChemREVIEW ARTICLEwww.ijapc.come-ISSN 2350-0204Ayurvedic and Modern Approach to Cleft Lip w.s.r. to AusthasandhanGunjan Keshri1*, Subhash Y. Raut2, Arun M. Lakhapati3 andNita M. Kedar41,2,3,4Shalyatantra Department, Government Ayurvedic Hospital, Sakkardara square, Nagpur, Maharashtra, IndiaAbstractPlastic or reconstructive surgery in Ayurveda comes under the heading of Sandhan karma.Acharya Sushruta have mentioned Sandhan karma for various types of deformities of Nasa,Karna and Austha in Karnavyadhabandhvidhiadhyay.Cleft lip and cleft palate are congenital abnormalities of the mouth and lip. Acharya Sushrutahave already described it as birth abnormality in his text. Cleft lip is an abnormality in which thelip does not completely form during fetal development. Cleft palate occurs when the roof of themouth does not completely clos e, leaving an opening that can extend into the nasal cavity.This study shows the evolution of modern surgery of cleft lip from Ayurvedic cosmetic surgeryof Austha sandhan and highlights the principles of Sandhan karma.KeywordsCleft lip, Cleft palate, Austha sandhanGreentree GroupReceived 04/06/16 Accepted 30/06/16 Published 10/07/16Gunjan et al.2016 Greentree Group IJAPCInt J Ayu Pharm Chem 2016 Vol. 5 Issue 1www.ijapc.com135[e ISSN 2350-0204]

Int J Ayu Pharm ChemINTRODUCTIONCleft palate occurs when the roof of theAcharya Sushruta, the father of Indianmouth does not completely close, leaving ansurgery has mentioned cosmetic surgery byopening that can extend into the nasaldescribingAushthacavity. The cleft may involve either side ofsandhan in Karnavyadhabandhvidhiadhyaythe palate. It can extend from the front of the1mouth (hard palate) to the throat (softKarna,Nasaand.Acharya Vagbhata also mentioned cleft lipas khandaustha due to vata prakopa andpalate).described it’s management as sandhanCleft lipkarma2.Cleft lip is an abnormality in which the lipCleft lip and Cleft palatedoes not completely form during fetalbirthdevelopment. The degree of the cleft lip canabnormalities of the mouth and lip. Acharyavary greatly, from mild (notching of the lip)Sushruta and Acharya Vagbhata haveto severe (large opening from the lip upalready described it as birth abnormality inthrough the nose).his text. Cleft lip and cleft palate occur earlyThere are different names given to the cleftin pregnancy when the sides of the lip andlip according to its location and how muchthe roof of the mouth do not fuse together asof the lip is involved.they should. A child can have cleft lip, cleftCleft lip and cleft palate may occur togetherpalate, or both. Cleft lip and cleft palatein an infant, or separately.Cleftlipandcleftpalatearetogether are more common in boys.Cleft palateUnilateral incompleteunilateral completebilateral completeFig. 1 Classification of cleft lipGunjan et al.2016 Greentree Group IJAPCInt J Ayu Pharm Chem 2016 Vol. 5 Issue 1www.ijapc.com136[e ISSN 2350-0204]

Int J Ayu Pharm ChemUnilateral incomplete- disruption of softsurgery there is no use of stem of Ricinustissue to variable extentcommunis (Eranda naala)1 . He told to doUnilateral complete – complete disruptionLekhan karma on Lip edges and create freshBilateral complete- both sides are involvedbleedingandthensuturingdone.Lalchandan, mulethi, rasaunt powder wasCauses of cleft lip and cleft palatethen sprayed, covered with cotton and tilThe exact cause of cleft lip and cleft palatetaila was spread over that continuously.is not known. Cleft lip and/or cleft palate areGhritapan was then advised after digestioncaused by multiple genes inherited fromfollowed by virechana karma1both parents, as well as environmentalAcharya Vagbhata mentioned, Khandausthafactors.chikitsa as followed – first snehan-swedanaIt can be considered as Kulaja / Sahaja /then sanshodhana and lekhana karma overKulodbhavlip edges followed by suturing. Sadyovrana/PrakritiprabhavVyadhiaccording to ayurvedic Acharyas.and vata nashak.chikitsa is advised2afterwards .Symptoms of cleft lip and cleft palateSurgery indicated in modern seems to beThe symptoms of these abnormalities areoriginatedvisible during the first examination.mentioned by Acharya Sushruta.Possible complications associated with cleftLekhan karma which is done in Ayurvedalip and cleft palate:can be compared to the flaps removed from Cosmetic abnormalitylip. Main purpose of this step is just to create Feeding difficultiesfresh bleeding which is required for healing. Ear infections and hearing lossSuturing and then dressing was then advised Speech and language delayby Acharya Sushruta and in modern surgery Dental re for Austha sandhanAcharya Sushruta described sandhan ofcongenital deformity of lip same as Nasasandhan. The only difference is that in lipTennison- Randall procedureGunjan et al.2016 Greentree Group IJAPCInt J Ayu Pharm Chem 2016 Vol. 5 Issue 1www.ijapc.com137[e ISSN 2350-0204]

Int J Ayu Pharm ChemFig 2 Tennison-Randall procedureadvisedSadyovranaandVataCleft lip repair done generally at 3 months.chikitsa to promote wound healing.Rule of tens employed in cleft lip surgeryAccording to modern science,related to increased anaesthetic safety ina)infantsdisruption of repair. Baby 10 week oldb) Weight 10 poundsucking effort. Hb 10 mg/dlc)nashakArm restraints for 3 weeks to preventSpecialized nipple/bottle to decreaseSoft diet should be given to the childfor 7 to 10 days after surgery.This operation is totally based uponComplications of cleft lip repairmathematical principles and measurements.1)Inadequate reapproximation.Different landmarks are firstly made with2)Inaccuratethe help of wooden stick and methylene bluevermilion cutaneous junction leaving stepdye. Then incision takenoff deformity.along the linesVerticalalignment3)showed in second figure.inadequate rotation can cause shortening ofPost operative carethe lip segment leading to a notch in theAcharya Sushruta mentioned Avchurnan ofvermilion and a whistle deformity.different herbal drugs and til taila Sinchan as4)a post operative care and Acharya Vagbhatastenosis.nostrilcontracturethemarked in the figure and suturing done asNarrowscarofwithorvestibularGunjan et al.2016 Greentree Group IJAPCInt J Ayu Pharm Chem 2016 Vol. 5 Issue 1www.ijapc.com138[e ISSN 2350-0204]

Int J Ayu Pharm Chem5)Dehiscence and scar widening.CONCLUSIONAfter reviewing literature of Ayurveda andmodern science it is observed that, the keenknowledge of Acharya Sushruta whilementioning the Sandhan karmaasamanagement of Karna, Nasa, and Austha.Whichdenotesthatmodernsurgicaltechniques like plastic surgery is derivedfrom the basic principles of Ayurveda statedby Acharya Sushruta as a Sandhan karma inhis ancient text, Sushruta samhita.Gunjan et al.2016 Greentree Group IJAPCInt J Ayu Pharm Chem 2016 Vol. 5 Issue 1www.ijapc.com139[e ISSN 2350-0204]

Int J Ayu Pharm ChemREFERENCES1. Ambikaduttshastri(2010).Ayurvedtatvasandipika on Sushruta samhita.84-912. Brahmanandtripathi(2013).Astanghridyam. 1022,10353. Bart van de ven(2008). Cleft lip surgery apractical guide 12-664. Shriram Bhatt M(2009).SRB’s Manual ofSurgery, 301-3045. Makhan Lal Shah(2013). Bedside Clinicsin Surgery, 478-4876. Bailey and Love(2004). Short Practise ofSurgery, 645-6497. MargaretFarrquharsonandbredanthmoran. 9 Edition. Farquharson’s Textbookof Operative General Surgery, 186-188Gunjan et al.2016 Greentree Group IJAPCInt J Ayu Pharm Chem 2016 Vol. 5 Issue 1www.ijapc.com140[e ISSN 2350-0204]

Int J Ayu Pharm Chem 2016 Vol. 5 Issue 1 www.ijapc.com 135 [e ISSN 2350-0204] Int J Ayu Pharm Chem REVIEW ARTICLE www.ijapc.com e-ISSN 2350-0204 Abstract Plastic or reconstructive surgery in Ayurveda comes under the heading of Sandhan karma.