Grant: Cleft Lip and Palate Surgeries
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Grant after surgery to repair his cleft lip and palate
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At 20 weeks pregnant, Mandy was excited to get a glimpse of her baby for the first time through a 3-D Ultrasound. She watched the screen as the baby’s face was scanned and noticed right away that something was wrong. There was a line from his nose to the lips. As a dental hygienist trained in oral hygiene, she suspected that her baby had cleft lip. The doctor confirmed her suspicions and said that he also might have a cleft palate.
“I was very upset,” said Mandy. “I cried for about two days and then I got on the Internet and did some research. I also talked to a lot of people in the field.”
A cleft is a birth defect that occurs when the tissues of the lip and/or palate do not fuse early in pregnancy. A cleft lip is an opening in the upper lip that can extend into the base of the nostril. A cleft palate is an opening in the roof of the mouth. They are among the most common of all birth defects. Approximately 1 in 800 children have one or the other or both.
In preparation for her baby’s arrival, Mandy and her husband, Jason, met with John F. Teichgraeber, M.D., a Children’s Memorial Hermann Hospital pediatric surgeon and professor of pediatric surgery at The University of Texas Medical School at Houston, and his team at the Texas Cleft-Craniofacial Clinic. The clinic is a joint venture between The University of Texas Dental Branch and The University of Texas Medical School at Houston created to primarily treat patients with cleft and craniofacial deformities.
“We visited with Mandy and Jason to show them photos of babies that were born with cleft lip and palate so that they would be prepared for what their baby would look like when he was born,” said Teichgraeber. “We explained the possible procedures, taught them how to feed the baby through a special device and gave them additional resources to review.”
Mandy’s pregnancy continued to be monitored closely because cleft lip or palate can sometimes be associated with other underlying syndromes. The rest of her pregnancy was uneventful and in October of 2007, Grant was born.
“Because I had been so prepared for what he would look like, his appearance didn’t affect me at all,” said Mandy. “I kept saying to myself that this could all be fixed.”
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Grant before surgery
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Shortly after Grant’s birth, he was examined by Teichgraeber and his team. He did have a cleft palate in addition to the cleft lip. Grant was fitted with a presurgical nasoalveolar molding appliance to help reduce the size of the gap before his first corrective surgery. Using the device at home can be complicated and labor intensive. If it is done successfully, it offers better results with fewer subsequent surgeries and less scarring. Mandy’s dental hygienist training helped her get through the most difficult parts of the process and ensured that Grant had a positive outcome.
At 5 months old, Grant underwent his first surgery to repair his lip and put tubes in his ears at Children’s Memorial Hermann Hospital. Babies who have cleft lip and palate are prone to ear infections.
“Our goal in repairing a cleft lip was to reconstruct all the cleft structures,” said Teichgraeber. “We closed the lining of the lip and its muscle and then the overlying skin. At the same time we worked on the nose.”
The next surgery was to repair the palate. It was performed two days before Grant’s first birthday. Tissues from the roof of his mouth were moved together to close off the floor of the nose and the roof of the mouth. At the same time the muscles of the palate were reconstructed so that the palate could move to help with speech.
Barring any complications with his speech, Grant’s next surgery won’t take place until he reaches 7 to 9 years of age. At that point, Teichgraeber will put bone from his hip in the palate to help with tooth eruption and to stabilize the upper jaw.
“The changes are so amazing,” said Mandy. “I look at Grant every day and I’m so thankful for all that Dr. Teichgraeber and his team have done for him. You can’t even tell that he was born with a cleft lip and palate.”