Pediatric Cleft Lip and Palate Treatment and Management

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Happy Baby Gio. His parents are holding a benefit dinner to raise funds for his surgery. Photo by Daphne Demabildo-Villarosa.

While we often hear of the Operation Smile that promises hope and corrective surgery to those who have cleft lip or with cleft lip and palate (CLAP), we do not really know the extent of what needs to be done in order to correct this situation.

Late last year, Baby Gio, son of our friends Ian and Daphne Villarosa was born. But before he was delivered, Daphne knew that through ultrasound that her son has a cleft lip. We prayed hard that it was only that. But her fears were confirmed when Baby Gio was born and the extent of the anomaly was revealed. Gio has Unilateral Cleft Lip and Palate or CLAP.

For a family with a child born with a cleft lip and palate, they will have the daily routines to live with. Unlike any regular newborn whose natural instinct is to suckle his mother’s breast for milk, Baby Gio could not. This makes him always hungry and irritable. Daphne resorted to giving milk by the dropper or through a syringe. Eventually, she discovered that there is a bottle especially designed for babies with CLAP but it was only available in the United States. Thankfully, a friend connected her to a friend in the US who bought the bottle for Baby Gio. This had helped them a lot.

Baby Gio with and without the obturator. Photo courtesy of Dr. Dianne Lim of Comfydent Dental Clinic.

First 2 Weeks: Nasoalveolar Molding (NAM)
I talked with our pediatric dentist, Dr. Dianne Margaret Lim of Comfydent Dental Clinic here in Bacolod City, who is also handling Baby Gio’s case and this is what she said, “Neonates or newborn babies with this kind of condition are suggested to wear an appliance called Nasoalveolar Molding or NAM. NAM is a non-surgical method of reshaping the premaxilla, lip, and nostrils before CLAP surgery. But technically for me, NAM is important for feeding and esthetics.

“Patients with CLAP like Gio should be fitted with a custom-made molding plate within the first couple of weeks after birth. Gio’s NAM has a nasal conformer to raise the ala of the nose so that after surgery, Gio’s nose is lifted and narrowed.”

The challenge of the NAM is that the patient should wear the molding plate 24/7, especially when feeding. The tape should also be changed regularly and the appliance cleaned daily or as needed. So the caregiver really needs to diligently monitor that it is clean and always in place.

After religiously wearing the appliance for a week, Baby Gio has to go back to the clinic so that the dentist could reshape his plate. Dr. Li says that each adjustment is very small, if not negligible, as it is just to guide his developing jaw as it grows. The patient should be brought to the dentist’s clinic weekly for the adjustment of the molding plate. Each session lasts abut 40-60 minutes. The dentist has to do the adjustment until the cleft gap is small enough so that there is lesser tension when the surgeon closes the cleft.

Dr. Lim says that Baby Gio will be wearing this molding appliance for only 2-3 months, or until his weight is ready for surgery. “With this appliance, Gio will be able to drink his milk without the milk leaking out of the nostril area. The nasal conformer will also help the ala of the nose be lifted and narrowed. This is a big help esthetically,” the dentist explained. Meanwhile, the tape over the upper lip will help the lip and the premaxilla close together so that during surgery, tension is reduced. And most of all, feeding will improve, Dr. Lim adds.

In Baby Gio’s case, he will undergo a series of surgical procedures that include but are not limited to surgical repair of the cleft lip and palate, alveolar bone grafting in the cleft area, orthognathic surgery, closure of the oroantral fistula, and scar revision. And each time, he will be under general anesthesia.

Pre-Valentine Benefit Dinner
Since Baby Gio will have so many procedures to go through, the family sought for financial assistance or free procedures from different foundations. However, since the father has a regular job, they are not qualified as “indigent.” With that, the family is hosting a Pre-Valentine benefit dinner on February 7, 2015 at the Mely’s Garden, 6th-Lacson Streets, in order to raise funds for Baby Gio’s surgical needs. Tickets are at P500, which includes a buffet dinner and entertainment from Angelica Prado and Aire Acoustic. You may contact Daphne at this number: 0923-9634436. Please find the poster below.

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