Cutting Edge

Title
Cutting-edge technology provides better outcomes for children born with cleft palate
Date
02/01/2017
Article

Wyatt Miller was born Nov. 11, 2015. His mother, Sameria Brown, remembers it well.

“He weighed 7 pounds, 10 ounces and he was 21 and ¾ inches long,” she said. “As soon as he was born, they took him back for an examination. When they brought him to me, they told me he had a soft cleft palate.”

About one in every 1,500 babies is born with a cleft palate in the U.S. every year. The palate is both the hard and soft part of the roof of the mouth. When the palate is not completely formed, it results in a split-like opening from the roof of the mouth to the nose, which is called a cleft palate. Similarly, a cleft lip occurs when there is a split in the baby’s lip. Most babies born with a cleft have both a cleft lip and a cleft palate, but they can occur separately.

Cleft lip and palate occur very early, between week 6 and week 12 of pregnancy, but what exactly causes the clefts to form is still unknown.

“It’s a multi-factorial anomaly, and we don’t really understand everything that’s responsible for cleft palate forming,” said Paul Kloostra, MD, DDS, co-director of the CAMC Cleft Center. “There are a number of syndromes that are associated with the cleft palate, and we know that it’s something to do with the fusion of the jaw coming together, but exactly what is happening that’s causing the problem to happen, we don’t know.”

“For some reason, here in West Virginia, we see a higher number of isolated cleft palates, and we’re not really sure why that is,” Kloostra said.

Cleft lip and palate can cause feeding difficulties, ear infections and hearing loss, as well as dental problems. If the palate is not repaired, the child will not have the tools he or she needs to speak correctly. The extent of these issues depends on the condition’s severity. A team of experts that specializes in cleft cases can help patients and families overcome these challenges by providing helpful tools, like special bottles for feeding, reassurance and counseling, as well as performing procedures to treat middle ear infections, straighten teeth and address other dental conditions.

When a cleft palate is repaired, the surgery is called a palatoplasty. During the surgery, the hard and soft parts of the roof of the mouth, which are made up of very delicate tissue, are carefully reconstructed.

This involves carful dissection then rearranging of the muscle bundles to provide a soft palate that functions properly, allowing the child to develop normal speech.

Traditionally, surgeons performed palatoplasties wearing a pair of glasses that contain magnifying lenses. However, advancing technology has enabled surgeons to perform the surgery using a high-powered microscope that provides more light and magnification. This makes the dissection and reconstruction of the palate easier, and allows the rest of the surgical team to see and better assist the surgeon in the operating room. In addition, the microscope allows the surgeon to maintain a straighter posture to avoid fatigue during the procedure, which can take several hours to complete.

Kloostra is the only surgeon in the state performing microscopic palatoplasty. Wyatt is the fifth patient on whom he has operated using the microscope.

It is recommended that surgery be completed around 12 months of age. Wyatt’s surgery was completed Oct. 27, 2016, a few weeks before his first birthday. “I was nervous, but everything went well,” Brown said. “Within a couple of days, he was just back to his happy, playful self. It’s just been a wonderful experience. I highly recommend Dr. Kloostra and his team. I love that he treated Wyatt as his own kid.”

“Dr. Horswell and myself are very passionate about children with cleft and facial differences, and this is why we’re here in West Virginia, and why the cleft team exists,” Kloostra said. “We want to be able to provide answers for you. We like to meet with moms before they even have their babies, and if it wasn’t diagnosed before, as soon as we can afterward, to let them know that we’re here that we want to support them that they’re not going through this alone.”