Born to smile
Posted on 3 April 2018
Cleft lip and palate surgery performed on baby Bryan, sees him smiling broadly for his parents less than two years later.
When Bryan Cadle was born, his mother Lucille felt blessed. She also knew she’d be returning to the operating theatre with Bryan a few months later for surgery.
What is a cleft lip or palate?
A cleft lip or palate happens when the structures that form the upper lip or palate fail to join together when a baby is developing in the womb. This usually occurs for no identifiable reason. This results in an incomplete closure of the lip, palate or both. These structural differences, in addition to being aesthetically problematic, can hamper speech development. It can also cause feeding problems and even lead to dental and hearing problems owing to recurrent infections.
A staged approach
‘We had the first surgery in March 2016 when Bryan was five months old,’ recalls Lucille. ‘My obstetrician and gynaecologist referred me to Dr Sharan Naidoo, a Maxillofacial and Oral Surgeon with a Fellowship in Cleft Lip and Palate and Craniomaxillofacial surgery at Mediclinic Midstream. Dr Naidoo explained that the surgery needs to be performed at approximately five months age. Before there are any signs of speech development, such as babbling sounds like ‘mama’.
Dr Naidoo explains: ‘We first made a specially designed oral plate within the first week of life to improve Bryan’s feeding and align the arches in his mouth. We then spoke to Bryan’s parents to introduce the standard procedures that we follow together with the Facial Cleft Deformity Clinic at the University of Pretoria’.
‘We usually start by operating on the soft palate. In Bryan’s case, the soft palate had an abnormal muscle attachment. We wanted to do it at five months old to limit speech impediments as much as possible,’ he explains. ‘We performed a specialised soft palate closure technique for a wide cleft (over a centimetre wide)’.
‘We then waited for more muscle bulk to form in the following two months before we operated on the lip. When Bryan was around seven months old, we performed a closure of the lip, the anterior nasal floor as well as the hard palate cleft. In other words, we followed a staged approach for tight closure.’
Smiles all round
The surgery was a success – Bryan has both functional and aesthetic closure and has been referred for ongoing speech therapy. He may require further surgeries until his face stops growing at roughly 18 years old, depending on his unique needs. If he speaks very nasally, surgeons can look at another procedure using tissue from the back of the throat to attach to the soft palate allowing for further closure.
‘We are exceptionally happy with the treatment Bryan received at Mediclinic Midstream. It wasn’t always easy watching our tiny baby go through surgery. But right now he’s just a really happy healthy toddler and we’re so grateful that everything went smoothly,’ says Lucille.