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UTHSCSA doctors use new procedure to repair facial birth defect

Cleft lip and cleft palate occur in about 800 live births

San Antonio (Feb. 12, 2003) — When Stacey and Juan Gallegos' baby, Sydney, was born with a large 16-millimeter cleft lip and palate, they sought the help of Timothy Henson, D.M.D., assistant professor in the department of pediatric dentistry at The University of Texas Health Science Center at San Antonio (UTHSCSA). Dr. Henson is one of only a handful of doctors in the country, and the only one in South Texas, using nasal alveolar molding, a new procedure repairing cleft lips and palates with significantly fewer surgeries than traditionally required.

Cleft lip and cleft palate are the most common facial birth defects, occurring in approximately one in every 800 live births. In the early stages of pregnancy, a baby's face is formed when the sides of the face fuse in the middle. Sometimes, lips and jaws do not completely grow together as they normally should, leaving a hole in the baby's face. The resulting separation in the lip and the roof of the mouth, or palate, is called a cleft. Because lips and palates form separately, it is possible for babies to have either a cleft lip or cleft palate, or in Sydney's case, both a cleft lip and cleft palate.

"Normally, children can require about 12 surgeries between birth and age 18 to correct cleft lips and cleft palates," Dr. Henson said. "With this new procedure, we can have the cleft repaired in about two surgeries."

As soon as five days after birth, babies are fitted with a custom-made device, much like a retainer, that fits into the mouth and over the nose. It is held to the baby's face with rubber bands and tape. "The device orthopedically moves the gums around before lip closure surgery when the baby is about 14 weeks old. Closing the cleft at that time is important because we want the surgeon to be able to sew the lips and gums together during the same surgery," Dr. Henson said. In addition to closing the cleft, the device molds the cartilage of the nose. "Usually babies with cleft lips and palates have a flat, deformed nose," Dr. Henson said. "Without the molding, it could take six, eight or more plastic surgeries over the child's lifetime to fix the nose."

The Gallegos family had an appointment with Dr. Henson seven days after Sydney was born. Parents undergo counseling because the process can be intimidating. "Parents sometimes worry they will hurt their baby," Dr. Henson said. "It can be tough for them because they have to diligently tighten the device so that the lips and palate are pulled together. They have a lot to do in the next three or so months, but they receive instant gratification because they can see changes every week."

The Gallegos family watched Sydney's cleft close slightly at every one of his weekly visits with Dr. Henson. In the first week, Sydney's cleft shrunk to 10 millimeters. After that, it was eight millimeters, then five, then three. Right before he was scheduled for his first surgery with Health Science Center plastic surgeon Peter Wang, D.M.D., M.D., assistant professor in the department of surgery, Sydney's cleft finally closed. His procedure has worked so well that Sydney may not require a second surgery for a bone graft.

"We were determined," Stacey Gallegos said. "The first 14 weeks were difficult, and his cleft was so large. He hated the appliance on his face. But now he's perfect. He has a small scar above his lip, but other than that you can't tell. This new technology is incredible."

Contact: Aileen Salinas