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Facing the Future

Armed with the latest technique, HSC doctors reshape the most common facial birth defect

February 2003

by Aileen Salinas

When Stacey and Juan Gallegos mailed out pictures of their six-month-old baby, Sydney, friends and family talked of how beautiful he was. Sydney’s own relatives had no idea he had been born with a facial birth defect. The picture offered no indication of the large 16-millimeter cleft lip and palate Sydney was born with - a cleft that had closed just three months before the photo was taken. "He’s perfect," Stacey Gallegos said. "He has a small scar above his lip, but other than that you can’t tell."

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 together 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.



Seven days after his birth, Sydney Gallegos began treatment to repair his 16-millimeter cleft lip and cleft palate.


  Sydney Gallegos
Gallegos knew something was wrong from the beginning of her pregnancy. "I felt like I was having contractions all the time," she said. So four months into her pregnancy, she had tests performed to rule out spina bifida. During a sonogram, her doctor noticed an irregularity in the baby’s face that looked like a cleft lip and cleft palate. Gallegos, who lives in Del Rio, went to a specialist in San Antonio. An ultrasound used to detect birth defects showed baby Sydney’s tongue sticking out through his nose, confirming the doctor’s suspicions.

"I went through the stages of grieving," Gallegos said. "I was in denial at first. I was relieved he didn’t have spina bifida. Then it dawned on me that he’d have a physical defect. Then I got upset." Gallegos had been keeping a dairy since the beginning of her pregnancy. "I kept wondering why this had happened. So I looked back through my diary to see what I had done wrong - maybe it was the food I ate or something," Gallegos explained.

With the help of her diary and lots of research, Gallegos discovered she could not have prevented or caused Sydney’s cleft lip and cleft palate. "But I realized this was not something insurmountable - it can be fixed," Gallegos said. She became determined to find the best treatment for her baby.

Her research helped her discover a new technique called nasal alveolar molding. It is not yet standard procedure, but the unique treatment offered a less-invasive cleft lip and cleft palate repair in much less time than normal procedures could provide.

Very few doctors performed this technique, but Gallegos’ determination led her to the Health Science Center. Timothy Henson, D.M.D., assistant professor in the department of pediatric dentistry, is one of only a handful of people in the country, and the only person in South Texas, who can repair cleft lips and cleft palates using nasal alveolar molding.

"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 attached to the baby’s face with rubber bands and tape. "The device orthopedically moves the gums around before lip closure surgery. That surgery occurs 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 in 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 months, but they receive instant gratification because they can see changes every week."

Stacey and Juan 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.

"We were determined," 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 isevery bit as gorgeous as our daughter. This new technology is incredible."

Sydney’s first surgery went so well that he has a good chance of avoiding a second surgery. With the help of Dr. Henson and Dr. Wang, Sydney has avoided a lifetime of surgeries and potential psychological harm – all before his first birthday.

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Updated 12/11/14