Steven Buchman, M.D., is director of the U-M Craniofacial Anomalies Program

An Early Start

Prenatal consultations available for cleft lip and palate

issue 23 | spring 2015

When Toni Enstep was 20 weeks pregnant, a routine ultrasound revealed that her baby would be born with a cleft lip and likely a cleft palate. Her obstetrician referred her to the University of Michigan C.S. Mott Children's Hospital Craniofacial Anomalies Program for a prenatal consult.

"While there are no fetal interventions for a cleft lip and palate approved at this time, there are a number of things we can do with families to help them prepare for the unique needs a baby with a cleft will have," says Steven Buchman, M.D., pediatric plastic surgeon and director of the Craniofacial Anomalies Program.

For example, families should anticipate that babies with a cleft often experience feeding problems. The baby will want to suck, but can have difficulties making an airtight seal around a nipple.

"Our prenatal consults allow us to go over special bottle types that work well with infants with cleft lips, as well as review what the child's treatment will likely consist of," says Carolyn Walborn, nurse practitioner, who works with the program.

"My husband and I were scared. We did not understand what cleft was or how we would care for our son. Meeting with Carolyn before Dominic was born greatly eased our stress and we could start to prepare for what was ahead, and how to care for him," says Enstep.

Shortly after Enstep's baby, Dominic, was born, he was seen at the Craniofacial Anomalies clinic, where Enstep and her husband learned to tape Dominic's lip to provide for better alignment. Taping also aims to bring the lip segments closer together in preparation for surgery, in order to achieve a more effective repair.

Dominic Wietecha underwent successful repair surgery for cleft lip at 4 months and cleft palate at 13 months. The before and after photos were taken at 2 weeks and 4 years.

Dominic was also seen by pediatric otolaryngologists to be evaluated for hearing and possible drainage tubes, and by pediatric geneticists to determine any potential syndromic cause for his condition. At 4 months old Dominic underwent surgery to repair his cleft lip, and again at 13 months to repair his palate.

"The benefit of our integrated program here is that a family has access to all the various subspecialists who may be involved in the care of a child with a craniofacial anomaly," says Buchman. "A multidisciplinary team approach is the most beneficial to the child born with a cleft, because these children have a broad range of treatment needs that no one specialist can fulfill. We all work together to provide unparalleled care for each and every child we treat."

Patients are usually seen periodically for routine follow-up by their plastic surgeon until around age 3, at which point they are seen by the full multidisciplinary craniofacial team, including pediatric dentistry, speech pathology, orthodontia, oral surgery and neuropsychology, to evaluate any additional needs that may have developed.

"It is comforting to know we are not in this alone, and that we have a full team of specialists helping Dominic, to ensure he continues to progress and to evaluate his needs as he gets older and develops," says David Wietecha, Dominic's father.

"Today, Dominic is an outgoing, social little boy. He is like all the other little boys in his class," says Enstep. "We're so grateful to the team at Mott for helping him."