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Bill Klaproth:(Host) Having your baby born with a cleft lip or palate is very concerning for parents. However, the ECMC Center for Dental Care offers a full scope of general and special dentistry. So let's learn more about cranial facial and cleft lip treatment with Dr. Jessica Canallatos, a prosthodontist at the ECMC center for dental care at Buffalo General Medical Center. Dr. Canallatos, thank you so much for your time. So first off, how does cleft lip and cleft palate develop?

Dr. Jessica Canallatos:(Guest) Cleft lip usually develops around four to seven weeks in utero and it results from the failure of the nose and lip to fuse together when the face is forming. Cleft palate, a fusion would normally occur around six to nine weeks in utero, and failure of the two sides of the face to fuse together results in a space in the palate and then the lip, which causes the communication between the nose and the mouth.

Host: And this is something you don't know until the baby is born, is that correct?

Dr. Canallatos: So cleft lip can actually be found on the anatomy ultrasound. When the pregnant woman gets the anatomy ultrasound at 20 weeks, they're able to see and like that three-D image, the space, which would be the cleft lip, but cleft palate is a little bit harder to see on that ultrasound.

Host: This is fascinating. You can tell if the baby does have a cleft lip while the baby is still in the womb. So I guess my next question is, can you treat it while the baby is in the womb?

Dr. Canallatos: So at the point of the 20-week ultrasound, the development has already occurred in the face. So there's actually no way to fix it in utero at that point. So women can take prenatal multivitamins, especially folic acid to help prevent cleft when they find out they're pregnant. But even at that point, the face may have already been formed. So there's no way to treat it in utero. No.

Host: So with cleft lip, you'll know before the baby is born cleft palate. No. So then you're ready for it.  So then how do you assess the severity of it once the baby is born?

Dr. Canallatos: We can assess the severity of the cleft lip at the anatomy ultrasound visit and then the cleft palate we can assess the severity when the baby is born. We'll go visit the newborn in the hospital, as members of the cranial facial team, and just take a look at the baby's mouth and we can know how large the cleft is just by looking at it.

Host: Got it, so then what problems will the child experience because of the cleft lip before the treatment begins?

Dr. Canallatos: Before the treatment, the baby can experience some difficulty with eating if there's a cleft palate involved. Just because there's that communication between the nose and the mouth. So to help with this, there's some special bottles out there that help deliver the milk to the back of the mouth to bypass that communication. And also just because the mouth is involved, there's some speech and dental issues associated with the cleft.

Host: So then how do you treat this, what are the treatment options?

Dr. Canallatos: Yeah, that's a good question. So I make an appliance within the first week of birth, that's called the Nam appliance. It stands for nasal alveolar molding. It looks like a retainer. And what it does is it helps lessen the severity of the cleft. So it brings a segment closer together before the lip is repaired surgically. So this also helps with eating because then the nipple of the bottle can help rest on the appliance. And that's my baby usually love having the Nam in. So they'll undergo lip repair surgery, then palate repair, and then various nose and lip revisions along the way as well. And a bone graft also to help fill in the gap and the gums where the cleft is.

Host: Wow, this is amazing. And then generally, at what age can you start surgery to repair either the cleft lip or palate?

Dr. Canallatos: The lip is repaired usually around three months of age after the Nam therapy is complete. And then cleft palate is a little bit later on because we like to wait for the baby starts babbling or around 12 to 18 months. And then bone grafting takes place around six to eight years of age.

Host: Alright, and then what type of therapy is generally required following the surgery slash recovery?

Dr. Canallatos: Immediately following the surgery is there's not many therapy successes, there's cup feeding that's involved because the babies can't have a bottle after the surgery because we don't want to disrupt the site. So the parents will actually use a cop to help drop the milk and cereal into the baby's mouth. And then the baby also wears arm restraints to make sure that the hands can't touch the face and disrupt whatever we did in the surgery.

Host: I imagine this is a trying time for parents with a lot of unknown. Do children with cleft lip and or cleft palate generally go on to lead a full normal life. They won't have any long-lasting effects from this?

Dr. Canallatos: Yeah, most clefts are not associated with syndromes. So these kids will go on to live a happy, healthy, normal life. There are some facial differences associated with the cleft, but these are all things that can be fixed. So socially it's the baby the child may struggle, but they will be happy and healthy with the help of all of the amazing doctors out there.

Host: So true, thank you. You're putting at ease Dr. Canallatos. So what else do you want to say to parents who obviously if they're listening to this, they have a grandchild or a baby or someone in their family is experiencing this. What do you generally tell parents or what do you want them to know?

Dr. Canallatos: I love this question because I was actually born with a cleft lip and palate, so I can really put myself in that situation. I think the most important thing to know about cleft lip and palate is that even though there's facial differences, it's something that can be fixed and it's very common and it's caused by many different factors that can be genetic or environmental. So while there's many surgeries along the way, there's a light at the end of the tunnel. And as a prosthodontist, I love that I'm involved in the very beginning with the Nam appliance, helping you close up that gap. And then I'm there at the end also being able to restore the patient's smile. So I replace the missing teeth with implants, a bridge, or a denture. Either way function and confidence can be restored and allow for a beautiful quality of life for the patient.

Host: That is so great to hear and thank you for sharing that with us. So you're there from the beginning to end, you're there for the whole journey of the patient, and I bet that's gotta be really satisfying for you?

Dr. Canallatos: It's so rewarding. It's really a dream come true for me. This is what I've always wanted to do since I was little.

Host: Oh my God, that is so cool, so cool. We'll Dr. Canallatos I love that. And again, thank you for sharing your story, and thank you for the great information. This has really been informative. We know our children are in good hands when they're with you and the people at ECMC. Thank you so much for your time today. We appreciate it. That's Dr. Jessica Canallatos, and to book an appointment at the ECMC center for dental care at Buffalo General Medical Center call 716-859-4180 you can also visit ECMC.edu. And if you found this podcast helpful, please share it on your social channels. And check out the entire podcast library for topics of interest to you. This is the True Care Healthcast from Erie County Medical Center. I'm Bill Klaproth. Thanks for listening.