Education 4.12 - Flipbook - Page 6
6
| Sunday, April 12, 2026
Sponsored Content
A Complete Care Journey for
Cleft Lip and Palate Patients
University of Maryland specialists form
deep relationships that last for years
S
urgical procedures are often
nerve-racking, but especially
for parents when their newborn
baby is the patient. One thing
that can offer comfort during this time is
having a multidisciplinary team of experts
working together to care for your child.
And for a child born with a cleft lip and
palate, this is exactly what their families
can expect at the University of Maryland
Medical Center and School of Dentistry.
According to the U.S. Centers for
Disease Control and Prevention, “A cleft
lip happens if the tissue making up the
upper lip doesn’t join completely before
birth, leaving an opening. Children with a
cleft lip also can have a cleft palate if the
tissue that makes up the palate doesn’t
join together completely. Together, these
birth defects are called orofacial clefts.
Orofacial clefts, especially cleft lip, can be
diagnosed during pregnancy by a routine
ultrasound.”
John Caccamese Jr., D.M.D., M.D.,
FACS, a Pediatric Maxillofacial Surgeon,
Professor, Vice Chair and Medical
Director within the Department of OralMaxillofacial Surgery at the University of
Maryland School of Dentistry, says that
cleft lip and palate is seen in about one in
700 live births, while cleft palates on their
own are seen in about one in 2,000.
Noting that it’s a congenital facial
difference, Dr. Caccamese notes there
are particular instances that can happen
during pregnancy that may contribute
to the likelihood of a child being born
with the condition. “Factors may include
the mother taking certain medications, a
genetic mutation that runs in the family,
smoking, or a lack of prenatal care, such
as not taking folate.”
He adds that it’s more common in
Native Americans and Asians than in
Caucasians and African Americans.
Before treatment can begin, Dr.
Caccamese says that babies will generally require a special bottle to assist
with feeding. “It’s generally a bottle that
doesn’t rely on suction because the gap
between the two sides of the roof of the
mouth and the palate prevents suction.
Dr. Brown’s makes a very widely available
specialty feeder, converting a bottle into
a cleft feeder with a one-way valve that
allows forward flow.”
Treatment plans begin before birth
Since most babies with cleft lip and
palate are typically diagnosed on ultrasound while in utero, Dr. Caccamese
says that he and his team will conduct
a prenatal consult as an initial first step.
“We have an opportunity to talk with
the parents ahead of time and build a
relationship to prepare them for the road
ahead and let them know what kind of
feeding expectations they should have
and what the roadmap looks like for their
child for treatment success. Then we’ll
Photo: Adobe Stock
see the baby when they’re delivered.”
He explains that generally, these children are treated by an interdisciplinary
team of specialists – surgeons, speech
pathology, pediatrics, audiology, nutrition,
social work, genetics, pediatric dentistry,
and orthodontics all working together
to create a roadmap each year for the
patient. “Then we share that the roadmap
with their pediatrician and pediatric dentist so that they have an understanding of
where that child is in treatment.”
Dr. Caccamese adds that most
patients will need ear tubes inserted, too.
“The muscles in the palate are actually
what open the eustachian tube, which
equalizes the pressure in your middle ear.
For children with clefts, the muscles in
the palate aren’t anatomically aligned the
way that they’re supposed to be.”
At about three months of age, Dr.
Caccamese and his colleagues will perform surgery to repair the lip and the
nose as a first stage of treatment, and
then typically the palate is repaired at
about a year, which is when ear tubes are
inserted.
“The reason for that is that babies
start to talk or attempt to talk at around
18 months, so we want the palate to be
working and the ear tubes in so that they
can hear their family, and they can model
speech,” he says..
After those two surgeries are complete, patients with a defect in the bone
of the upper jaw will return at around
age 5 or 6 for a bone graft so that their
upper jaw is one continuous unit to provide a healthy environment for their teeth
to erupt into. That sets the patient up
for orthodontic treatment when ready in
order to correct their smile.
Building strong, long-term
relationships
For children with clefts, the care provided by the University of Maryland can
last through the end of their teen years,
Dr. Caccamese says.
“One of the side effects of having
several surgeries on the upper jaw as an
A Complete Care Journey,
continued on page 21
