Johns Hopkins All Children's Hospital

THE CLEFT PALATE TEAM Addressing a cleft lip or cleft palate involves special care from a large cast of team members, including individuals from many departments and disciplines: � Parents � Plastic and craniofacial surgeon � Team pediatrician � Audiology � Nursing � Orthodontics � Otolaryngology � Pediatric dentistry � Psychology/ socialwork � Speech and languagepathology expecting parents and provide prenatal consulting on what to expect and how the cleft lip and palate would be addressed. "We were so relieved to find Dr. Rottgers. We knew instantly he was the doctor we wanted," recalls Melissa, Camden's mom. "He sat and talked with William, Camden's dad, and me. He reassured us about everything. Dr. Rottgers provided stats and percentages. He created a complete timeline of everything that was going to take place with Camden's care. It was so helpful and it meant so much to us to be that prepared going into the birth." Fully accredited by the American Cleft Palate-Craniofacial Association, the cleft and craniofacial team at Johns Hopkins All Children's treats patients with congenital and acquired abnormalities of the head and neck. e most common conditions the team treats include cleft lip and palate, craniosynostosis, hemifacial microsomia, facial paralysis, and deformities of the ears and jaws. Less common conditions such as Apert syndrome, Crouzon syndrome, Treacher Collins and craniofacial clefts also are treated through the multidisciplinary program. A customized treatment plan is devised to meet each patient's needs. CARE INCLUDES REASSURANCE "We want our families to know that everything is going to be OK," Rottgers says. "We have an expert team and a plan to make sure their child gets the best outcome possible. Having a baby should be one of the most special times in their life. We want to make sure we address all of their concerns so they can enjoy it." After the initial prenatal consultation, Rottgers contacted Camden's parents by phone to reassure them once again—he anticipated they would likely turn to the internet for more information. Camden has a more severe cleft and his timeline includes up to six or seven surgeries and procedures throughout childhood. At 9 months old, he has successfully completed the first three. "One of our main focuses with a cleft lip is preoperative molding, which can make all the difference in the patient's outcome," Rottgers explains. "We close the cleft and properly line it up as a first step, laying the foundation for better symmetry and a nicer aesthetic. You only get one opportunity to fix a cleft lip correctly. A little extra work at the start sets the patient up for future success. It also allows us to do a more effective operation on the nose, which is the most difficult part of the condition to treat." e process includes taking dental impressions at three months to create a personalized presurgical orthodontic device. "We are moving bone, not teeth, but a process like this requires that our team include orthodontists to ensure that everything moves smoothly," Rottgers adds. "Once the device has done its job, we can repair the lip and palate." For now, Camden gets a break from surgery for a few years. He has completed his cleft lip and palate repair, but the Johns Hopkins All Children's cleft/craniofacial team will continue to follow him closely as he grows and develops. Soon he will enter the phases of language and dental development, when speech pathologists, dentists and orthodontists will play a big role in his care. His family, once tearful and afraid, is thrilled with his progress. "I can't come up with the words to describe how I felt when he came out of surgery," Melissa recalls. "We were so prepared for what to expect, and they literally called us from the operating room while he was in there to reassure us. It was amazing how beautifully it all turned out. Most of all, he's healthy. "Dr. Rottgers loves my son," she continues with confidence and pride. "He is so kind and loving to Camden. He has known him since birth. e entire medical team is in awe of him and how far he's come. ey are like family to us, and it is such a good feeling knowing they will care for him throughout his childhood. I don't have to ever worry about handing him off to another physician. is is it for us." For more information about the Cleft and Craniofacial Center at Johns Hopkins All Children's Hospital or to refer a patient, call 727-767-7337. Camden's bilateral cleft lip and cleft palate were identied before birth. Summer 2017 15 Craniofacial

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