Pat Ricalde, MD, DDS, FACS
Patient History
• Male infant patient diagnosed in-utero with a cleft lip and possible cleft palate.
• During a free prenatal consultation, Dr. Ricalde explained the diagnosis and treatment options, and answered all of the parents’ questions to ease their anxiety so they could move on with a stress-free pregnancy.
• Dr. Ricalde saw baby after birth at full-term, patient diagnosed with left unilateral, cleft lip and palate. A specialized feeding plan was initiated.
• A superficial ulcer on the vomer developed; and feeding plan was modified.
• Dr. Ricalde along with her expert team then developed a comprehensive treatment plan for the patient.
• Tension-free closure of the oral and nasal layers was accomplished.
• No bare denuded bone was exposed.
• The patient also had pressure equalization (PE) ear tubes placed at this time in a tandem, separate procedure.
• The patient tolerated the procedures well.
Treatment
• Taping was begun to bring together the cleft segments, in preparation for surgery. Stage I surgery took place once he reached 10 pounds and around 2 months of age. A cleft lip repair with primary rhinoplasty was accomplished.
• It was noticed that the dry vermilion distance on the non
cleft side was much smaller than on the cleft side.
• The non-cleft lip was very short; therefore the lip length
was made more accurate with a rotation/advancement flap.
• The existing muscle and tissues of the child’s lip and nose were used to close the cleft lip, and the connected muscular position allowed for lip competence and proper control of saliva and foods.
• The baby’s nasal asymmetry was corrected.
• A wide, unilateral cleft palate remained, and the septum was asymmetrically fused to one side.
Before and after cleft lip and palate surgery
Outcome
• The patient’s postoperative course was uneventful for both stages.
• The palate healed well with no fistulae.
• The lip scar healed well.
• A follow up occurred 1 year after the second procedure at age 2.
• There is very mild nasal asymmetry. The palate is intact.
• A left alveolar fistula is present, as expected at this age.
• No hypernasality is suspected and speech skills are increasing and within normal ASQ limits.
• Mom reports no concerns at 2 years of age.
• A bone graft is planned at age 6 to correct the alveolar deficiency.
• Since some children with a cleft palate experience
• During stage II of surgery, at 10 months of age, a Bardach abnormal dentition, hearing difficulties, or two-flap palatoplasty was performed on the patient. speech and language delays, the child
• This operation allowed closure of the hard palate will be monitored closely for continued progress.
Offering Leading Cleft-Related Expertise
Children born with a cleft lip and/or palate and related disorders may face a variety of challenges in areas to include: feeding, hearing, dentition, resonance, speech production and language, facial growth, vision, learning and psychosocial issues. For these reasons, it is critical that care is provided in a team environment working with a multitude of specialists, as Dr. Ricalde does with the St. Joseph’s Children’s Craniofacial Center. As a main focus of her practice and the most common craniofacial birth defect, Dr. Ricalde has performed hundreds of surgical procedures for cleft lip and palate repair.
Before cleft lip & palate surgery
After cleft lip and palate surgery
This team approach provides pediatric patients with a comprehensive, state-of-the-art, interdisciplinary solution to treating complex craniofacial anomalies. In an effort to increase patient convenience, often all specialists are present to maximize the patient’s time. Caregivers and family members are encouraged to ask questions throughout the decision-making process. Another benefit is that often tandem surgeries can be performed to reduce hospitalizations. For one example, as in this case, a lip or palate repair may be performed in coordination with an
ENT specialist placing ear ventilation tubes.
Dr. Ricalde offers complimentary prenatal consultations for expectant parents, providing them opportunities to meet with the team and have questions answered. This allows parents to learn how to use specialized feeding techniques, and they are provided bottles ahead of birth to feel fully prepared for their baby’s arrival.
Because of her training in dentistry, medicine and surgery, Dr. Ricalde specializes in the management of cleft lip and palate. She can monitor growth throughout the child’s progression and provide the necessary dental, alveolar, facial and jaw formation treatments throughout development. The multi-stage process of cleft repair can all be done with Florida Craniofacial Institute, from infancy to adulthood.
The post Treatment of Cleft Lip and Palate appeared first on Florida Craniofacial Institute.