A Smile for Sebastian
Pediatric Dental Team Prepares Infants for Cleft, Lip Palate Surgery
When Lia Medrano of San Antonio was pregnant, she started retaining excess amniotic fluid. A prenatal ultrasound at 20 weeks was scheduled to determine the cause.
During the ultrasound, Lia and her husband, Alejandro Medrano, learned the shocking news—their first-born child had a bilateral cleft lip. The tissues that make up the lip did not fuse together as they should have in the second and third months of pregnancy, resulting in an opening or cleft. Bilateral is more severe because both sides of the mouth are affected.
“It was something we weren’t expecting,” Lia said. “We had prepared ourselves for the absolute worse. When they told us it was a bilateral cleft, we started doing research online. We joined Facebook groups and talked to other parents.”
At 30 weeks, the couple consulted with Peter Wang, M.D., a plastic surgeon with UT Health San Antonio, who gave them an overview of treatment, which can involve multiple surgeries and orthodontia through early adulthood.
“He told us about surgeries, speech issues, teeth abnormalities and more. It was a lot to take in. But, we were able to start making plans and buy what we needed to be prepared,” she said.
When tiny Sebastian—nicknamed Bash—was born in 2015, he spent 10 days in the Neonatal Intensive Care Unit. On the afternoon of the 10th day, the new family went straight from the hospital to UT Dentistry San Antonio, the dental practice of the School of Dentistry. Before he even went home, Bash was seen by Maria Jose Cervantes
“Dr. Cervantes Mendez examined him and introduced the device to us that Bash would soon begin wearing,” Lia said.
Dr. Cervantes Mendez said her team in the Greehey Family Foundation Pediatric Dental Clinic prepares the newborns for their first surgery with a technique called presurgical nasoalveolar molding or PNAM. This technique presurgically restores the correct skeletal and soft tissue alignment in infants born with a cleft lip and palate. An acrylic molding plate and tape allows reshaping of the gums and the nasal cartridge, which are deformed by this condition, she explained.
When Bash was a week old, the family met with Dr. Cervantes Mendez and Pediatric Dentist Jungyi Alexis Liu, D.D.S., M.S., who took an impression of his mouth so the PNAM appliance could be customized to fit the roof of his mouth. From two weeks to 12 weeks of age, Bash wore the device and was seen weekly by Drs. Cervantes Mendez or Liu.
“We went every week. He was growing so quickly. They adjusted the appliance weekly. He ended up having two devices because he kept growing and changing,” Lia said.
The doctors and parents agree on the difficulty of keeping the tape, which goes across the face, and the internal appliance on the infants at all times, even during feedings. Alejandro, a registered nurse, said some days were much better than others.
“It took constant vigilance and monitoring. At first, it was hard to see how it would even work. After a couple of weeks, you started noticing the difference in his mouth. It really did work,” he said. “After a few weeks, it became normal to Bash. Closing the gap allowed him to consume more formula. That made feedings much easier.”
Dr. Liu said the appliance is designed to bring the two sections of the separated gum together so that surgery can be performed. The device also helps reduce the number of surgeries needed as they grow. When the two sections are aligned together, the surgeon can do his job. “At 12 weeks, Sebastian’s gums had come together; he then had the surgery to repair his lip. At 1 year of age, Sebastian had the palate repair surgery,” she said.
Dr. Cervantes Mendez said after the surgery, Sebastian started coming to the dental clinic every six months for a cleaning and an exam. “We monitor to make sure he is meeting milestones. He will need dental treatment for his entire life. When he is 8 or 9 years old, he may need another surgery and usually two rounds of braces. These children often have missing or malformed teeth,” she said.
Both doctors said they get to know the families and the children really well after seeing them for many years. “As their pediatric dentists, we guide them through the process. As they grow, we refer them to the correct specialists,” she said.
Dr. Liu said their work is very rewarding. “It is hard at first. The parents are struggling caring for a newborn who needs a lot of extra care. Then, they start seeing the changes due to the appliance. After the surgery, they come back with this new looking infant. Each time they come back to see us, we try to do something preventative to help them as they travel this path.
“We are happy to be a part of the team and to be able to treat the cleft palate patients,” she said. “We serve San Antonio and South Texas. We even have patients from as far away as El Paso and Monterrey, Mexico.”
Dr. Cervantes Mendez said the relationship between the team members and the family has proven to be crucial to the program’s success.
“I think they appreciate not only the dental care but all the understanding and support we provide,” she said. The appointments are scheduled in the same block of time so parents have the opportunity to meet and talk about their concerns and problems and share what they have learned, Dr. Cervantes Mendez explained.
Dr. Liu said families will visit before and after their appointments and sometimes go to lunch together. “The children are all at different stages of care. Those with newborns can learn from the parents who have already experienced the first or second surgery,” she explained.
Lia said they are grateful to have been referred to the School of Dentistry where they learned from the dentists, students and fellow families. “We found everyone to be professional, knowledgeable, driven and energetic. They have a lot of experience and have done the research on the device. They want it to succeed. I highly recommend them.
“They are always happy to see Bash and are great with him. Going to the School of Dentistry never feels like a chore. He gets a toothbrush and a sticker, and we know we are on this journey with people who care about our son,” she added.