The Children’s Craniofacial team has discontinued with the retirement of Dr. Whateley and Dr. Shupe and those anticipated in the next few years. If your child needs cleft lip and palate care, we recommend Riley’s Children’s Hospital cleft team program. If you or your child was a patient with the Children’s Craniofacial Center and need further care or direction, please call our office to schedule an appointment with Dr. Severinac. He would be thrilled to see you!
The Children’s Craniofacial Center Team met every other month to evaluate and provide ongoing care and planning for these very special children. The team members included Dr. Severinac (Plastic Surgery), Dr. Whateley (Orthodontics), Dr. James Shupe (Pediatric Dentistry), Dr. Stephen Schreck (Otolaryngology), Dr. Mulokozi Lugakingira (Oral Surgery), , and Rebecca Ghent (Nurse Coordinator).
Dr. Severinac was the co-founder and co-director of the Children’s Craniofacial Center with Dr. Baron Whateley from 1996 to 2019. The center specialized in a team approach treating children with craniofacial abnormalities from birth through adolescents. This team approach is crucial because children born with severe deformities require treatment from several medical specialties.
Cleft lip and palate are the most common craniofacial deformities affecting newborns in the United States. According to the American Society of Plastic Surgeons, the problem affects approximately one in every 800 babies born. Cleft lip and cleft palate are associated birth defects and occur while the infant is still developing within the womb. Under normal conditions, the left and right sides of the upper lip and the roof of the mouth (palate) will meet and grow together within the early weeks of development. In the case of a cleft lip or palate, however, these two sections never fully meet. If the two lip sections fail to grow together, the result is a cleft lip. If the two portions of the roof do not meet, the result is a cleft palate. It is possible for a child to be born with a cleft of the lip, cleft palate, on one or both sides, in any combination.
The children closely for speech and hearing difficulties. Dr. Schreck directed ear care. Almost all patients with cleft palates need ear tubes to drain the middle ear in order to avoid recurrent infections, hearing loss, and subsequent speech failure. Dr. Shupe directed tooth hygiene and dental cavity care which can be a challenge in these children. Dr. Whateley directed orthodontics and helps to plan the plastic and orthognathic procedures performed by the surgeons in the group.
Our surgical approach for cleft lip and palate repair was working from the inside out. The dental and facial bone structure was corrected with a custom dental maxillary activated appliance [DMAA] also known as the Latham Appliance, made from a palatal impression and placed a few months after birth by Dr. Whateley. During that same surgery, Dr. Schreck placed ear tubes to allow drainage of the middle ear. The appliance brought the palatal segment slowly together as the baby’s parents turned a screw a small amount each day. At about 4 to 6 months, the appliance was removed and the gum line portion of the palate was repaired with bone graft by Dr. Severinac. This established the dental arch form through which the teeth can grow. At about nine to 12 months, the remaining palate and lip was repaired by Dr. Severinac.
Most centers do no repair the gum line area initially and leave this open until early puberty. In these cases, the teeth will be severely misaligned and a hole from the mouth to the gumline will persist causing cosmetic embarrassment and fluid escape through the nose when eating. An operation to close the gum line with bone graft will be necessary later in childhood or adolescence, a very difficult and embarrassing burden to a teenager. Our team, on the other hand obtained complete repair by around one year of age, giving the patient the best chance for normal speech and dental development. This was only possible with Dr. Whateley’s expertise with the DMAA in bringing the wide clefts together and his keen knowledge of the dental and medical literature supporting his techniques. Dr. Severinac’s surgical skill was required in performing these very delicate and challenging procedures.
In cleft children, inadequate growth of the midface and upper jaw is often encountered. Dr. Whateley and Dr. Lukakingira worked together to realign the upper jaw if needed in the teenage years. This is best done in the intact dental arch our protocol establishes early on.
Here is a blast from the past, about 20 years ago when ABC featured the Children’s Craniofacial Center: