Dr. Severinac is the co-founder and co-director of the Children’s Craniofacial Center with Dr. Baron Whateley. Since 1996, the center specializes 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’s Craniofacial Center Team meets every other month to evaluate and provide ongoing care and planning for these very special children. The team members include Dr. Severinac (Plastic Surgery), Dr. Whateley (Orthodontics), Dr. James Shupe (Pediatric Dentistry), Dr. Stephen Schreck (Otolaryngology), Dr. Mulokozi Lugakingira (Oral Surgery), Cole (Speech Therapy), and Rebecca Ghent (Nurse Coordinator).
Dana Cole watches the children closely for speech and hearing difficulties. Dr. Schreck directs ear care and realizing that 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 directs tooth hygiene and dental cavity care which can be a challenge in these children. Dr. Whateley directs 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 is working from the inside out. The dental and facial bone structure is 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 places ear tubes to allow drainage of the middle ear. The appliance brings the palatal segment slowly together as the baby’s parents turn a screw a small amount each day. At about 4 to 6 months, the appliance is removed and the gum line portion of the palate is repaired with bone graft by Dr. Severinac. This establishes the dental arch form through which the teeth can grow. At about nine to 12 months, the remaining palate and lip are 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 obtains complete repair by around one year of age, giving the patient the best chance for normal speech and dental development. This is 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 and Severinac’s surgical skill 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 work 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.
If you have a baby with a cleft or know someone that does, please call our office for the best available treatment. We love these special children. Here is a blast from the past, about 20 years ago when ABC featured the Children’s Craniofacial Center: