Cleft 101

Before we met Lily, I had never seen a cleft palate. I had seen many cleft lips before from Smile Train advertisements and from numerous referral photos on Chinese adoption sites. I want to share with you and document what an open palate looks like:

Ok - this is not the best photo. And forgive the amount of boogies that are in poor Lily's nose! But I think you can see the cleft in the roof of her mouth. She wasn't terribly cooperative as you can imagine for the taking of this photograph. This was back in October of 2011, shortly after she came home. If I could have gotten a better shot, you would be able to look up into her cleft and see her nasal bone. Lily had a bilateral complete cleft palate - that means that there were two clefts in her upper lip, gumline, and hard palate - and the two clefts fuse into one large cleft when it hits the soft palate. That is what you can see here - the one large cleft towards the back of her mouth.

Here is a photo of her from about a week ago. As you can see (more or less), the palate is repaired - looks like one piece - and it is. Dr. H did a three flap palatoplasty to close up her cleft.

Again, forgive the boogies! I promise she doesn't always have a runny nose!

And I wanted to show her cleft gumline. You can't see it when her mouth is closed, or even when Lily smiles because her top teeth do not show when she smiles. I think this is pretty typical of cleft affected children in the early years after lip repair - the lip is just very tight and does not have a lot of "give."

So. . . Lily's gumline is cleft on two sides. You can see here how her top middle teeth and gums are kind of on an "island." There is a cleft (gap) on either side, kind of where your canines would be. Her top jaw is essentially in three pieces.

When she is 8 or 9, Lily will undergo a surgery that will graft bone into those gaps to reconstruct the gumline. They time this surgery with the emergence of her permanent teeth in that area. When it is all done (the bone graft surgery and lots of orthodontia) - her gumline will look more or less like a typical person's - one piece with straight teeth going all the way across. I am documenting this now because I know that someday I will forget what her gumline looked like. I am already forgetting what her cleft palate looked like!

In order to get these last two pictures, we had to persuade Lily to open her mouth by having all of the brothers get their mouths photographed. Here are some of those photos hee hee.

Silly brothers! But it worked :-).