Kristen M. Lowe, DDS, MS, is a craniofacial orthodontist in the Division of Plastic and Reconstructive Surgery at Children’s Hospital. She specializes in cleft lip and palate, craniosynostosis, hemifacial microsomia, nasoalveolar molding, and other jaw anomalies and facial differences
I can only imagine the barrage of thoughts and emotions our families face when their child has been diagnosed with cleft lip and palate. Coordinating the multiple requisite doctors’ visits alone is daunting, and most families are understandably surprised at the recommendation to consult with me, an orthodontist, for care of their newborn. Most people associate orthodontics with uncomfortable images of headgear and braces during the adolescent years, so I am frequently met with confusion (and occasional trepidation) when one of our surgeons calls me in for consultation.
The craniofacial orthodontic subspecialty is uniquely devoted to the specialized care of patients with congenital facial differences, such as cleft lip and palate, from birth through adulthood. It also extends to those patients with special needs who are best treated in a hospital setting. I am fortunate to practice in the Division of Plastic and Reconstructive Surgery at CHOP, which has one of the handful of dedicated cleft lip and palate programs in the country. I focus on our patients’ unique and complex orthodontic needs.
Children born with cleft lip and palate will need multiple surgeries throughout their lives, and I work closely with my surgical colleagues as part of a multidisciplinary team approach to care. When a child is born with a cleft deformity, I consult with the family for nasoalveolar molding (NAM), a presurgical technique aimed at facilitating surgical repair of the lip, nose, and alveolar segments. Treatment with NAM reduces the severity of the oronasal cleft deformity prior to surgical repair by closing the labial and alveolar clefts and shaping the nose to restore anatomical form and symmetry. Our team’s goals are to eliminate the need for two-stage surgical lip repair and achieve excellent esthetic outcomes leading to lasting psychosocial benefits for our patients and reduced need for revision surgeries.
NAM is labor intensive. It utilizes an appliance akin to an orthodontic retainer that I adjust every 1 to 2 weeks for 3 to 6 months, depending on the severity of the deformity. Parents are responsible for care of the appliance at home and attending frequent visits. While some may consider this a large burden, my personal observation has been the opposite. Though challenging, most families come to enjoy their visits. I notice a sense of empowerment develop as treatment progresses and parents feel a sense of pride in participating in their child’s care. Appointments are also an opportunity for our team to connect with and support families during a difficult time, and we never cease to be amazed at the strength, love, and dedication our parents display.
I was a middle school teacher before I entered the dental profession, and I was drawn to orthodontics because it allowed me the opportunity to similarly work with youth and positively impact a child’s self-confidence. Seeing students succeed academically and patients smile brightly after treatment brings a great deal of personal and professional satisfaction. I am truly humbled by the inspirational children and families with whom I work and am grateful for the opportunity to be a part of such a talented and passionate team at CHOP.
Figure A: presurgical repair. B: wearing the NAM appliance. C: postsurgical repair
To refer a patient to the Cleft Lip and Palate Program, call 215-590-2208. To refer to the Craniofacial Orthodontics Clinic, call 215-590-2523.