To accomplish this goal, Dr. Cutting teamed up with orthodontist Barry Grayson, DDS, who works with infants for several months prior to surgery to reduce the severity of the cleft and deformity of the nose.

During the first two weeks of life, using a technique called nasal alveolar moding, Dr. Grayson inserts a custom-fitted denture (molding plate) in the baby's mouth. Every week, he carefully adjusts this molding plate to gradually reshape the roof of the mouth and gum pads. The plate causes the bones of the upper jaw to grow toward each other and the space between the gum pads to narrow. It also separates the oral and nasal cavities, which are open to each other in babies with cleft lip and palate.

Reshaping

Dr. Grayson found a way to use the molding plate to correct a deformity of the nose commonly associated with clefts. "Most children with cleft lip and palate have collapsed nasal cartilages that cause a noticeable flattening of the nose," says Dr. Grayson. "Children endured teasing about their misshapen nose even after the cleft was repaired. We can now reshape a baby's nose without surgery, especially during the first few months of life, when the nasal structures are highly malleable."

To accomplish this, Dr. Grayson developed a nasal extension that rises up from the forward edge of the molding plate and lifts the nose and nasal cartilages into place. Dr. Grayson's adaptation also helps children with severe clefts on both sides of the mouth who are missing all or most of the columella -- the structure above the lip that separates the left and right nostrils. Dr. Grayson's technique enhances the columella, eliminating the need for extensive surgical reconstruction.