Hey all,
On December 10th, Lucille had her third appointment at Sick Kids in Toronto. This visit would be the first of Lucille's plate adjustments. This type of adjustment will be done every other visit up until her first surgery at 4-5 months. Dr. B and Dr. Caro took care of her assessment today and were both very impressed and pleased at how far she's come. More specifically they're happy with the way that her gums are coming together. The last six weeks have flown by and we can't believe how much the gap between her gums has closed. Take a look for yourself at the pic. It's VERY noticeable.
Two adjustments were made by Dr. B based on how Lucille's gums have grown so far. I've included a picture of her plate so that you can a) see what it looks like and b) see the adjustments that were made at this appointment. The light pink areas are the pieces that were added to the existing plate. It's a a soft rubber material. The second piece of pink is close to my thumb along the front edge.
The plate in it's own is referred to as a passive approach. The additions are called an active approach as they are deliberately added to guide the gums. It's amazing that such a minor adjustment can help do SO much.
Esther came across a really informative article about the plate that Lucille wears and it's purposes. It's pretty heavy on the medical jargon so if you don't want to read it, I won't judge. It does however give a good description of the process. Here it is: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884748/#!po=56.6667
If you want to read the article and prefer the Cole's Notes version that applies to Lucille so far, here it is (medical jargon included):
•The principal objective of presurgical NAM is to reduce the severity of the initial cleft deformity. This enables the surgeon to enjoy the benefits associated with repair of an infant who presents with a minimal cleft deformity. These goals include lip segments that are almost in contact at rest, symmetrical lower lateral alar cartilages, and adequate nasal mucosal lining, which permits postsurgical retention of the projected nasal tip
•Additional objectives of the plate include reduction in the width of the alveolar cleft segments until passive contact of the gingival tissues is achieved. As reduction of the alveolar gap width is accomplished, the base of the nose and lip segments achieve improved alignment. Tapes that actively bring the lip segments together are used in conjunction with the molding plate and nasal stent. Taping the lips together helps to make the inclined columella upright along the midsagittal plane. As the lower mid-face skeletal elements (alveolar ridges and lower maxilla) improve in relation to each other, the overlying soft tissues follow
•Weekly visits are required to modify the molding plate to guide the alveolar cleft segments into the desired position. Closure of the alveolar gap brings the lip segments together, reduces the nasal base width, and introduces laxity of the alar rim. Care should be taken not to add the nasal stent before achieving laxity of the alar rim because an increase of the nostril circumference may result.
I've also included a picture of Lucille's mouth mid-wail tonight when we changed the tape on her cheeks. It allows you to see the cleft in her palate VERY clearly. Excuse the sheen on her face as we applied coconut oil right after removing the tape as its pretty hard on her skin.
Our next appointment is on December 23rd where the Dr's will simply be making sure that she is continuing to make progress.
Til then,
Brandon
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