Children’s expanding, improving services for children treated for cleft palates and lips

By:Dr.John Grant with UAB and Children’s Hospital

During my first year at UAB and Children’s Hospital about 16 years ago, I performed about a half dozen operations to correct cleft lips and a couple of surgeries to correct cleft palates. Last year—along with my partner, Dr. Peter D. Ray—our team performed about 200 operations. This phenomenal growth in our clinic has been accompanied by improved quality.

We use advanced techniques along with a comprehensive team approach that provides care well beyond the operating room. For example, within the past decade, pediatric plastic surgeons have learned to correct underlying muscles in cleft lips and palates, thus providing a much more natural look and better speech for our patients. The face is dynamic, and these new techniques lead to a broader range of facial expressions and better speech control. Of course, we usually work with young patients, but there is an enormous opportunity to improve outcomes for older children and even adults who underwent cleft surgeries before these new techniques were widely used.

Due to our growth, Children’s now houses one of the nation’s busiest clinics for treating cleft lips and palates. We add about 150 new patients annually, and follow them through adolescence. We are excited about our upcoming move into larger quarters. The area that previously housed the emergency department in Children’s McWane Building has been renovated and will nearly double our space. We hope this makes us more efficient and enable us to shorten waits in our clinic for children and their families.

We already offer a full-service program that is staffed with experienced health care professionals, such as audiologists, speech-language pathologists and registered nurses as well as specialized physicians and dentists. They’ve seen hundreds of patients, and there’s a cumulative knowledge base. Our staff has realistic expectations about how children heal, how much pain they may or may not have and airway issues for babies versus adults.

We are excited about the launch of our new international fellowship program. For many years, American doctors have traveled to developing countries where they quickly perform operations for cleft palates and lips. Unfortunately, there is often a lack of follow-up care, and many patients go untreated. We want to educate doctors from these countries so they can establish their own full-service clinics that will provide more thorough and consistent care. The first fellow will be coming this summer from Ghana, West Africa, for 11 months of training, and another will come next year from Egypt. We are hopeful that they will become the teachers for the next generation of doctors in their countries and make it possible for children in those places to have full-time, quality follow-up and coherent planning, instead of care based on chance.

Additionally, we are improving our techniques for conditions other than cleft lips and palates. One service line we want to increase is a technique called tissue expansion. It’s been used a lot in secondary burn reconstruction. But we are also using it for children with giant congenital nevus, or dark patches of skin, often on the face or scalp. We surgically place flat balloons under adjacent, normal skin, and families are taught to slowly inflate these balloons over weeks so a child’s skin is stretched. Then, the patient returns to the hospital for an operation that utilizes the stretched skin to replace discolored skin, restoring normal tissue. We have enhanced this service line with the help of Dr. Bruce S. Bauer of Chicago, a pediatric plastic surgeon who is renowned for his refinement and application of this technique. It’s low risk for the patient and requires little time in the hospital.

All this work is extremely rewarding for our team. Seeing families get their babies back after a cleft operation is an occasion that many parents tell us is nearly as joyful as giving birth.



Dr. John Grant is a board certified plastic surgeon with more than 15 years of experience working with children. He is chief of pediatric plastic surgery and craniofacial surgery at Children’s of Alabama, and heads the UAB Cleft and Craniofacial Center. He holds the James C. Lee III endowed chair in pediatric plastic surgery and teaches nationally and internationally.