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Team approach pays off

When Nicole Peske went for a routine 20-week ultrasound, she and her husband, Rob, were looking forward to learning whether their son, Ben, would be welcoming a brother or sister.

“The news our baby had a cleft lip and possible cleft palate rocked our world,” she said.

“Knowing about a cleft lip and possible cleft palate can help parents prepare,” said Dr. Kathleen Perkerewicz, Sanford Health obstetrician/gynecologist. “It’s also reassuring for them to learn cleft lips and palates can be corrected surgically to restore function and achieve a more normal appearance with minimal scarring.”

Cleft lip and cleft palate are among the most common birth defects. A cleft is an opening or split in the upper lip, the roof of the mouth (palate) or both, which result when developing facial structures in an unborn baby don’t close completely. Cleft palate may not be detected by ultrasound.

“While cleft lip primarily affects feeding and appearance, a cleft palate is associated with feeding issues, ear infections and hearing loss, dental problems and speech difficulties,” said Dr. Rafael Ocejo, Sanford Health neonatologist and pediatrician. “A cleft lip also creates stress for parents because it is disfiguring and can’t be hidden when introducing the new baby to friends and family.”

  Evan Peske After he had reconstructive surgery at Sanford Health, Evan Peske's parents sometimes have to remind themselves that Evan was born with a cleft lip.
Peske’s online research emphasized the importance of having an experienced plastic surgeon and the resources of a cleft palate team. She found both at Sanford Health.

Dr. Davis Bronson
Dr. Davis Bronson

Plastic surgery

Dr. Rafael Ocejo
Dr. Rafael Ocejo
Neonatology
pediatrics

Dr. Kathleen Perkerewicz
Dr. Kathleen Perkerewicz
Obstetrics and
Gynecology
  “Because children with cleft lips and palates tend to have problems with other areas, Sanford Health established the cleft lip and palate clinic,” Dr. Ocejo said. “We provide a team approach involving a pediatrician; ear, nose and throat specialist; a speech therapist; an audiologist and a dentist."

This team approach means convenience for the families and one-stop care.

“Patients are rotated through each specialty, and a comprehensive summary is developed to determine what each child requires for ongoing care,” Dr. Ocejo said. “This eliminates the need for parents to make separate appointments.”

A cleft lip is repaired when the baby is between 2 and 3 months old. A cleft palate is repaired between 10 and 12 months.

“We had chosen Dr. Ocejo based on his reputation,” Peske said. “He met with us before Evan was born to talk about what to expect if there were palate issues. It eased our concerns to know there was a plan in place.”

Peske hadn't been aware of the resources available locally.

“It was such a relief not to have to travel to Minneapolis because Sanford Health offered all the services and expertise our baby would need if he had both a cleft lip and palate,” she said.

In addition to consulting with Dr. Ocejo before the birth, Dr. Perkerewicz also contacted Dr. Davis Bronson, Sanford Health board-certified plastic surgeon.

Dr. Bronson has more than 30 years of experience repairing cleft lips and palates. He is a board member of InterFace, a group of volunteer plastic surgeons and other healthcare professionals who focus on providing cleft lip and palate repair to children in Mexico.

When the Bismarck couple welcomed Evan on Aug. 19, 2010, they were elated to learn their son did not have a cleft palate, and the cleft lip was mild. Evan was able to breastfeed normally.

“We had spent 20 weeks preparing for the worst-case scenario,” she said. “The care at Birthcenter One was exceptional, and the day became more amazing when we learned he didn’t have any palate issues.”

Dr. Bronson performed the cleft lip repair the morning of Nov. 16, 2010, and the family was home in time for lunch.

“This type of surgery changes lives,” Dr. Bronson said. “It’s important for parents who have a child with a birth defect to understand there are doctors who can address the problem, and resources are available to help them.”

The couple is grateful for the care from Sanford Health providers.

“Our total package experience at Sanford Health, from our doctors’ expertise to the nursing care at Birthcenter One, completely exceeded our expectations,” Peske said. “Now, Rob and I will occasionally look at Evan and have to remind ourselves he had a cleft lip. It’s a great feeling.”

Click here for more information on Sanford Health's children's services.

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