By Jane Ehrhardt

“There are kids we meet when they’re sometimes prenatal,” says René P. Myers, MD, a

craniofacial and pediatric surgeon. He serves as a plastic surgeon on Children’s of Alabama’s specialized team of providers who treat patients with cleft lip, cleft palate, and other craniofacial disorders.

Recently, the team became one of only 200 approved teams in the U.S. and Canada recognized for meeting the Standards of Team Care for Cleft and Craniofacial Teams, awarded by the American Cleft Palate Craniofacial Association (ACPA). “We are excited about this,” says Cassi Smola, MD, the team’s pediatrician. “We were awarded this because we have all of the team members required and enough of the experience, research, and national expertise to meet their approval.”

Children’s is the only team in the state to hold the honor. Their members range from plastic surgeons, advanced practice practitioners, neurosurgeons, orthodontics, ENTs, and nurses to specialists in sleep medicine, speech pathology, genetics, and audiology.

Genetics come into play when some conditions the team face stem from genetic syndromes. The genetic counselors screen the patients for those who might be at risk. “This way, we can find out if the patient also has heart problems or if they have anything related to their brain or their lungs that would need special anesthesia for surgery or other services and medicines and treatments as well,” Smola says.

“We’re a pretty busy center. There’s not a whole lot that surprises us anymore,” Myers says. “A few of the most complex conditions we face include Apert syndrome, Crouzon syndrome, and the more common, Pfeiffer syndrome. These rare genetic disorders cause the bones of their skull to prematurely fuse which can put pressure on the brain. Those particular children wind up needing very in-depth care from an early age all the way up through usually 16 to 17 years old, with a variety of operations along the way.”

“General pediatricians might see some of these diagnoses once in a lifetime, whereas we encounter them almost every day,” Smola says. “They are surprised by the volume and complexity that we take care of.”

Even a cleft lip and palate, the most common condition seen by the team, can take five to six surgeries with care needed over the 18 years of their childhood. It begins at around four months, when the first surgery fixes the lip. Then at ten to twelve months, the team fixes the palate. Before heading to school, they occasionally make a revision to the lip or palate. At eight or so, the patient frequently needs a bone graft to make their upper jaw a single piece, then a few years later, they may need another surgery if their jaw bones don’t align correctly. The final procedure occurs around 18, with a rhinoplasty.

Many times, the team begins to work with a family before the child is even born. “This is because we may be asked to discuss things with the parents after they’ve had an ultrasound,” Myers says. “And then we wind up taking care of the child from infancy all the way through high school graduation or even beyond.”

“Working with the young patients who spend their first years in the hospital is not as dour as people might think,” Smola says. “They’re fun to see come through the clinic because they’re just having a good childhood, living their life unaware that anything’s different for them because this has been what they’ve known from birth.”

Children’s cleft and craniofacial program has been around for about 25 years, started by John Grant III, MD, who now heads the team and serves as the hospital’s chief of pediatric plastic surgery and craniofacial surgery. “Prior to him being here, there was no coordinated cleft and craniofacial care in Alabama,” Myers says. “We have a long history of outstanding results and getting this additional national accreditation is sort of the icing on the cake.”

The accreditation by the ACPA comes with a listing on their website and referrals to parents who call the association for recommendations. “We’re doing this so that patients can feel comfortable coming to us,” Myers says. “It’s one of the only places in the entire region where you know if you have a baby who has these sorts of problems or if you have a child who’s traumatized, you can comfortably bring them to the Children’s of Alabama hospital and expect that we have all of the equipment, all the expertise, and all the people around or take care of those things very well.”