Across Florida, babies diagnosed with cleft lip and/or palate face a difficult reality: specialized care is scarce, and the window for early intervention is measured in weeks, not months.
Experts in the University of Florida College of Dentistry, alongside UF Health craniofacial surgeons, have moved quickly to close this gap, custom-fabricating appliances that gently reshape infant faces before surgery — a pursuit that has, since this spring, provided previously out-of-reach care for many Florida families.
“Watching our residents collaborate with UF Health’s craniofacial team to help these children speak, smile and thrive instills immense pride,” said College of Dentistry Dean Isabel Garcia, D.D.S., M.P.H. “They play a vital role alongside surgeons, orthodontists and specialists, restoring function and hope.”
Mi Sook Lee, D.M.D., M.S.D., Ph.D., a clinical assistant professor of pediatric dentistry at UF, has taken the lead in mastering the rare skill of customizing appliances for these infants. And pediatric dentistry residents Kaitria Abbatematteo, D.M.D., and Jonathan Sorsok, D.M.D., presented this pre-surgical infant orthopedics research at grand rounds.
When an infant is born with a cleft lip and/or palate, the treatment team has just six weeks to capitalize on a biological window when residual maternal estrogen makes infant cartilage most malleable.
“Think of a baby’s face as a puzzle,” Sorsok said. “Most of the time, the pieces connect perfectly. But if one piece doesn’t fuse during the first four to nine weeks of fetal development, the result is a cleft lip or palate.”
Without early intervention, surgeons must apply more tension to close gaps during repair, affecting jaw development and dental alignment.
“Pre-surgical infant orthopedics doesn’t always begin with advanced technology; often, it starts with something as ordinary as tape,” Sorsok said, describing medical taping used to gently guide lip segments together. “What’s great is that parents can help daily, and it can be used for any case, even the most severe.”
The most sophisticated option is the nasoalveolar molding appliance, which guides the gums, lips and nose into position. Infants treated with these appliances undergo fewer surgeries, with weekly visible improvements.
Lee custom-makes each appliance using skills she acquired through intensive training that culminated in March 2025 at Duke University.
While nasoalveolar molding treatment has become more widely available, mastering the hands-on fabrication of the appliances requires intensive expert-led training, which is why so few treatment centers have an in-house specialist.
“Not a lot of people in this country have the skillset [to develop these appliances],” Sorsok said. “Most of these babies won’t know how [Lee] is changing their lives until they’re older.”
The treatment involves frequent clinic visits and significant caregiver commitment, and surgeries typically start with lip repair when babies are three to six months old, followed by palate repair at nine to 12 months for speech development.
With careful pre-surgical molding, “you may not even know [these patients] had clefting,” Pediatric Dentistry Program Director Matthew Cooke, D.D.S., M.D., M.P.H. said.
As children with cleft lip and/or palate grow, secondary effects become apparent: missing, extra or malformed teeth, and inadequate upper jaw development from scar tissue. The UF orthodontics team plays a crucial role, widening the upper jaw and guiding teeth into position.
With the help of UF’s dental and surgical teams — providing everything from early molding to orthodontic treatment — patients born with cleft lip and/ or palate are now eating, growing and speaking with confidence.
Editor’s note: This is the latest in a series of columns sponsored by the University of Florida.
