Why not restart posting 7 years after the last one?! This seemed like a good time to get into some detail about Cadence's most recent surgical process (with her full permission of course). Since the time Cadence came home in 2010 she has undergone 10 surgeries/ procedures. Some of the first ones included a repair of her cleft palate which required tissue and bone grafting to be done. When people have grafting done to the roof of their mouth scar tissue forms. This scar tissue prevents the maxila (top part of the mouth) from growing the same amount as the mandible (low part of the mouth). As a result, people who have had cleft palate repairs sometimes have an underbite. Besides any aesthetic concerns, the underbite can affect how the teeth come together when someone chews and this can have long term dental implications. We knew that once Cadence stopped growing that she would need a LeForte procedure to help realign the jaw. This is not a small operation so we wanted to make sure the doctor doing it was specialized in this area. Thus began the search for a surgeon. 

    We started consultations in spring 2025 (hoping to be done with surgery by the time she goes to college) and found a surgeon that we felt very confident about in Georgetown. We had found a new orthodontist to work with in Charlottesville (because 4 years of orthodontics isn't enough for one person) and knew that they would have to collaborate for her Leforte surgery. To make a long story short, getting the surgeon to work together with the orthodontist, and us for that matter, was like pulling teeth (no pun intended!). After 10 months of trying, and failing, to get the surgeon to collaberate, we decided we needed to move on. Various Facebook groups for kids with clefts had mentioned Dr. Padwa in Boston. Every single one of them sang her praises and people traveled from all over the country to work with her. I decided to reach out to the office. I emailed them on a Saturday, got a response Sunday, and a phone call Monday. I breathed a big sigh of relief feeling like we would finally get some traction to get the process started!

    Fast forward to making our way to Boston for our initial consultation with Dr. Padwa and her team this past June. We were introduced to her resident who did the basic assessment. When the resident was done she said that she would go get Dr. Padwa and that "she is force"! Dr. Padwa came in to the office, leaned up against the counter, looked at Cadence, crossed her arms and said "She's complicated." That's NEVER what you want to hear in the doctor's office. Basically the bone graft that Cadence had to fill the gap in her gum line had when she was 9 years old had failed/ dissolved over time. She has had a TON of tooth movement with her orthodontics which could have affected it. Regardless, Dr. Padwa said that Cadence didn't have enough healthy bone to move teeth around or even to place an implant. The doctor felt like the gap was large enough that simply regrafting it at this time would have a high likelihood of graft failure. Dr. Padwa works at Boston Children's with a very resourceful orthodontist, Dr. MacLaine. Dr. MacLaine has created a device to narrow the gap. Ideally, when she has another graft there will be a higher chance of success! Our trip to Boston this week included a segmental osteotomy (there was an incision made in the roof of her mouth to allow for maxillary movement) with device placement. We have been given a tool to turn the device to make the gap smaller (basically the opposite of a palate expander for those who have enjoyed that process!).

This is the device! Its... A LOT!

    Brad brought Cadence to Boston last week for the device fitting and I was able to take FMLA to spend 8 days in Boston with Cadence after her surgery. They wanted to keep a close eye on her to make sure things are moving in the right direction (literally). We landed in Boston last Tuesday and spent a very fun day in Salem, MA! Surgery was midafternoon on Wednesday. I was so impressed with Boston Children's hospital! They had many areas for families and patients to enjoy while being in the hospital.

This was one of their indoor gardens

    Cadence did well in surgery and the PACU nurse was amazing! She liked the feeling of the air on her nose and the nurse gave her ice packs for her whole face. But her post op recovery was uneventful.

One downside is the "no chew diet" that she has been assigned. The struggle is real!

Two teeth removed, but we got a really cool tool?! (Headlamp for looking in her mouth to turn the device)

Sitting in a hotel room for a week is a specific type of torture for me. We planned ahead and brought Alfie! Best. Choice. Ever!

Thankfully Cadence has a pretty high pain tolerance and has managed to get through most of her post op periods fairly easily. The last part of our trip we've manage to get out of the hotel for an outing most days (except for the day it rained continuously and we didn't bring an umbrella!). We enjoyed puppy yoga and Snowport that just started in Boston. We have watched a movie most nights and I have enjoyed this time with her... but we are both so ready to be home! Follow up with Dr. Padwa today was great! The segment is moving as we hoped and we follow up tomorrow with the one truly in charge at this point, Dr. MacLaine. And then we head home! I'm so grateful to have found this team at Boston Children's and that we have the time and resources to receive care here. Crossing my fingers that this is the beginning of the end of surgical procedures for her. (We are still looking at a 2-3 year process) She's a champ!