A reason to smile

The first time Nemanja Draca ate solid food was something of an experiment. He wanted to see if he could swallow food without it coming out of his nose.

He opened the refrigerator and pulled out a slice of meat. He carefully chewed and swallowed it. One by one, the then- 8-year-old grabbed anything he could reach and tested it. It was the first time he had eaten food that was not soup or pureed to go through a straw.

Nemanja was born in Croatia with a severe bilateral cleft palate and lip. But after a team of plastic surgeons, craniofacial specialists and orthodontics staff at Children's closed the palate, Nemanja was finally able to eat like a healthy, growing boy should.

A rough start

Born during the Serbo-Croatian war in the early 1990s, Nemanja was lucky. Many children in foreign countries who are born with cleft lip (separation in the upper lip) or cleft palate (separation in the roof of the mouth) are abandoned by their parents. Nemanja's mother, Nada Repaja, would not leave his side.

Repaja searched for doctors who could repair his mouth and lip, and finally found one in Serbia. But, after several unsuccessful surgeries, Nemanja was never fully repaired.

With the help of a charity organization, Repaja moved her children to the United States in search of a doctor who could help her son. The family settled in Dallas just miles away from Children's, where Repaja met the team of doctors and nurses who would change Nemanja's life.

Dr. Supakit Peanchitlertkajorn, an orthodontist on the dental staff at Children's, adjusts Nemanja's braces, which are a critical part of the cleft palate treatment.

Teaming up

Patients treated at Children's for cleft lip and palate generally see an orthodontist within days after they are born. Treatment continues with a coordinated effort among craniofacial and plastic surgeons who work with the orthodontist. About 60 percent of the patients seen in the orthodontic clinic are children with cleft lip/cleft palate. Depending on severity of the cleft, these patients may receive treatment until they reach their late teens or early 20s.

"With Nemanja, we essentially had to start over — taking everything apart and putting it back together," said Dr. Steven Byrd, a plastic surgeon on the medical staff at Children's.

This started with Dr. Supakit Peanchitlertkajorn, an orthodontist on the dental staff at Children's, who expanded Nemanja's narrow upper jaw with a palate expander. A year later, when Nemanja was 9, Dr. Byrd took bone from Nemanja's hip and grafted it to his palate — the procedure that finally allowed him to eat solid food.

After braces and another surgery to move Nemanja's upper jaw forward, Nemanja can eat anything he wants now — but he still sticks to healthy foods.

"Children's gave Nemanja new life," said his mother, Nada Repaja. "It's the best place, with the best people."

Tags: cleft lip, cleft palate, Peanchitlertkajorn