I had just read Dr. Brian's informative post about all the things that go
into a mouth that can change the shape of the palate.  Then a mom I recently
saw called   to tell me about something from within that had caused her son's
palatial assymetry.
    I saw this baby  when he was three weeks old.  He had been pulling off
the breast repeatedly since birth, and was still significantly under birth
weight at 3 weeks.  A ped. and a family practice dr. both watched mom and
baby breastfeed.  Ped noted some palatial assymmetry and nasal stuffiness.
 Family dr. noted nothing untoward.  Both referred to me for consultation.
 Ped had checked for coanal atresia (when bones block  the back of the
nostrils, blocking airway).  When able to pass a feeding tube, encouraged use
of humidifier and bulb syringe.  Pulling off breast considered a BF
management problem, maybe related to palate.  (Gotta give them credit for at
least watching them nurse...)
    I made home visit along with new LC  whom I mentor (mom's permission of
course.  Istill  think we need supervision before certification, but that was
last week :) ).  What we saw was that this baby latched well, then would
suck, suck, suck, swallow, pull back to mouth breathe around the breast
awhile, then back to suckle again.  He had significant suprasternal and
intercostal retractions (his chest sucked in when he inhaled).  He kept
blowing around the breast like a zerbit (is zerbit international?).  It was
obvious that he could not breathe  through his nose at all and that he pulled
off justto breathe.  It's a wonder he was so willing to go to the breast.
 Was BF the confounding variable for the dr.s?  If he had been behaving this
way with artificial feeding methods, would it have been picked up sooner?
 While very upset, the mom was so releived that someone confirmed what she
already know.  Something was WRONG with her baby.
   Turns out he had 2 cystic teratomas.  Embryonic cells encapsulated in dura
(that's what covers the brain).  One was in his nasopharynx (behind his nose)
blocking his airway.  The other was in his maxillary sinus, causing the
palatial symmetry.  That one required a coronal flap where they peel back the
face and break the eyebrow and cheek bones to get in.  The one in the
nasopharynx was reached through his palate.  The fiberoptic tube they used to
diagnose caused swelling and necessitated intubation and a ventilator.
    After being ventilated for two stretches totalling 10days, gram neg.
sepsis, and  2  surgeries, this baby (palate now symmetric?) is
breastfeeding.  To the credit of Children's Hospital of Phila., they put him
back to breast once he was extubated, leaving the feeding tube in place until
he could nurse well .  Mom's supply is down a little, and we're (SHE's)
working on that.  I hope that you find this as interesting as I do (and the
mom is hoping the rest of this little one's life will be boring!)
    Debi Ferrarello, BSN, IBCLC