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Veterinary and human craniofacial patients meet face to face

By John Lewis, VMD, FAVD, Dipl. AVDC

Posted: September 10, 2013, 11:50 a.m. EDT

On July 17, the University of Pennsylvania’s School of Veterinary Medicine—widely known as Penn Vet—hosted what may indeed be the first formal gathering of multiple human and veterinary craniofacial patients together in one room.

Four dogs with craniofacial abnormalities (patients from the school’s Ryan Hospital) and 20 patients from the Children’s Hospital of Philadelphia and their families met at Penn Vet to share experiences and inspire each other during the "Best Friends Bash.”

Cleft Lip Pup
Lentil was born with a bilateral cleft lip and cleft palate, and has become an "ambassadog” for children and animals with cleft lip and palate. His palate was repaired but his lips were not. Penn Vet 2013

The hope is that this program will blossom into a specialized form of pet therapy in which human patients can better relate to pets with similar conditions, having undergone similar experiences and procedures throughout their lives.

Pets and people are often affected by the same illnesses. Treatment for those illnesses is often remarkably similar. Craniofacial deformities can be some of the most challenging diseases for a patient to cope with, due to stigmas associated with facial differences.

Many of these deformities are congenital, and in humans, multiple surgeries are often necessary to improve function and cosmetics. It is not uncommon for some patients to require more than 30 surgeries throughout life if born with severe congenital craniofacial deformities.
 
Therefore, human patients may need to spend much of their time in the hospital for procedures and recheck examinations. These visits can be made much more palatable if there is a four-legged friend awaiting one’s arrival. The bond created is even more special when the dog shares a common ailment with the child.

Dogs have always inspired me with their ability to not shy away from adversity, to not dwell on negative aspects of their lives and to not worry about those things they cannot control (at least as far as we can tell!). In speaking with some of the doctors and patient caretakers at the Children’s Hospital, I learned that children with craniofacial defects can be equally inspiring.

Repairing
The "Best Friends Bash” on July 17 brought together veterinary patients with acquired and congenital facial defects. Lentil, a 6-month-old French bulldog born with a cleft palate and bilateral cleft lip, has developed a huge Facebook following. Lentil’s cleft palate was repaired in late May, but because his cleft lips were more of a cosmetic than a medical concern, they were not repaired so that he could serve as an "ambassadog” for pets and humans with clefts.

Corrine, a 14-year-old with a repaired cleft palate, was in attendance on July 17. She anxiously looked forward to meeting Lentil, since she and he have a shared history of a cleft palate and surgical repair. Seeing them interact and bond was magical.

The gathering also featured Georgia, a Gordon setter who was diagnosed with a fibrosarcoma of her left maxilla at just 18 months of age in 2007. Georgia had curative surgery, in which the tumor was removed with 2 centimeter margins of normal skin, bone and nasal conchae, resulting in a change in her facial appearance.

Georgia’s maxillary defect was closed with a rotational skin flap from the neck, and therefore, the hair on her left muzzle is much longer than on the rest of her face.

Everything is Golden
Buddy, an 8-year-old golden retriever, also attended. He was diagnosed with a fibrosarcoma of his rostral mandible in April 2012.

Curative surgery left him looking different, but losing the rostral portion of his right and left mandibles has not slowed him down, nor has it adversely affected his function.

These veterinary patients with acquired defects show visible facial differences, as do patients with congenital craniofacial deformities such as Apert syndrome.

A Word From Jaci
I met a 30-year-old woman named Jaci at the gathering. Jaci was born with Apert syndrome, an inherited autosomal dominant condition. It is caused by mutations in the gene that codes for fibroblast growth factor receptor 2. This gene defect causes craniosynostosis, where some of the bony sutures of the skull close too early.

Jaci
Jaci, a 30-year-old woman with Apert syndrome, gives Lentil a hug at the "Best Friends Bash.” Penn Vet 2013

Symptoms include early closure of sutures between bones of the skull, as seen by ridging along sutures; frequent ear infections and hearing loss; fusion or webbing of the second, third and fourth fingers and toes; prominent or bulging eyes; severe underdevelopment of the midface; and limb length abnormalities.
 
Though Jaci is now 30, she often attends gatherings like the "Best Friends Bash” because doctors and caretakers at Children’s Hospital of Philadelphia have become family to her over the years. After multiple surgeries, Jaci has become comfortable with her function and appearance.

She feels canine therapy dogs, especially dogs who had craniofacial procedures themselves, "will be great for kids born with Apert syndrome, cleft lip and cleft palate, since the kids can see how well the dogs do with their differences.”

Diana Sweeney, parent liaison at Children’s Hospital, said it best:
"As I stood back and watched my patients and the dogs meet, I couldn’t help but feel that the dogs gave unspoken comfort to the children, almost as if they knew that they have a common connection, something that doesn’t need words to explain the depth of their feelings. It makes you glad to be a part of something so much larger than yourself.”

I came away with the impression that this is just the beginning. 

Dr. Lewis, FAVD, Dipl. AVDC, is assistant professor of dentistry and oral surgery at the University of Pennsylvania School of Veterinary Medicine in Philadelphia. 

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