Ekler gets a hug from his mother before his cleft palate repair surgery. The Batcher family are grateful for the expert craniofacial team at Gillette.
To say Ekler Batcher has charisma is an understatement. The 11-month-old from Shakopee, MN has the power to make nurses rush over to see him. Gillette Children’s staff members will drop what they’re doing just to say “Hi” or engage with Ekler. He has that certain something.
“I don’t know what it is about him!” his mother Abigail laughs. “Apparently my son is a little rock star.”
Certified pediatric nurse practitioner, Anna Rauch, is part of Ekler’s Gillette care team and enjoys watching him grow. “Ekler is such an adorable little guy. His smile lights up a room and brightens everyone’s day!”
In a pre-op appointment, Ekler charms certified pediatric nurse practitioner, Anna Rauch, and many other members of the Gillette craniofacial team.
A prenatal plan for cleft lip and palate
Ekler’s parents, Abigail and Zak, discovered their son would be born with a cleft lip and palate after viewing their 23-week ultrasound. “It was good that we knew about it before he was born,” Abigail says. “That way we could be prepared and get a plan in place.”
A cleft lip is a separation in the upper lip and a cleft palate is a split in the roof of the mouth. These are the most common types of conditions that affect the skull and face. During the fourth and eighth weeks of pregnancy, separate areas of a baby’s face develop individually and then join. When the sides of the lip and roof of the mouth do not fuse as they should, the result can be a cleft lip, palate, or both.
The Gillette craniofacial team has extensive training and experience
Before Ekler was born, Abigail and Zak were referred to the craniofacial team at Gillette who treat children with cleft lip and palate and other craniofacial differences. This team is led by Jo Barta, MD, a certified, fellowship trained, craniofacial pediatric plastic surgeon. The team includes pediatric plastic surgeons, otolaryngologists, pediatric nurse practitioners, orthotics, a PhD trained speech and language pathologist, audiologists and fellowship trained orthodontists specializing in nasoalveolar molding and cleft orthodontia.
“We really liked Dr. Barta right away,” Abigail recalls. “We were impressed with the whole craniofacial team.”
Gillette craniofacial and plastic surgeon, Jo Barta, MD, meets with Abigail, Zak and Ekler Batcher to discuss the plan for Eker's cleft palate repair surgery. Dr. Barta repaired Ekler's cleft lip when he was 5 months old.
Cleft Lip surgery first, then a palate repair
With an initial plan in place to care for Ekler’s cleft lip and palate, his parents met with the Gillette craniofacial team again shortly after he was born. It’s important to get early care for a child who has a cleft lip and palate because cartilage molds easily during the first six weeks after birth.
Ekler wore a nasoalveolar molding device that was custom made by Gillette orthodontists. It is a presurgical orthopedic appliance that brings gum segments together, reducing the gap in the mouth, stretching the lip muscles, and helping with the shape of the nose.
“I had tears in my eyes the first time I put the nasoalveolar device in Ekler’s mouth,” Abigail recalls. “The device really helped and got Ekler ready for his lip and palate surgery. I find it remarkable that I actually had tears in my eyes the LAST time I put the device in Ekler’s mouth. I got emotional because it would be the last time he and I would have that moment together.”
Successful Cleft Lip Repair Surgery
The pre-surgery preparations paid off and Ekler was about 5 months old when Dr. Barta repaired his cleft lip.
“I prefer to do the initial lip repair around 6 months,” Dr. Barta says. “The infant is older and bigger which means a more accurate repair as the structures are larger. This reduces the need for revisions as well as allows coordination of ear tubes placement, if needed.”
Ekler’s dad, Zak, is pleased, “We are super happy with the results of Ekler’s cleft lip surgery. The hardest part in his recovery was making sure he was eating and getting the nutrition he needed. The Gillette team really helped us with that.”
Certified nursing assistant, Nick Lohmer, is a former Gillette patient and tries to make the pre-op process go as smoothly as possible for families. He makes getting a pre-op weight check fun for Ekler.
A Timeline of Ekler’s Cleft Palate Surgery Day
The Batcher family arrives at Gillette Children’s in St. Paul for Ekler’s cleft palate surgery at 10:06 am on June 10, 2024. They check in at the main reception desk before heading down to the third floor to get Ekler ready in Pre-Op Room 6.
Certified nursing assistant, Nick Lohmer, helps Ekler get changed into a hospital gown and takes his blood pressure, temperature, and other vitals. Nick has worked at Gillette for 23 years and was a patient himself as a child. “I know what these families go through on surgery days,” Nick says. “I try to make things as easy as possible, so there’s not any additional stress.”
At 10:24 nurse Jessica Palmer pops in and helps clean Ekler’s skin and two other nurses, Jody and Kelsey, stop by to ask about Ekler’s medications. The nurses offer to put Ekler in a fun, red push car so his parents can help distract him during the wait for surgery. The ever-social Ekler enjoys having his dad drive him around the Pre-Op area so he can smile and wave to the Gillette staff.
Gillette pediatric otolaryngologist, Micah Berman, MD and Dr. Barta meet outside the operating room before Ekler's cleft palate surgery and hearing test. These two providers are part of a large team of craniofacial experts at Gillette.
An Expert Team Checks-in and Supports Parents
Gillette audiologist, Analise Ludwig, comes into Pre-Op Room 6 at 11:05 and checks Elker’s ears while reminding Abigail and Zak that she will be working with pediatric otolaryngologist, Micah Berman, MD, to test Ekler’s hearing while he is under anesthesia. Children born with cleft lip and palate issues can have hearing problems due to tube dysfunction in the middle ear.
Anesthesiology checks in at 11:14 and explains that Ekler will be under general anesthesia and will be closely monitored during surgery. Dr. Berman enters and outlines what he will do during Ekler’s hearing test.
Dr. Barta arrives at 11:20 and takes her time explaining exactly what she’ll do during the cleft palate surgery. She tells Abigail and Zak what to expect the first few hours after the procedure. She stresses the importance of keeping Ekler on a liquid diet for a few days so the surgical site area on his palate can heal properly. Ekler will then be on a soft food/pureed diet for two weeks.
Abigail and Zak sign some final medical consent forms. Dr. Barta takes a small Sharpie pen and draws a smiley face on Ekler’s left cheek to indicate he is a cleft palate surgery patient.
Dr. Barta then heads to the operating room to scrub in and consult with Dr. Berman. The anesthesiology team wants to ensure Ekler has fully digested any food he ate in the morning, so it’s suggested Ekler take a few more laps around the Pre-Op area in his red push car.
At 12:41 Abigail and Zak give Ekler kisses goodbye as he’s wheeled into the OR. They are remarkably calm as they head into the family waiting area.
Dr. Barta spent about two hours in surgery to repair Ekler's cleft palate. She is a certified, fellowship trained, craniofacial pediatric plastic surgeon.
Covering a king-sized gap with a twin-sized sheet
Dr. Barta reports her surgery time with Ekler will be about 2.5 hours.
“I tell parents of children who have very wide cleft palates that as a surgeon, I’m basically trying to make a king-sized bed with a twin-size sheet,” Dr. Barta says.
“In Ekler’s case, I was happy to see that because of the pre-op care his parents did utilizing the NAM device. His cleft was easier,” Dr. Barta says. “The gap was narrower, and I had more tissue to help cover the gap in his palate. It was like having a queen-sized sheet covering a king-sized gap.”
Abigail and Ekler are all smiles the morning after his cleft palate repair surgery. “We are truly grateful to the entire team at Gillette,” Abigail says.
A successful cleft palate surgery
It was an 11-month journey to get Ekler’s cleft lip and palate repaired, and his parents are relieved to have this surgical chapter behind them before their son’s first birthday.
“We are truly grateful to the entire team at Gillette,” Abigail says. “We know our son has a bright future and, hopefully, this will just be another part of his birth story that we share with him.”
Zak agrees and says, “I’m amazed that the cleft palate surgery was not as difficult as I imagined. We felt prepared the entire time and are very happy with the results.”
Dr. Barta is also pleased. “At his first post-operative visit, Ekler’s palate is healing beautifully,” she reports. “His parents have done a good job of keeping fingers and other objects out of his mouth that can disrupt the repair. This helps prevent fistula formation and ensures the muscle in the palate that facilitate good speech have time to heal well.”
Gillette Children’s is a leader in craniofacial and plastic surgery and use the latest surgical techniques and technology to help children who have cleft lip and palate and other craniofacial differences.
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