Simple things. Taken-for-granted-by-the-rest-of-us things.

That’s what Nathan Mackenzie most treasures these days.

Like eating apples. And smiling.

When he sees a West Michigan orchard in full fruit-bearing fashion this fall, he’ll be doing both.

At the core of Nathan’s gratitude is a genetic condition he was born with—cleft lip and palate. Because of it, he has learned to respect and admire little nuances in life that so many of us seem to overlook.

As a Spectrum Health Helen DeVos Children’s Hospital patient for the past 18 years, he has conquered many obstacles that once seemed like forbidden fruit.

Creating a smile

Robert Mann, MD, a Spectrum Health Medical Group pediatric plastic and craniofacial surgeon, performed cleft lip and palate repair surgery on Nathan when he was 2 years old. When Nathan turned 10, Dr. Mann grafted bone from Nathan’s hip to his cleft palate. Earlier this year, Dr. Mann’s colleague, John Girotto, MD, operated on Nathan’s jaw to move it forward.

“I feel like I’m a lot better off now than I used to be before my surgeries,” said Nathan, who lives in his family’s home in tiny Pierson, Michigan, about 20 minutes north of Grand Rapids. “Before, my teeth never lined up, so I couldn’t bite anything. Now, I’m able to chew. And I can smile. I’ve never been able to smile in my whole life.”

There’s a lot to smile about these days.

“I can eat an apple,” Nathan said. “It’s hard to describe, being able to eat something for the first time. The pleasure of being able to chew is amazing.”

With the newfound bite came newfound sensations.

“It was weird (before the most recent surgery),” Nathan said. “My lips didn’t move much. Now I can feel them and move them more. I have more feeling in my mouth. It’s definitely been a good journey.”

Big brother’s footsteps

Besides Dr. Mann and Nathan’s parents, Josh and Diana, somebody else has been closely watching Nathan’s progress: his brother Gavin, who is two years younger.

Gavin, also born with cleft lip and palate, has followed in Nathan’s surgery footsteps. Dr. Mann has operated on Gavin as well.

Nathan said he’s happy to be a role model.

“I’m about two years ahead of him on everything,” Nathan said. “I was always the guinea pig. I’ve showed him a few tricks of the trade. He was asking me a lot about what was going on and how everything was going to happen. I was helping him out a little bit.”

Dr. Mann said this is likely the end of the surgery line for Nathan, although with constant advances in scar repair, other procedures may become a possibility someday.

Having each other has been helpful for the brothers throughout their treatments. Dr. Mann said about 20 percent of cleft lip patients have a close relative with the same condition.

“Cleft lip and palate is just rare enough that some of the children feel isolated and have difficulty relating with other children who do not have the same treatment challenges,” Dr. Mann said. “Having a friend or family member (with the same condition) can be very helpful.”

Fraternal strength

On a recent weekday, as Nathan headed off to go fishing at Little Whitefish Lake, Gavin, 16, had just finished football practice at Tri-County High School.

Gavin took off his helmet and yanked the sweaty black-and-gold Vikings uniform over his head on this warm, humid Wednesday.

Like his brother, Gavin also delights in overcoming obstacles in his path. His favorite part about playing on the varsity team as an incoming sophomore? Overpowering opponents.

He’s able to wear a mouth guard with no problems, but like Nathan, he has a cross bite and will have jaw surgery in about two years.

Gavin said watching his big brother helps relieve his fears.

“It seems like it’s going to help me in the long run,” Gavin said. “It will really help with my teeth lining up.”

‘Leaps and bounds’

Josh, who paints for a living, said he’s proud of his boys. He can also relate to their medical journeys, as he has traveled the same path himself—he and his twin brother were both born with cleft lip and palate in 1970.

“I think (medical professionals) have grown leaps and bounds in how they can deal with it now,” Josh said. “Many people would not even know now that Nathan was born that way.”

When the boys were little, Josh’s parents took them all over the Midwest, “trying to find the best of the best” medical care.

“They were really on it as far as researching stuff like that,” he recalled.

Because he lived the cleft life story, Josh said he wasn’t alarmed about his sons’ conditions.

“It wasn’t very scary for me,” Josh said. “It wasn’t what I wanted for them, but it wasn’t overwhelming. I sure wasn’t going to worry as much as my folks did. I felt like I had a pretty good life.”

Compassion and caring

Josh and Diana’s youngest child, 10-year-old Madeline, has no cleft issues. Josh now has a hard time remembering that Nathan did.

“I still second-glance when I look at him because he looks so different,” Josh said. “When we go into Dr. Mann’s office, he has this little magnet he gave out with before and after pictures. It’s just amazing. Not only is he a talented physician, he has wonderful bedside manner. The caring just oozes out of him. He’s one of a kind for sure.”

That kind of compassion and caring has helped his sons adapt socially.

“Gavin is playing football and he’s got girlfriends galore,” Josh said, a smile audible in his voice. “They make friends left and right. I couldn’t be more happy with the way they’ve adjusted socially. I think society in general has changed. We’re more open with people who are different. Even up in hick town Pierson, we can be a little more flexible.”

Josh said he wrote a thank-you letter to Dr. Mann recently.

“Dr. Mann has been a real positive influence on all of our lives,” Josh said. “You wouldn’t think such little things done with human hands could impact somebody’s life like that, but they do. Then you multiply that by the hundreds of thousands of others that he’s touched. … We are all grateful.”

Dr. Mann said he’s impressed with the attitude of the boys and the family.

“These young men have developed very good coping skills—a credit to their personalities and to their parents,” Dr. Mann said. “Good coping skills allow individuals not only to get through life’s challenges but to grow and become more complete people as a result of those challenges.

“Nathan and Gavin have a terrific attitude on life and I wish that kind of attitude for all my patients,” he added.To view more patient stories on "Plastic & Craniofacial Surgery", click here.