Innovations in Managing Cleft Lip/Palate: A Multicenter Perspective

Abstract

Program Description: Cleft and craniofacial teams with both pediatric otolaryngology and facial plastic surgery backgrounds continue to develop. Novel approaches in the management of children with cleft lip and palate have contributed to a variety of treatment paradigms. Each institution and individual surgeon brings a unique perspective of treatment preferences that are worthy of discussion. Beginning in the prenatal period, advances in ultrasound technology now allow parents and surgeons to begin early preparation and education. Presurgical orthopedic devices introduced in the 1960s by the late 1990s have developed into nasoalveolar molding. The appliance is created in conjunction with an orthodontist with adjustments leading to approximation of the alveolar segments, as well as to mold the nasal deformity (columellar lengthening). Recently published modifications of the microform, unilateral, and bilateral cleft lip repair will be presented. Other innovations seeking to improve the aesthetic outcomes such as the subunit approach, suture choice, tissue glue, and scar prevention with silicone gel will be justified. Cleft surgeons from five institutions will present their approach to the cleft lip nasal deformity at the time of cleft lip repair. This can range from delaying repair (no rhinoplasty) to bolstering placement, or even direct lower lateral cartilage repositioning with rhinoplasty. This miniseminar will provide the participant a perspective on how different institutions approach common problems in management of the cleft lip, palate, and nasal deformity. This forum supports the goals of the Specialty Surgery Committee of the AAFPRS in fostering collaboration between those cleft surgeons within pediatric otolaryngology and the facial plastic surgery subspecialties. Secondary speech surgery evaluation and treatment will be presented with fluoroscopic and endoscopic examples and panelist discussion. Lastly, difficult cases will also be presented. Audience touchpad interaction will facilitate discussion. The format will include presentations including intraoperative video and subsequent discussion of the following topics: Presurgical nasoalveolar molding, unilateral cleft lip and nasal deformity repair, bilateral cleft lip and nasal deformity repair, primary cleft rhinoplasty options, and management of the extremely wide cleft lip and nasal deformity.

Educational Objectives: 1) Understand the timing and techniques for cleft lip/palate repair based on evidence-based guidelines. 2) Learn the panelists’ preferred basic and advanced cleft lip repair designs. 3) Be able to interpret and choose treatment for velopharyngeal dysfunction audibly, on fluoroscopy, and nasopharyngoscopy.