Cleft Lip and Palate

Samuel Berkowitz Editor

Cleft Lip and Palate

Diagnosis and Management

Third Edition

ISBN 978-3-642-30769-0 ISBN 978-3-642-30770-6 (eBook) DOI 10.1007/978-3-642-30770-6 Springer Heidelberg New York Dordrecht London

Library of Congress Control Number: 2012954868

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Editor Samuel Berkowitz , DDS, M.S., FICD Adjunct Professor Department of Orthodontics College of Dentistry University of Illinois Chicago, IL USA

Clinical Professor of Surgery and Pediatrics (Ret) Director of Research (Ret) South Florida Cleft Palate Clinic University of Miami School of Medicine Miami, FL USA

Consultant (Ret) Craniofacial Anomalies ProgramMiami Children’s Hospital Miami, FL USA

My professional growth has been nurtured by my understanding wife, Lynn, who made it possible for me to spend endless uninterrupted evenings at my desk, while at the same time encouraging me to “stay with it.” Warm hugs to my two daughters, Beth and Debra, Ruben and Edward, and my eight outstanding grandchildren for their endless expressions of support and love.

Last, but by no means least, I cannot say enough for the countless children with various palatal and facial clefts whom I have treated over the past four decades and for their understanding parents. This book is dedicated to all of them as a token of my appreciation for their enduring perseverance and fortitude. My young patients have taught me much about the human spirit and the joy that can spring from surmounting nature’s adversities.

Finally, my work was made possible by the support of D. Ralph Millard, Jr., who appreciated the value of serial records starting at birth. S.A. Wolfe and I have differed on a few areas of treatment, but we strongly agreed that only through the analyses over time of objective growth records could progress in treatment be accomplished. J.D. Subtelny, Chairman of the Department of Orthodontics at Eastman Dental Center and author of many articles on clefts, and I have been friends for 40 years and at many of our meetings it was a pleasure to hear of his experience treating children born with clefts of the lip and palate.

vii

Foreword

I am deeply honored by the opportunity to write the foreword to this new edition of Dr. Samuel Berkowitz’s classic volume on cleft lip and palate.

As a lifelong student of past and current cleft palate literature on facial palatal growth and development he is a strong advocate for good record keeping and carefully conducted clinical studies. He possesses extensive knowledge and insight in the effects of treatment interventions on cleft lip and palate patients and their parents which has led to this book.

Samuel Berkowitz wrote his master’s thesis in cleft palate under the super-vision and guidance of Samuel Pruzansky at the Cleft Palate-Craniofacial Program at the University of Illinois School of Dentistry in 1959. From there he went to the University of Miami School of Medicine to help develop, with Dr. D. Ralph Millard Jr., Chief of Plastic Surgery, a craniofacial anomalies program and clinic (1960–1998). They collaborated in developing an exten-sive collection of longitudinal clinical records of dental casts, cephaloradio-graphs, panorexes and photographs from birth to adolescence. These records are now housed at the Museum of Health and Medicine associated with the Institute of Pathology at Walter Reed Hospital in Washington, D.C. Dr. Berkowitz’s main goal was to create lasting treatment concepts based on a better understanding of the natural history of cleft palate and facial growth and development. This book discusses in detail the resulting treatment con-cepts, which are supported by in-depth case analyses.

During his and my time as clinician providers committed to care of chil-dren with congenital facial differences, we have seen major improvements in the overall long-term outcomes in the young adult with a cleft, managed from infancy in an interdisciplinary team setting. Our expectations for the fi nal outcome are normal speech, harmonious facial features, well and stable occlu-sion and good self esteem. The improvements are due to several factors, many of which are the result of careful clinical studies, long-term observations and the learning and experience that the providers obtain by working together in a team. We have also experienced waves of new clinicians professing new insights into how tissues will respond to certain new or reinvented techniques or manipulations, only many years later to fi nd no improvement in outcomes or even detrimental effects on growth and development. The clinical records, long memory and experience that are found in an established team can have a moderating effect on new members without curbing enthusiasm and creative thinking. It remains a fact that treatment interventions must proceed stepwise

viii Foreword

according to biologic development and that there are wide individual varia-tions among individuals with clefts.

In this new edition, Sam Berkowitz has assembled the most outstanding specialists in their speci fi c area of experience and expertise and some new talents. The student of this text will fi nd solid data where that exists and well founded theories where data is not yet available. This text and the teaching materials that Sam has produced to be used in orthodontic specialty programs, attest to his burning desire and commitment to educate future clinical special-ists in the care of individuals born with a cleft. He strongly believes that all specialists should know each others problems to better design a meaningful solution.

San Francisco, USA Karin Vargervik

ix

About the Editor

Dr. Berkowitz , an orthodontist, was a Clinical Professor of Pediatrics and Surgery associated with the South Florida Craniofacial Anomalies Program at the University of Miami School of Medicine. He was also Adjunct Clinical Professor at Nova Southeastern University College of Dentistry – Orthodontic Department, and Adjunct Clinical Professor of Orthodontics at the University of Illinois College of Dentistry. His main goal is to develop teaching materi-als in cleft palate for professionals in plastic and oral surgery, orthodontics, and speech language pathology. He is a past President of the American Cleft Palate Association Educational Foundation, the Florida Cleft Palate Association, was President of the Miami Craniofacial Anomalies Foundation. Dr. Berkowitz was active in the American Association of Orthodontics, Florida Cleft Palate Association, and The Edward Angle Society of Orthodontists. He has published widely in medical and cleft palate journals and is the author of Volume I and the editor of Volume II of Cleft Lip and

x About the Editor

Palate Perspectives in Management – First Edition; he coauthored Plastic Surgery of the Facial Skeleton with S. A. Wolfe, M. D, and wrote The Cleft Palate Story for parents of a child born with a cleft. Dr. Berkowitz is a popular speaker on cleft lip/palate topics and has presented many workshops and seminars in the USA and abroad.

His research interest focused on improving surgical-orthodontic treatment planning for cleft lip and palate children as well as those with other craniofa-cial anomalies. Dr. Berkowitz was project director of a clinical research pro-gram that was studying the long-term effects of various surgical treatment procedures on palatal and facial growth and development. He created a quan-titative method for determining when to close the palatal cleft space, based on the 10 % ratio of the cleft space to the area of the surrounding palatal surface medial to the alveolar ridges. He has created an audiovisual PowerPoint lec-ture series for surgeons and orthodontists to enable them to better understand and teach others the effects of surgery on the face from birth through adolescence.

Dr. Berkowitz has been awarded the title “Honoree” by the Edward Angle Society of Orthodontists, and “Honoree” by the First World Congress of the International Cleft Lip and Palate Foundation for his many contributions to the fi eld of cleft lip and palate treatment. His extensive serial clinical records of dental casts, lateral cephaloradiographs, facial and intraoral photographs, and panorexes are in the National Museum of Health and Medicine (associ-ated with Walter Reed Hospital’s Institute of Pathology in Washington DC), where they will be available for continued study.

xi

Preface

In the fi rst page of the fi rst edition of this book, I quoted Samuel Pruzansky who, after participating at an International Symposium on Cleft Lip and Palate held in 1969, and re fl ecting on what he heard at that meeting, stated, “The same tired questions have been asked as at every similar clinical meet-ing. And I despair at the general unfamiliarity with the pertinent literature.”

Fortunately, since the 1950s, many clinical investigators in the fi eld of cleft palate have performed excellent clinical studies of the management of cleft lip and palate that have contributed to the intellectual ferment over the last 50 years. To these studies we are indebted, since to know this literature is vital for correct treatment planning.

When selecting signi fi cant references for this text, every attempt was made to carry out an exhaustive literature search to include all of the excellent arti-cles on each subject covered. That, however, has been an insurmountable task. To investigators whose research articles were not included, I apologize and I advise readers to conduct their own literature search, which must include papers on the “opposing schools” of thought. There is no doubt in my mind that their fi nal conclusions will be the same as mine when they consider the results of long-term palatal and facial growth studies that involved the analy-sis of objective records.

To familiarize clinicians with the appropriate literature and its importance to the treatment of cleft lip and cleft palate, the chapters in this book are struc-tured to improve clinicians’ understanding of the natural history of the cleft defect, the face in which it exists, the in fl uence of surgery on palatal growth and development, and equally importantly in developing an appreciation for the heterogeneity that exists even within a single cleft type.

These chapters will show that chronological age is not the parameter that really matters in determining the age at which to close the cleft in the palate. What is important is morphologic age and physiologic fi tness, that is, whether the tissues are adequate in quantity and quality and whether the geometric relationship of cleft parts is favorable or unfavorable for reconstruction. Some questions incidental to growth, which date back 25 years, concern the rela-tionship of the malformed palatal segments to the contiguous skeletal anat-omy, which, in turn, may be anomalous. These following questions are also addressed: Are the palatal segments static in their de fi ciency or does the de fi ciency diminish in time, that is, is “catch-up-growth” a predictable phe-nomenon? And if so, what surgical procedures (as to age and type) make it possible?

xii Preface

Many of Pruzansky’s thoughts, written so many years ago, still hold true today and are worth repeating. He stated that whoever sees things from their beginning will have the most advantageous view of them. To that end, most of the serial cases presented in this volume start soon after birth when plaster casts and photographs of the palatal and facial defect are taken. Serial lateral cephaloradiographs are added as soon as the child is manageable, and again taken periodically through adolescence.

It is hoped that clinicians who are just beginning their involvement in cleft palate will learn the pathology and its natural history of cleft palate from the cases presented in this book and appreciate the need to keep careful records (casts, cephaloradiographs, photographs, and panorexes) which are of vital importance to both the processing of knowledge and self-criticism.

One last note of great importance – it is rare that two members of a team, such as I, an orthodontist, and D. Ralph Millard Jr., a plastic surgeon, can successfully work together even when some differences in treatment philoso-phy exist. We succeeded because we were professionally compatible and because we shared an obsessive need to determine why some procedures are successful and why others fail even when the same treatment procedures were used. Failures, we discovered, occur principally because of misinterpretation of physiological principles and/or a lack of technical pro fi ciency.

Dr. Millard understood the value of serial objective records dating from birth as the essential starting point in determining the long-term utility of any surgical cleft treatment program. Although I was always free to voice a con-trary opinion as to what surgery should be performed (and when), our work-ing relationship was based on recognizing the right of the surgeon to reject recommendations and follow his own dictates. And it was my right, as a member of a team involved in growth studies, to document the anatomical changes to the face and palate for future analysis. Respecting our mutual rights and responsibilities was no simple task. Strong emotional and concep-tual barriers had to be overcome in the process of communicating with each other.

Our 40-year search for a better understanding of the natural history of cleft lip/palate growth and development and the effects of various surgical-orth-odontic treatment procedures ultimately led Dr. Millard to a conservative approach of staged surgical treatment without the intercession of maxillary orthopedics with periosteoplasty, which he tried and found wanting.

Reference

Pruzansky S (1969) Early treatment of cleft lip and palate. In: Cole RM (ed) Proceedings of the second international symposium. Cleft Lip and Cleft Palate Institute, Northwestern University School of Dentistry, Chicago, p 116

xiiiPreface

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An Audio-Visual PowerPoint 7 hour online lecture is available from Dr. Samuel Berkowitz and the University of Illinois, College of Dentistry, Orthodontic Department, for all specialist on a cleft palate team. It consists of a tutorial of over 400 illustrations utilized in the 3rd edition of Cleft Lip and Palate: Diagnosis and Management .

Biological Concepts that underlie Cleft Palate Treatment: The E-Learning Course:

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This course is designed as supplemental material for any program cover-ing craniofacial anomalies and cleft lip and palate topics.

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To enroll or view a free trial module, visit www.cleftlippalateaudiovisual-lecture.org . The trial module is available by logging in as a guest.

Topics covered include: Embryopathogenesis of cleft palate development • The natural history of cleft palate growth and development from birth to • adolescence (with or without presurgical orthopedics)

Complete bilateral cleft lip and palate – Complete unilateral cleft lip and palate – Isolated cleft palate –

Use and abuse of presurgical orthopedics with/without • gingivoperiosteoplasty The velopharyngeal mechanism and variations in the pharyngeal architec-• ture which in fl uences nasal air fl ow The use of a pharyngeal fl ap versus pharyngioplasty to control air fl ow • Timing of palatal closure as it in fl uences occlusion, speech, and facial • growth The use of a protraction facial mask to avoid midfacial surgical • advancement Craniofacial surgery and distraction osteogenesis •

Samuel Berkowitz, DDS, M.S., FICD Editor

xv

Acknowledgements

Since the Third Edition involves the assistance of those who aided in the creation of the Second Edition I am happy to list their names again. I extend heartfelt thanks to Dr. Maria Camila Caro, Leslie Gagnon, Gillian Kelley, George Diaz, Ms. Marta Mejia, Juan Hernandez, Pedro Ibarra, Ana Belmonte and the late Francis Fink for his excellent photography. For the Third Edition I want to give special thanks to Jay Abbott and Howard Siegel for their com-puter skills involved in this edition.

Also, immeasurable thanks to my many colleagues in The American Cleft Palate-Craniofacial Association and those involved in various cleft palate clinics in the USA, Europe and Asia for contributing to my understanding of cleft lip and palate patient management. To them, too many to recognize by name, I shall be forever grateful for their professional knowledge and per-sonal friendship.

Special acknowledgement needs to be given to my mentor, Dr. Samuel Pruzansky, orthodontist who was director of the Cleft Palate-Craniofacial program at the University of Illinois College of Dentistry when I was a resi-dent in orthodontics. There is no question he motivated me as well as all of those with whom he made contact to go in the right direction to understand the natural history of the face with the cleft palate defect. His aim was to be able to uncover signi fi cant information to perform differential diagnosis in treatment planning.

xvii

Contents

Part I Facial Embryology and Neonatal Palatal Cleft Morphology

1 Embryogenetics of Cleft Lip and Palate . . . . . . . . . . . . . . . . . . 3Geoffrey H. Sperber and Steven M. Sperber

2 The Value of Longitudinal Facial and Dental Casts Records in Clinical Research and Treatment Analysis . . . . . . . . . . . . . 35Samuel Berkowitz

3 Facial and Palatal Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Samuel Berkowitz

Part II Types of Clefts

4 The Effect of Clefting of the Lip and Palate and the Palatal Arch Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Samuel Berkowitz

5 Alternative Method Used to Correct Distorted Neonatal Cleft Arch Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Samuel Berkowitz

6 Complete Unilateral Cleft of the Lip and Palate . . . . . . . . . . . 95Samuel Berkowitz

7 Complete Bilateral Cleft Lip and Palate . . . . . . . . . . . . . . . . . . 133Samuel Berkowitz

8 Lip Pits: Orthodontic Treatment, Dentition, and Occlusion – Associated Skeletal Structures. . . . . . . . . . . . 227Samuel Berkowitz

Part III Facial Growth in Cleft Palate Children

9 Characteristics of Facial Morphology and Growth in Infants with Clefts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245Sven Kreiborg, Nuno V. Hermann, and Tron A. Darvann

xviii Contents

10 A 25-Year Longitudinal Facial Growth Study of Unilateral Cleft Lip and Palate Subjects from the Sri Lankan Cleft Lip and Palate Project. . . . . . . . . . 259Brijesh Patel and Michael Mars

11 Airway Management in Patients with Robin Sequence . . . . . 279Kevin D. Han, Mitchel Seruya, Diego A. Preciado, and Albert K. Oh

12 Pierre Robin Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287Samuel Pruzansky and Julius B. Richmond

Part IV Audiology/Otology

13 Management of Otopathology and Hearing Loss in Children with Cleft Palate and Craniofacial Anomalies. . . 299Amelia F. Drake and Jackson Roush

Part V Effects of Surgery and How It Was Utilized

14 Palatal Wound Healing: The Effects of Scarring on Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309Johannes W. Von den Hoff, Jaap C. Maltha, and Anne Marie Kuijpers-Jagtman

15 Facial Growth Related to Surgical Methods . . . . . . . . . . . . . . 325Gunvor Semb and William C. Shaw

Part VI Lip and Palate Surgery: Millard–Berkowitz Protocol

16 The Influence of Conservative Surgery on Growth and Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347Samuel Berkowitz

17 Choosing the Best Time for Palatal Surgery . . . . . . . . . . . . . . 389Samuel Berkowitz

Part VII Another Tested Good Surgical Procedure

18 Two-Stage Palatal Surgery with Early Veloplasty and Delayed Hard Palate Repair: A Balanced View on Speech and Midfacial Growth Outcome . . . . . . . . . . . . . . . 413Hans Friede, Jan Lilja, and Anette Lohmander

Part VIII Facial Growth: Time Is the Patient’s Ally

19 Management of the Premaxilla/Maxilla in Bilateral Cleft Lip and Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441Karin Vargervik and Snehlata Oberoi

xixContents

Part IX Presurgical Orthopedics

20 Neonatal Maxillary Orthopedics: Past to Present . . . . . . . . . . 455Anne Marie Kuijpers-Jagtman and Charlotte Prahl

21 A Comparison of the Effects of the Latham–Millard POPLA Procedure with a Conservative Treatment Approach on Dental Occlusion and Facial Aesthetics in CUCLP and CBCLP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473Samuel Berkowitz and Martha Mejia

Part X Midfacial Orthodontic/Orthopedic and/or Surgical Changes

22 Protraction Facial Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511Samuel Berkowitz

23 Protraction Facial Mask for Early Correction of Midfacial Retrusion: The Bergen Rationale . . . . . . . . . . . . 519Rolf S. Tindlund

24 LeFort I Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537S.A. Wolfe and Samuel Berkowitz

Part XI Orthognathic Surgery

25 Cleft Jaw Deformities and Their Management . . . . . . . . . . . . 557Jeffrey C. Posnick

26 Secondary Bone Grafting of Alveolar Clefts . . . . . . . . . . . . . . 601Frank E. Abyholm, Sayuri Otaki, and Masatomo Yorimoto

27 The Need for Differential Diagnosis in Treatment Planning . . . 613Samuel Berkowitz

Part XII Distraction Osteogenesis

28 Rigid External Distraction: Its Application in Cleft Maxillary Deformities . . . . . . . . . . . . . . . . . . . . . . . . . . 633John W. Polley and Alvaro A. Figueroa

29 Remodeling the Mandible by Distraction Osteogenesis . . . . . 649Fernando Molina

30 Management of Maxillary Deformities in Growing Cleft Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671Eric J.W. Liou and Philip K.T. Chen

31 Preventing Relapse Following Distraction Osteogenesis for the Cleft Midface in Adults . . . . . . . . . . . . . . . . . . . . . . . . . 693N.K. Koteswara Prasad, Syed Altaf Hussain, and Jyotsna Murthy

xx Contents

Part XIII Speech

32 Diagnostic Procedures and Instruments Used in the Assessment and Treatment of Speech . . . . . . . . . . . . . . . 707Samuel Berkowitz

33 Variations in Nasopharyngeal Skeletal Architecture . . . . . . . . 715Samuel Berkowitz

34 The Velopharyngeal Mechanism . . . . . . . . . . . . . . . . . . . . . . . . 741Robert J. Shprintzen

35 Surgical Management of Velopharyngeal Dysfunction . . . . . . 759Richard E. Kirschner and Adriane L. Baylis

36 Velopharyngeal Dysfunction Management Algorithms . . . . . 777Jeffrey L. Marsh

37 Optimal Age for Palatoplasty to Facilitate Normal Speech Development: What Is the Evidence? . . . . . . . . . . . . . 787Sally J. Peterson-Falzone

38 Speech, Language, and Velopharyngeal Dysfunction: Management Throughout the Life of an Individual with Cleft Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803John E. Riski

39 Prosthetic Speech Appliances for Patients with Cleft Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 821Mohammed Mazaheri

40 Palatal Lift Prosthesis for the Treatment of Velopharyngeal Incompetency and Insufficiency . . . . . . . . . . . . . . . . . . . . . . . . 839Mohammed Mazaheri

Part XIV Third World Cleft Treatment

41 Cleft Palate Treatment in Developing Countries of Africa . . . 855Fadekemi O. Oginni and Wasiu L. Adeyemo

42 Birthing and Building Nascent Cleft Teams in Developing Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871Emad Hussein, Hala Borno, and John van Aalst

43 Challenges in Cleft Care in Underdeveloped Countries . . . . . 879Isaac L. Wornom III

Part XV Psychological/Team Function

44 Examining the Team Process: Developing and Sustaining Effective Craniofacial Team Care . . . . . . . . . . 885Lynn M. Fox and Patricia Ann Stone

xxiContents

45 Living with a Cleft: Psychological Challenges, Support and Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 907Nichola Rumsey and Nicola Marie Stock

46 Managing Teasing and Bullying . . . . . . . . . . . . . . . . . . . . . . . . 917Sara Shavel-Jessop, Joanna Shearer, Elizabeth McDowell, and Daniela Hearst

Part XVI Multicenter Clinical Reports

47 Eurocleft and Americleft Studies: Experiments in Intercenter and International Collaboration . . . . . . . . . . . . 929Ross E. Long Jr., William C. Shaw, and Gunvor Semb

Part XVII Recording Patient Orthodontic/Surgical Findings

48 Berkowitz Recording Patient Information Form . . . . . . . . . . . 947Samuel Berkowitz

Part XVIII The Patient’s World

49 Social, Ethical, and Health Policy Issues in the Care of Children with Major Craniofacial Conditions . . . . . . . . . . 955Ronald P. Strauss

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 967

xxiii

Contributors

Frank E. Abyholm , M.D., DDS, Ph.D. Department of Plastic Surgery , Rikshopitalet National Hospital , Oslo , Norway

Wasiu L. Adeyemo , BDS (Ib), FMCDS (Nig), FWACS, Ph.D., Cologne, FICS Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos , Nigeria

Adriane L. Baylis , Ph.D., CCC-SLP Director, Resonance Disorders Program , Nationwide Children’s Hospital , Columbus , OH , USA

Assistant Professor of Clinical Plastic Surgery, Speech and Hearing Science, and Pediatrics , The Ohio State University , Columbus , OH , USA

Samuel Berkowitz , DDS, M.S., FICD Adjunct Professor, Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA

Clinical Professor of Surgery and Pediatrics (Ret), Director of Research (Ret), South Florida Cleft Palate Clinic, University of Miami School of Medicine , Miami , FL , USA

Consultant (Ret), Craniofacial Anomalies Program , Miami Children’s Hospital , Miami , FL , USA

Hala Borno School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA

Philip K. T. Chen Section of Craniofacial Surgery, Department of Plastic, and Reconstruction Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan

Tron A. Darvann , M.Sci., Ph.D. 3D Craniofacial Image Research Laboratory , School of Dentistry, University of Copenhagen , Copenhagen , Denmark

Department of Oral and Maxillofacial Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen , Denmark

Amelia F. Drake , M.D., FACS Department of Otolaryngology , The University of North Carolina School of Medicine, UNC Hospitals , Chapel Hill , NC , USA

Alvaro A. Figueroa , DDS, M.S. Rush Craniofacial Center , Chicago , IL , USA

xxiv Contributors

Lynn M. Fox , M.A., Med Department of Dental Ecology, University of North Carolina School of Dentistry , Chapel Hill , NC , USA

Hans Friede , DDS Department of Orthodontics , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden

Kevin D. Han , M.D. Department of Plastic Surgery, 1PHC , Georgetown University Hospital , Washington, DC , USA

Daniela Hearst Psychosocial and Family Services , Great Ormond Street Hospital for Children NHS Trust and the North Thames Cleft Lip and Palate Service , London , UK

Nuno V. Hermann , DDS, Ph.D. Department of Pediatric Dentistry and Clinical Genetics , School of Dentistry, University of Copenhagen , Copenhagen , Denmark

Syed Altaf Hussain , M.S., FRCS, DNB Department of Plastic Surgery, Cleft and Craniofacial Centre , Sri Ramachandra University , Chennai , India

Emad Hussein , M.S., FRCS, DNB Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry , Arab American University , Jenin , Palestine

Richard E. Kirschner , M.D., FACS, FAAP Chief, Section for Plastic and Reconstructive Surgery , Director, Cleft Lip and Palate Center, Nationwide Children’s Hospital , Columbus , OH , USA

Professor of Clinical Plastic Surgery and Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA

Sven Kreiborg , DDS, Ph.D., DrOdont Department of Pediatric Dentistry and Clinical Genetics , School of Dentistry, University of Copenhagen , Copenhagen , Denmark

Anne Marie Kuijpers-Jagtman , DDS, Ph.D. Department of Orthodontics and Craniofacial Biology , Cleft Palate Craniofacial Unit, Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands

Jan Lilja , M.D., DDS, Ph.D. Department of Plastic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden

Eric J. W. Liou , DDS, M.S. Department of Orthodontics & Craniofacial Dentistry, Chang Gung Memorial Hospital, Taipei , Taiwan

Anette Lohmander , SLP, Ph.D. Division of Speech and Language Pathology , Karolinska Institute , Stockholm, Sweden

Previously af fi liated with Sahlgrenska Academy at University of Gothenburg, Sweden

Ross E. Long Jr., DMD, M.S., Ph.D. Lancaster Cleft Palate Clinic , Lancaster , PA, USA

xxvContributors

Jaap C. Maltha , Ph.D. Department of Orthodontics and Craniofacial Biology , Radbound University Nijmegen Medical Center , Nijmegen , The Netherlands

Michael Mars , DSc (Hon), Ph.D., BDS, FDS, D.Orth, FRCSLT (Hon), FSLCP (Hon) North Thames Cleft Centre – Great Ormond Street Hospital for Children , London , UK

Faculty of Medicine, Peradeniya , Sri Lanka

Jeffrey L. Marsh , M.D. Department of Surgery, Plastic and Reconstructive , St. Louis University School of Medicine , St. Louis , MO , USA

Department of Pediatric Plastic Surgery , Cleft Lip/Palate and Craniofacial Deformities Center, Mercy Children’s Hospital , St. Louis , MO , USA

Kids Plastic Surgery , St. Louis , MO , USA

Mohammed Mazaheri , MDD, DDS, M.Sc. Professor of Surgery Pennsylvania State University , Hershey Medical Center, Past Medical and Dental Director, Lancaster Cleft Palate Clinic, Lancaster, PA , USA

Elizabeth McDowell Psychosocial and Family Services , Great Ormond Street Hospital for Children NHS Trust and the North Thames Cleft Lip and Palate Service , London , UK

Marta Mejia , DDS Division of Plastic Surgery , Miami Children’s Hospital , Miami , FL , USA

Fernando Molina , M.D. Department of Plastic and Reconstructive Surgery, Hospital General “Dr. Manuel Gea Gonzalez”, Delegacion Tlalpan , Mexico

Jyotsna Murthy , M.S., Mch (Plastic) Department of Plastic Surgery, Cleft and Craniofacial Centre , Sri Ramachandra University , Chennai , India

Snehlata Oberoi , DDS Department of Orofacial Sciences, Center for Craniofacial Anomalies, University of California, San Francisco , San Francisco , CA , USA

Fadekami O. Oginni , BChD (Ife), FMCDS (Nig), FWACS Department of Oral and Maxillofacial Surgery, Faculty of Dentistry , College of Health Sciences, Obafemi Awolowo University , Ile-Ife , Osun , Nigeria

Albert K. Oh , M.D. Department of Surgery and Pediatrics , The George Washington University School of Medicine , Washington, DC , USA

Department of Plastic and Reconstructive Surgery , Children’s National Medical Center , Washington, DC , USA

xxvi Contributors

Sayuri Otaki , M.D., DDS, Ph.D. Department of Plastic Surgery , Tane General Hospital , Osaka-Shi , Japan

Department of Plastic Surgery , Osaka City University Medical School , Osaka-Shi , Japan

Brijesh Patel , BDS (Hons), M.Sc., MFDS, M. Orth, FDS (Orth) North Thames Cleft Centre – Great Ormond Street Hospital for Children , London , UK

St. Andrew’s Hospital, Chelmsford, UK

Sally J. Peterson-Falzone , Ph.D., CCC-Sp, FASHLA Clinical Professor Emerita, University of California , San Francisco , CA , USA

John W. Polley , M.D. Craniofacial Clinic, Rush University Medical Center , Chicago , IL , USA

Jeffrey C. Posnick , DMD, M.D., FRCS (C), FACS Director, Posnick Center for Facial Plastic Surgery , Chevy Chase , MD , USA

Clinical Professor of Surgery and Pediatrics , Georgetown University , Washington, DC , USA

Adjunct Professor of Orthodontics , University of Maryland, Baltimore College of Dental Surgery , Baltimore , MD , USA

Adjunct Professor of Oral and Maxillofacial Surgery , Howard University College of Dentistry , Washington, DC , USA

Charlotte Prahl , DDS, Ph.D. Department of Orthodontics , Academic Centre for Dentistry , Amsterdam , The Netherlands

Orthodontist Cleft Palate Team , Free University Medical Centre , Amsterdam , The Netherlands

N. K. Koteswara Prasad , MDS, FCFD Department of Orthodontics, Faculty of Dental Sciences, Cleft and Craniofacial Centre , Sri Ramachandra University , Chennai , India

Diego A. Preciado , M.D., Ph.D. Department of Otolaryngology, Pediatrics, and Integrative Systems Biology , The George Washington University School of Medicine , Washington, DC , USA

Division of Pediatric Otolaryngology, Department of Otolaryngology , Children’s National Medical Center , Washington, DC , USA

Samuel Pruzansky , DDS (Deceased) Cleft Palate Craniofacial Center , University of Illinois, Chicago , IL , USA

Julius B. Richmond , M.D. (Deceased) Department of Plastic Surgery, University of Illinois, Chicago, IL, USA

John E. Riski , Ph.D., CCC-S, FASHA Speech Pathology Laboratory , Center for Craniofacial Disorders, Children’s Healthcare of Atlanta , Atlanta , GA , USA

xxviiContributors

Jackson Roush , Ph.D. Division of Speech and Hearing Sciences, Department of Allied Health Sciences , University of North Carolina School of Medicine , Chapel Hill , NC , USA

Nichola Rumsey Department of Psychology , Centre for Appearance Research, University of the West of England , Bristol , UK

Gunvor Semb , DDS, Ph.D. Department of Orthodontics, University of Manchester, School of Dentistry , Manchester , UK

Mitchel Seruya , M.D. Department of Plastic Surgery, 1PHC , Georgetown University Hospital , Washington, DC , USA

Sara Shavel-Jessop Psychosocial and Family Services , Great Ormond Street Hospital for Children NHS Trust and the North Thames Cleft Lip and Palate Service , London , UK

William C. Shaw , BDS, Ph.D. Department of Orthodontics, University of Manchester, School of Dentistry, The University of Manchester , Manchester , UK

Joanna Shearer Psychosocial and Family Services , Great Ormond Street Hospital for Children NHS Trust and the North Thames Cleft Lip and Palate Service , London , UK

Robert J. Shprintzen , Ph.D. President and Chairman of the Board, The Virtual Center for Velo-Cardio-Facial Syndrome Inc., NY, USA

Geoffrey H. Sperber , BDS, M.S., Ph.D., FICD, Dr Med Dent (Hon causa) Faculty of Medicine and Dentistry , Edmonton Clinic Health Academy, University of Alberta , Edmonton , AB , Canada

Steven M. Sperber , M.S., Ph.D., FACMG Denver Genetic Laboratories, Department of Pediatrics , School of Medicine, University of Colorado , Aurora , CO , USA

Nicola Marie Stock Department of Psychology, Faculty of Health and Life Sciences , Centre for Appearance Research, University of the West of England , Bristol , UK

Patricia Ann Stone , M.A., CCC-SLP Department of Plastic and Reconstructive Surgery, Akron Children’s Hospital, Akron Children’s Hospital, One Perkins Square, Akron, OH, USA

Ronald P. Strauss , DMD, Ph.D. Departments of Dental Ecology and of Social Medicine, The University of North Carolina at Chapel Hill, Schools of Dentistry and Medicine , Chapel Hill , NC , USA

The UNC Craniofacial Center , Chapel Hill , NC , USA

Rolf S. Tindlund , DDS, Ph.D. Department of Orthodontics and Facial Orthopedics, Faculty of Medicine and Dentistry , University of Bergen , Bergen , Norway

xxviii Contributors

John van Aalst Division of Plastic Surgery, Department of Surgery , The University of North Carolina at Chapel Hill , Chapel Hill , NC , USA

Karin Vargervik , DDS Department of Orofacial Sciences, Center for Craniofacial Anomalies, University of California, San Francisco , San Francisco , CA , USA

Johannes W. Von den Hoff , Ph.D. Department of Orthodontics and Craniofacial Biology , Radbound University Nijmegen Medical Center , Nijmegen , The Netherlands

S. A. Wolfe , M.D. Chief, Division of Plastic Surgery, Miami Children’s Hospital, Miami , FL , USA

Isaac L. Wornom III, M.D., FACS Richmond Plastic Surgeons, Virginia Commonwealth University , Richmond , VA , USA

Masatomo Yorimoto , DDS Yorimoto Dental Clinic , Osaka-Shi , Japan

xxix

Introduction

The general aim of this volume is to present recognized experts from the clinical sciences of dentistry, medicine, speech, audiology, psychology, social work, nurses, genetics, ethics, and biology, so that all aspects of the treatment of cleft palate and other craniofacial anomalies can be scrutinized from a particular point of view: long-term clinical experience.

For the sake of brevity, many variations in cleft type and their treatment alluded to in this book were not presented. Because of the multiplicity of variables, no simple description or classi fi cation and treatment plan could possibly satisfy everyone concerned with this problem.

Pruzansky (1953) was once asked, “When should the orthodontist’s, speech pathologist’s, or prosthodontist’s interest in the cleft palate child begin?” His response: “The answer is quite clear. Everyone who seeks to serve the needs of the child with a cleft should begin at the beginning.” An interest in all events affecting these children is essential to the training and educational experience that each member of the team must obtain. Each spe-cialist emerges not only better informed in his/her own fi eld, but with an increased perspective regarding the means available for providing an inte-grated program of care for the handicapped child.

The material presented examines the face with a cleft in all aspects as a biologic continuum from birth through postnatal growth and development to maturity at various stages of treatment. In the past several decades, many advances have taken place in cleft habilitation procedures. Unfortunately, many of these changes have not ful fi lled all of their stated objectives, and in some instances, these procedures were found to be either injurious or at best unnecessary. These errors will be discussed in detail.

This book also brings together clinicians and biological scientists from the United States, Asia, Europe, and Africa, each of whom in his or her own way has been seeking answers to the multifaceted problem of cleft palate, regard-ing its embryopathogenesis, craniofacial growth, maxillary orthopedics, sur-gery, protraction of the maxilla, dental speech prostheses, secondary alveolar bone grafting, speech, hearing, genetics, psychosocial development, and craniofacial surgery.

Each contributor presents pertinent concepts so that a broad perspective of the entire habilitative process can be obtained. The conclusions the reader will reach will be the result of well-documented literature of selected well-controlled clinical research that has withstood the test of review and reexamination.

xxx Introduction

Because space limitations prevent thorough penetration of all aspects of each subject, a large bibliography is included for additional source material.

In no way could these chapters be expected to cover all aspects of this complex subject.

It is my hope that, through a better understanding of the cleft palate defect and face, all clinicians will be better able to evaluate present-day treatment practices and concepts to better plan their own treatment procedures.

We fully acknowledge the important contributions made by the authors and research programs from the institutions which have strongly in fl uenced much of what has been written in these volumes.

All lip and palate surgery of my cases were performed by Dr. Ralph Millard, Jr., except where otherwise indicated; S.A. Wolfe performed all skel-etal surgery and secondary alveolar bone grafting. They both performed superior-based pharyngeal fl aps. No presurgical orthopedics were used unless speci fi cally indicated.

Reference

Pruzansky S (1953) Description, classi fi cation, and analysis of unoperated clefts of the lip and palate. Am J Orthod 39:590