7-Hour Audiovisual Cleft Palate Treatment Course
It is necessary that more orthodontists/surgeons become involved with the study and guidance of the growth and development of the face and dentition from birth to maturity of the child with a cleft or other craniofacial anomalies.
The health and well-being of these children is dependent upon the clinical expertise of those who have served them. In addition, society as a whole is affected by the quality of their care because the potential of the affected individual for a positive contribution to the community is inevitably influenced by the adequacy of treatment.
Although the treatment of children with cleft lip/palate and other types of craniofacial anomalies in the United States has improved dramatically, many children still receive care that is substantially inferior to what can or should be provided. Inadequate care results from diagnostic errors, failure to recognize and treat the full spectrum of health problems associated with these anomalies, unnecessary and poorly timed treatment, and inappropriate or poorly performed procedures.
As a result of special training, the orthodontist's role includes diagnosis of changing facial morphology and jaw function starting at birth as a result of the cleft anomaly, followed by the surgical-orthodontic influence on growth. Orthodontists are involved in one way or another with virtually all the treatment procedures provided by all of the cleft palate-craniofacial team specialists. This educational program will improve their consultation with all of the other members of the cleft and craniofacial team. Since palatal clefts vary in the extent of osteogenic and muscular deficiencies surgeons and orthodontists have recognized that all clefts although similarly classified are not the same, therefore, each case requires differential diagnosis and treatment planning. What may be the treatment of choice for one patient may be very different for another child even with the same cleft type.
The general aim of this audiovisual lecture series is to present recognized treatment concepts from the clinical sciences of dentistry, medicine, speech, audiology, psychology, ethics and biology so that all aspects of treatment of cleft palate and other craniofacial anomalies can be scrutinized from long-term clinical experience using objective treatment records of serial casts, lateral cephs, and photographs.
The lectures examine 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 fulfilled all of their stated objectives, and in some instances, these procedures were found to be either injurious or at best unnecessary.
There are numerous types of congenital anomalies, the most common of which is cleft lip and/or palate. In the United States, this birth defect affects approximately one in 650 newborns each year. Approximately one half of these events has associated malformations, either minor or major, occurring in conjunction with the cleft. Although the incident figures for more complex anomalies or syndromes such as Apert syndrome, Crouzon disease, mandibular dysostosis or hemifacial microsomia are much lower than that of cleft lip and/or palate, the impact of craniofacial birth defects must be viewed in terms of the aggregate effect than the impact of any single entity. The impact is twofold: that of the patient and family, and that of society.
This lecture brings together accepted treatment concepts from clinicians from the United States, Asia and Europe each of who, in their own way, have been seeking answers to the multifaceted problem of cleft palate, regarding embryopathogenesis, craniofacial growth, maxillary orthopedics, surgery, protraction of the undersized or displaced maxilla, dental prosthesis, secondary alveolar bone grafting to replace missing alveolar bone, speech, hearing, genetics, psychosocial development, and craniofacial surgery. The conclusions reached are the result of well-documented cases using well-controled published clinical research that has withstood the test of review and re-examination. It must be stressed that the treatment principles presented are suitable for excepted surgical procedures used worldwide.
It is our hope that more students and practicing orthodontists through a better understanding of the cleft palate defect and face, will become involved in this crucial field to be better able to evaluate present day treatment practices and concepts.
The audiovisual lecture was previously used in six annual 2 1/2 day international seminars given in Miami by the Miami Craniofacial Anomalies Foundation. The worldwide attendees came from all specialties involved in the treatment of craniofacial anomalies.
By using this audiovisual digitized teaching technique, it is no longer necessary for the student/clinical staff to leave their institution and travel across the country. A two hour lecture per day for three to four days has been designed to cover all the necessary facets of treatment. It would be necessary for each residency program to supplement the lecture series with a copy of 'Cleft Lip and Palate – Diagnosis and Management,' edited by me and published by Springer Verlag, Berlin and New York. The serial cases and treatment concepts presented are covered in greater detail in this book with appropriate references. Past experience in evaluating the success of the lectures clearly supports the benefits of having the book available for continued review.
- 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 gingivoperisteoplasty
- The velopharyngeal mechanism and variations in the pharyngeal architecture which influences nasal air flow
- The use of a pharyngeal flap vs pharyngioplasty to control air flow
- Timing of palatal closure as it influences occlusion, speech, and facial growth
- The use of a protraction facial mask to avoid midfacial surgical advancement
- Craniofacial surgery and distraction osteogenesis
The course also includes an online version of the book Cleft Palate Treatment: The Road to Normalcy (200 pages). Contents include:
- When a Child Is Born with a Cleft
- Feeding Your Child
- The Anatomy of Clefts
- The Causes of Clefting
- The Cleft Palate Team
- Preparing for Surgery
- Surgery
- Facial and Dental Concerns
- Speech Concerns
To access the lectures and the book, visit www.cleftlippalateaudiovisuallecture.org.
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