Thursday 1:30 PM

Presenters: Robert J Mann MD, John A Girotto MD, Matthew Fahnrenkopf MD

Presenter Disclosures: Robert Mann has no relevant financial relationships to disclose.  Robert Mann has no relevant non-financial relationships to disclose.  John Girotto has no relevant financial relationships to disclose.  John Girotto has no relevant non-financial relationships to disclose.  Matthew Fahrenkopf has no relevant financial relationships to disclose.  Matthew Fahrenkopf has no relevant non-financial relationships to disclose.

Description: Background:  The challenge for the cleft palate reconstructive surgeon is to successfully repair every type and anatomical variation of cleft palate.  Presently, the vast majority of surgeons use single pattern repairs which are highly inflexible and may only work well on certain anatomic presentations.  Many surgeons revert to older, more growth restricting techniques on complete or wide clefts.  This leads to variability of success based on the width or type of the cleft.  This Buccal Flap workshop incorporates of new videos and  the lessons learned from the previous workshops. Purpose: To change the fundamental way we approach reconstruction of the palate, using the embryonic approach in primary repairs replacing  the deficient tissue with similar functioning  tissue ( the buccal flap). To improve the outcome of Palate reconstruction in secondary repairs, by adding the  missing  tissue  necessary to achieve success Description :Buccal Myomucosal Flap has great application in Cleft palate repair. This will be demonstrated Though video , slide didactic  presentation and audience interaction.  The senior presenter will relate his experiences with over 1,000 buccal flaps surgeries used in various cleft palate applications. Objectives:The learner will be able to list the steps to successfully elevate the buccal flap and to describe its use in both primary and secondary cleft surgeries.  The learner will be able to employ the buccal flap in multiple cleft anatomical presentations and use it effectively to salvage a procedure after a complication mid operation (i.e. torn velar flap).  The learner will identify how the use of the buccal flap can reduce the need for relaxing/releasing hard palate incisions and maintain better alveolar blood supply.  The learner will incorporate buccal flaps in the formulation of specific palatal flap patterns to treat various cleft shapes: wide or narrow, high arched or broad arched.  The learner will judge the effectiveness of buccal flap use through review of large group, long term follow up studies of cleft palate repairs.  This course will improve patient outcomes as the learner employs this efficacious reconstruction tool (buccal flaps) in their cleft palate reconstructive care plan.

Learning Objectives: Learner will list the steps to successfully use buccal flaps in both primary and secondary cleft surgeries.  Learner will recognize how the buccal flap can effectively salvage a procedure after a torn flap mid operation. The learner will incorporate buccal flaps in the formulation of specific palatal flap patterns to treat various cleft shapes: wide or narrow, high arched or broad arched.

 

Presenters: Adriane Baylis, Oksana Jackson, Cynthia Solot, Richard Kirschner

Presenter Disclosures:  Adriane Baylis has disclosed the following financial relationships: Salary from Nationwide Children’s Hospital The Ohio State University College of Medicine, consultant for Educational Testing Services National Advisory Board for Speech-Language Pathology, Contracted Research for National Institutes of Health NIDCR.  Adriane Baylis has disclosed the following non-financial relationships: ACPA, Preconference Co-Chair and Education Committee ASHA, SIG 5 Coordinating Committee.  Oksana Jackson has no relevant financial relationships to disclose.  Oksana Jackson has no relevant non-financial relationships to disclose.  Cynthia Solot has no relevant financial relationships to disclose.  Cynthia Solot has no relevant non-financial relationships to disclose.  Richard Kirschner has no relevant financial relationships to disclose.  Richard Kirschner has no relevant non-financial relationships to disclose.

Description: Successful management  of velopharyngeal dysfunction (VPD) in children with 22q11.2 deletion syndrome (22q11DS) is widely-recognized as a challenge for surgeons and SLPs.  Even in the hands of clinicians with extensive cleft/craniofacial experience , speech surgery outcomes for 22q11DS are often reported to be less optimal than those  of children with cleft palate or other causes of VPD. The nature of VPD in 22q11DS is complex, and thus treatment planning and surgical technique must be tailored to syndrome-specific and patient-specific factors in order to optimize outcomes. The purpose of this advanced session is to explore the diagnostic and mangement strategies involved with the management of VPD in children with 22q11DS. Surgeons and SLPs from the two largest 22q Centers in the US will present a variety of cases of VPD in children with 22q11DS. Cases will include challenges related to anatomic, airway, speech, medical, and technical-surgical   considerations.  Audio and video recordings of speech and VP imaging will be presented and discussed.  Each step of the diagnostic and treatment process will be reviewed including patient history, speech-language profile, cultural factors, speech diagnostic results, and VP imaging findings. In this interactive session, attendees will be able to participate in discussion regarding evaluation and treatment approaches. The presenters will describe how they use syndrome-specific knowledge to develop a treatment plan for each case and the presurgical workup used to maximize surgical safety and speech outcomes. Surgical approaches and revision options for patients with 22q11DS will also be illustrated.

Learning Objectives: Participants will be able to (1) describe strategies to ensure accurate differential diagnosis of VPD for speech in patients with 22q; (2) list at least 3 different factors which may influence preoperative VPD surgical planning in 22q; (3) describe surgical modifications of traditional VPD surgery for patients with 22q.

Thursday 3:30 PM

Presenters: Alison Kaye, Oksana Jackson, Susan Starling-Hughes, Leanne Magee

Presenter Disclosures:  Alison Kaye has no relevant financial relationships to disclose.  Alison Kaye has no relevant non-financial relationships to disclose.  Oksana Jackson has no relevant financial relationships to disclose.  Oksana Jackson has no relevant non-financial relationships to disclose.  Susan Hughes has no relevant financial relationships to disclose.  Susan Hughes has no relevant non-financial relationships to disclose.  Leanne Magee has no relevant financial relationships to disclose.  Leanne Magee has no relevant non-financial relationships to disclose.

Description: Congenital cleft conditions frequently occur in conjunction with a syndrome or constellation of other medical abnormalities. Some patients have very few medical issues while some are profoundly affected and require long-term intensive medical care. There are many well-identified syndromes associated with clefting including Stickler syndrome, Van der Woude syndrome, and 22q11.2 Deletion syndrome. There are also medically complex patients with rare syndromes and even those where a unifying diagnosis has not been identified, despite comprehensive genetic testing. The infrequency and uniqueness of presentation of some cleft-associated syndromes and conditions provides us with a number of patients for whom highly individualized treatment plans must be devised. Factors related to long term prognoses for issues of feeding, speech, hearing, dental development, and cognitive function must be considered when developing cleft care plans. Safety and appropriateness for surgery and the need to prioritize other necessary treatments are factors that may preclude adherence to typical cleft treatment protocols. This session will explore ways in which cleft care for medically complex patients may or may not differ from those without concomitant diagnoses. A multidisciplinary panel will examine the various issues surrounding the comprehensive management of patients with rare and complex cleft-associated conditions. Case studies will be used to highlight the medical, surgical, and psychosocial challenges presented by this special subset of Cleft Team patients. Management guidelines will be outlined and we will investigate reasons for delayed or avoided surgeries, adaptations in surgical techniques, and under-addressed or residual needs encountered in the care of these patients. The process of genetic diagnosis of ultra-rare or provisionally unique conditions will be reviewed. The role of early dismissal from Cleft Team or active non-treatment in these patients will also be discussed.

Learning Objectives: Each learner will be able to describe 3 complex medical conditions that may involve a cleft lip and/or palate diagnosis.   Each learner will be able to describe 3 reasons for adaptation of cleft care protocols to account for an associated complex medical condition.

Presenters: Pradip R. Shetye, DDS, Roberto L Flores, MD

Presenter Disclosures:  Pradip Shetye has no relevant financial relationships to disclose.  Pradip Shetye has no relevant non-financial relationships to disclose.  Roberto Flores has no relevant financial relationships to disclose.  Roberto Flores has no relevant non-financial relationships to disclose.

Description: Presurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with a bilateral cleft. The NasolAveolar molding (NAM) technique is a unique approach to presurgical infant orthopedics to reduce the severity of the initial cleft of the alveolar and the nasal deformity particularly in patients with bilateral cleft lip and palate. In infants with bilateral cleft lip and palate, the premaxilla may be protrusive, mobile, and may show varying degree of asymmetrical displacement and rotation. In some instances, the premaxilla may be everted placed on top of the nasal tip with a very short columella length. Protruded premaxilla and the associated nasal deformity present a special challenge for the surgeon in achieving optimal repair during primary reconstructive surgery. This study session will demonstrate the NAM technique to treat patients with severe bilateral cleft lip and palate. The technique of correcting the protruded and asymmetrically displaced premaxilla, molding the alar cartilage and non-surgical columella elongation will be discussed. Appliance design and weekly adjustment of the NAM appliance to accomplish the desired result will be presented. Special emphasis will be placed on leveling the premaxilla in asymmetric cases, retracting premaxilla in incomplete bilateral clefts and management of complications during the course of the NAM therapy will be discussed. For the successful outcome, the surgeon has to take the advantage of the NAM therapy during the primary repair. Surgical technique of one stage lip nose and alveolus surgery utilizing the pre-surgical preparation of infants with bilateral cleft lip and palate with NAM therapy will be discussed in detail. Long-term outcome of patients treated with NAM and primary reconstruction of nose lip and alveolus will be presented.

Learning Objectives: Describe the NAM technique in the management of patients with bilateral cleft lip and palate.  Describe the one stage surgical  repair of the lip, nose, and alveolus in patients with bilateral cleft lip and palate following NAM technique.