Eye Openers are included in registration and are open to all attendees, regardless of registration. Attendees are not guaranteed a spot in their first choice sessions.
Wednesday, April 10, 7:00 am – 8:00 am
Presenters: Jack Yu, Stephen Conley
Description: This Eye Opener will be given by members of ‘The Cleft Palate-Craniofacial Journal’ Editorial Board, Section Editors from a variety of disciplines will discuss what constitutes a good scientific manuscript, what kinds of manuscripts are accepted, and what is required by ‘The Cleft Palate-Craniofacial Journal.’ Common problems in manuscript preparation and ways of avoiding them will be addressed.
Presenters: Jamie Idelberg, B.S., RDH, Celia Heppner
Description: An overview of the team approval application process and review by the Commission on Approval of Teams will be presented. This session will help to demystify the team approval process by reviewing the application Standard by Standard. Helpful hints on how to confidently prepare to fill out the application will be provided. Any specific questions that team members might have about the applications process are welcome, making for a lively and interactive presentation.
Presenters: Patel SY, Schmidt CD, Woerner JE, Notarriani CE, Ghali GE
Description: Retrospective case series of complications encountered in one stage correction of orbital hypertelorism. Lecture presentation of case based complications with in-depth discussion on multidisciplinary team based approaches to avoid them.
Presenters: Aileen Blitz, Ph.D. Jennifer Russell, LCSW Dina Zuckerberg
Description: The concept of Social Stories, initially developed for children and adolescents with autism, was created and trademarked by Carol Gray in 1991. Our team modified this modality for children with craniofacial conditions to help improve their ability to cope with distressing or novel situations. Social Stories can include: specific information about expectations, emotions and feelings and why they occur, and empower children to gain mastery and resilience.
Presenters: Lindsay Schuster, Matt Ford
Description: Interdisciplinary aspects of orthodontic and speech therapy are presented by a speech therapy/orthodontic team. Topics included are: relevant anatomy, diagnosis of malocclusions and dental anomalies, speech errors related to cleft anatomy, treatment options, limitations of treatment, and current literature. Several cases will be presented in which orthodontic therapy facilitated best speech outcomes and speech insight informed orthodontic treatment planning.
Presenters: Brenda Louw, D.Phil. SLP Linda Vallino, PhD. CCC-SLP/A
Description: A brief overview of adolescents and young adults with CLP and their multidisciplinary needs will be presented and a service delivery model for transition of care described (Vallino & Louw, 2017). The key components of the clinical toolbox to be discussed are: 1) communication strategies and styles with adolescents and young adults, 2) practical strategies for preparing and supporting the adolescent, young adult, and their families for the transition of care, 3) tips for developing self-management of health through health education and health promotion, 4) assessments and protocols as outcome indicators incorporating the domains of the ICF with an emphasis on self-report to gain a holistic perspective of function and QOL, and 5) outcome indicators of transition of care for individuals with CLP.
Presenters: Adriane Baylis, Cindy Solot, Oksana Jackson, Richard Kirschner
Description: Surgeons and SLPs from the two largest 22q Centers in the US will present a variety of challenging cases of children with VPD and 22q11DS. Cases will include anatomic, airway, speech, medical, and technical 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 and psychosocial factors, VP imaging findings, and surgical and speech therapy decision-making. In this interactive session, attendees will be asked to participate in discussion regarding evaluation and treatment approaches. The presenters will describe their use of syndrome-specific knowledge to develop a treatment plan for each case and the pre-surgical workup used to maximize surgical safety and speech outcomes. Preferred approaches for surgical revisions in patients with 22q11DS will also be presented.
Presenters: Jeffrey Goldstein
Description: Secondary cleft lip deformities can be challenging to correct. They can result from the congenital deformity or be iatrogenic in nature. Scar, growth restriction, or complications from the primary repair can further compromise the aesthetics of the lip.The purpose of this eye-opener will be to address secondary unilateral and bilateral cleft lip deformities. Great attention will be placed on analyzing the various defects and then planning and executing surgery based on the underlying problem. The effects of malocclusion and facial growth restrictions upon lip aesthetics will also be addressed. Appropriate timing for different types of reconstruction will be reviewed. Long-term followups will be presented with an emphasis upon the effects of facial growth upon cleft lip revisional surgery. Grafting techniques(autologous fat and mucosa) will also be discussed.
Presenters: Theresa M. Snelling, M.A.,CCC-SLP
Description: The presentation will include specific strategies for the Speech Pathologist to use in addressing the cleft palate related needs of children in Birth to 3/Early Intervention programs, including, but not limited to: specific examples of how to choose sound/phoneme goals in the context of age appropriate play; how to address resonance concerns; and,how to effectively communicate/offer feedback to the child’s cleft palate team. Video presentations will be included that demonstrate these strategies, as well as effective verbal cues, visual-tactile cues, and parent training techniques related to indirect language stimulation in a natural environment.
Presenters: Susan Starling Hughes
Description: This session will focus on reviewing the concept of the diagnostic odyssey and its effect on patient care and families. This lecture will demonstrate and promote understanding of the current technologies for genetic testing, focusing on WES. A variety of specific case examples from our institution will be presented to emphasize the value of incorporating WES to improve the overall healthcare provided by the interdisciplinary team.
Thursday, April 11, 7:00 am – 8:00 am
Presenters: Adriane Baylis, Ellen Moore, Kaylee Paulsgrove, Alison Scheer-Coh
Description: The authors will present a variety of cases of individuals with cleft palate and associated craniofacial or velopharyngeal conditions. Cases include a variety of profiles related to speech, language, and hearing. The authors will compare and contrast different team approaches for the decision-making process in assessment and management. Each stage of the diagnostic and treatment process will be reviewed including case history, diagnostic protocol (including instrumental assessment and imaging, if available) and findings, treatment options, and intervention outcomes. Cases will be presented in both audio and video format. Attendee participation will be highly encouraged.
Presenters: Kristi Thaete
Description: This multidisciplinary presentation will identify the role of each feeding-related specialty involved in our cleft nutritional management approach and discuss pearls and pitfalls at each stage of infant development. The importance of early, frequent, and supportive interactions with families will be stressed and we will detail the appropriate assessments and interventions necessary to help these children and their families meet age-appropriate nutrition and lactation goals throughout the first year of life. We will highlight ways in which different team compositions can maximize their newborn feeding support, teach food and cup transitions, and provide appropriate post-operative nutritional recommendations. The target audience for this presentation will be anyone involved with nutrition, feeding, or lactation education and assessment of patients with a cleft or craniofacial condition.
Presenters: Brittney Sprouse
Description: This presentation will examine clinical case studies of patients being followed by UChicago Medicine Craniofacial Clinic while addressing the challenges and barriers of managing this patient population. Discussion will reflect the audiologic assessment and recommendations including treatment options for an osseointegrated device (Cochlear Baha and Oticon Medical Ponto) via a variety of coupling options including transcutaneous (Cochlear Attract), percutaneous (traditional abutment), softband or the Cochlear SoundArc. The objective of this presentation is to offer various case study scenarios where traditional amplification is not an option for children in this patient population. The prevalence of craniofacial anomalies such as cleft lip and/or palate and microtia/atresia along with craniofacial conditions such as Crouzon syndrome, Goldenhar syndrome, and Treacher Collins syndrome will also be discussed along with its impact on assessment, treatment and multidisciplinary care. This presentation will also address the importance of counseling during device selection as it pertains to transcutaneous or percutaneous and softband or Cochlear SoundArc when surgery is not in the best interest of the patient along with the challenges and ways to overcome barriers when fitting this patient population. Finally, the presentation will indicate areas of need within this patient population including areas of future research.
Presenters: Iris Sageser Jamie Idelberg
Description: The presenters will discuss the relationship challenges that care coordinators may experience with their patients and families of a cleft or craniofacial team. One of the most rewarding parts of a care coordinator’s role is making personal connections with patients and parents. Despite the challenges, there are ample opportunities to develop a connection. Relationships with patients and families of a cleft or craniofacial team has been evolving for care coordinators. Several factors have been contributing to this change: increased number of patients managed and seen in clinic, language/cultural differences, administrative decision-making, and the increase of electronic communication options with families. Relationships with a child and parents can now begin at different points of entry. Traditionally the initial relationship began prenatally or at the birth of the affected child and continued until young adulthood. Providers often now have defined roles and points of entry into the child’s cleft or craniofacial care. There may be more providers involved in a child’s care and this can result in fragmented relationship building between providers and families. Connections among cleft and craniofacial team providers can also be affected as teams expand and include more providers. At times this can cause unintended stressors within the team. However, it can also strengthen relationships as providers work collaboratively and face-to-face as a team on patients’ care. Discussion will include ideas on facilitating team and relationship building. For our cleft and craniofacial population, connecting patients and families can be powerful and long lasting. Discussion will include how we can still make meaningful connections through a variety of planned events and activities.
Presenters: Kathryn Barbash, PsyD and Janine Rosenberg, PhD
Description: This interactive presentation will describe and define the concept of resiliency, review key broader research findings about the resiliency in children and resiliency findings specific to our cleft and craniofacial population, and explore ways the interprofessional healthcare team can foster and support resiliency on a developmental continuum.
Presenters: Michael Lypka
Description: With a panel consisting of a craniofacial surgeon, otolaryngologist, sleep physician, and orthodontist, the course will explore a series of cases of Robin Sequence, with audience participation encouraged. Work-up, including airway and sleep evaluation, surgical technique, and long term follow up, including orthodontic considerations, will be discussed.
Presenters: Richard E. Kirschner, MD, FACS, FAAP
Description: Understanding and applying these ideas, including The Law of Significance (Yes, It Takes a Team!), The Law of Purpose (It Really is the Vision Thing), and the Law of the Helm (The Team Sinks or Sails on Leadership), will not only help your team fulfill its mission but also empower your team to achieve greatness. This all new session is designed for all team members and team leaders (which, on successful teams are truly one and the same). Finally revealed is the 5th Law, one that is certain to transform your team and lead it to the winner’s circle! Learning and practicing these laws will enhance your capacity to unlock your potential and to function effectively as a team leader, allowing you to provide your patients with the best in comprehensive cleft and craniofacial care.
Presenters: Pravin Patel
Description: For nearly half-a-century, reconstructing patients with craniofacial deformities has relied primarily on two-dimensional photographic images and radiographs. It was the surgeon’s eye and experience that integrated the two-dimensional records to generate the virtual three-dimensional image for surgical planning. In the last decade of the twentieth century, multi-dimensional visualization of the skeletal deformity became possible with the emergence of computerized tomography (CT). This allowed the surgeon the ability to visualize the complexity of the deformity but not the ability to simulate surgery. It is only within the last several years that rapid advances in computational software began to transform the pure visual imagery of CT to allow the surgical simulation to become a reality. Today surgeons are beginning to have the tools to simulate various craniofacial skeletal osteotomy patterns and the ability to manipulate each of the bony elements. However, the limitation of true simulation has always been the inability to fully visualize the third dimension on two-dimensional flat screen displays. Thus, surgeons relied on 3D printed models for tactile feedback and to visualize depth. With the recent introduction of immersive virtual reality (VR), augmented reality (AR) and haptic feedback (HF), true three-dimensional surgical simulation becomes a possibility. This presentation will review currently accessible technology for the practicing surgeon through a series of cases studies for patients who required various components of craniofacial surgery. This will include pre- and post-processing of diagnostic 3D surface and skeletal records; integrated orthodontic-surgical planning, 3D relevant software for both orthodontic and skeletal manipulation, translation from virtual to physical environment with CAD/CAM 3D printed models and guides. This presentation will also showcase the technology of the future where resident training and patient-specific planning for the surgeon will be done in an immersive VR environment that will closely simulate the operating theater.
Presenters: Pablo Antonio Ysunza M. D. Ph. D. ; Kongkrit Chaiyasate, M. D.; Matthew Rontal, M. D.
Description: The basic Anatomy and Physiology of adenoid and tonsils will be presented and discussed. The specific role of adenoid in velopharyngeal closure during speech will be thoroughly described. How enlarged tonsils can interfere with velar motion during speech will be presented. The indications for T & A in patients with cleft palate will be discussed. The different surgical techniques for performing tonsillectomy and adenoidectomy in patients with cleft palate will be discussed. The indications for performing T & A before velopharyngeal surgery aimed to correct VPI will be discussed. The different indications in syndromic and non-syndromic cases will be addressed. The timing of T & A and velopharyngeal surgery will be analyzed. In sum, the questions of why, when, how and who should T & A be performed in patients with cleft palate will be answered. Several cases of tonsil hypertrophy causing VPI in patients with cleft palate will be presented. Several cases of VPI following adenoidectomy either with palatal anomalies or without them will be presented. The importance of assessing tonsils and adenoids before velopharyngeal surgery in order to prevent sleep disordered breathing will be extensively analyzed and discussed.
Friday, April 12, 7:00 am – 7:45 am
Presenters: Lynn Marty Grames
Description: Description: A review of what is known of adaptive articulations from published literature will be covered, including terminology, cause, hypotheses regarding natural history, and descriptions. Video case examples of various adaptive articulations will be presented, with cases including cleft lip and palate, midface hypoplasia, macroglossia, and facial paralysis. Discussion will include whether or not these can or should be taught in therapy, what techniques might be effective, and how they might be taught to others. Future research ideas and possibilities for educating student and community speech pathologists will be canvassed.
Presenters: Alexander C. Allori, MD, MPH
Description: Raw data were obtained from North Carolina Birth Defect Monitoring Program (NCBDMP), Patient-Centered Outcomes Research Network (PCORnet), hospital electronic health records (EHR), and a condition-specific outcomes registry (CleftKit, which includes the ICHOM Standard Set, CLEFT-Q, etc.). A project-specific schema was defined following the PCORnet CDM with further inspiration from other common systems (e.g., PEDSnet and OMOP CDM and HL7 FIHR interoperability standards). Structured data were extracted from each raw source, transformed, and loaded (ETL) into a relational database (PostgreSQL/PostGIS) according to this schema, and unstructured data were stored in a parallel document database (MongoDB). Data linkage and deduplication were performed using retained PHI and/or statistical matching. A custom API was programmed in Python to facilitate clinical queries and exploratory analysis. Best practices of software development and reproducible research were followed, including use of version control for code stability, virtual environments and containers for reproducibility, Jupyter notebooks for exploration and communication, and use of highly tested open-source software.
Presenters: Raymond Tse, David Fisher
Description: We will use step-by-step explanations to illustrate and clarify the approach. We will use case examples that span the spectrum of presentations from complete to microform clefts. We will describe ways to verify and adapt the repair for final tailoring so that there is some flexibility in final repair. We will use a combination of photos, videos, illustrations, and discussions to ensure that attendees benefit from the session. Even if more experienced surgeons do not adopt the technique, an understanding of the approach can help with the non-overt landmarking that occurs with cut-as-you-go repairs. Careful planning makes for accurate and efficient repair and that ultimately benefits our patients!
Presenters: Helen Huff, Brenda Sitzmann, Erin Lindhorst
Description: This presentation provides an overview of our multidisciplinary educational program for medical professionals which focuses on cleft care for the newborn and why these infants have difficulty with breast and bottle feeding from a standard bottle nipple. We will describe our hands-on approach for providing this valuable cleft feeding education and support for primary care and bedside providers. Additionally, we will discuss how we have targeted our different learning cohorts for future replication of similar education programs elsewhere
Presenters: Pablo Antonio Ysunza M. D. Ph. D. ; Kongkrit Chaiyasate, M. D.; Matthew Rontal, M. D.
Description: The methodology for performing VNP and MPVF will be presented and discussed. The advantages and disadvantages of each one of these procedures will be extensively discussed. The use of strategies for enhancing patient compliance during these procedures will be presented. The importance of using an adequate speech sample and its specific characteristics for the performance of these procedures will be discussed. The importance of recording these procedures with sound will be discussed. Specific measures for reducing radiation dosage while providing adequate imaging data during MPVF will be presented. Evidence based data concerning the interpretation of findings of VNP and MPVF and the use of these data for contriving surgical procedures aimed to correct VPI will be analyzed. Besides describing the methodology for adequately performing these procedures, several cases of VPI will be presented and the relationship between planning and outcome will be analyzed.
Presenters: Joyce K. McIntyre MD Amanda Gosman MD Alicia Sigler MD
Description: The first portion of this 60 minute session will be a lecture format and authors will review the principles of the Helsinki Accords as they relate to informed consent and recent efforts by national societies like the American Society of Plastic Surgeons to adopt a code of ethics around social media. The second portion of the session will include collaborators from several patient advocacy groups to discuss in a round table format their efforts to change how patients with a cleft/craniofacial difference are commonly portrayed in media (plan to invite collaborators from Face to Face Colorado, ACPA Family Services, Changing Faces and CCAKids) The final portion of the session will be hands on where participants can critique de-identified examples of advertising and apply the principles they have learned to create positive web based and social media communications.
Presenters: Patricia Keenan, M.A., CCC-SLP Speech Language Pathologist Akron Children’s Hospital
Description: The Gold Standard in Cleft and Craniofacial Care is the ‘TEAM’ approach. ACPA has established Standards for Craniofacial Team Care and evaluation processes to ensure each Team is providing optimal care. Issues will arise when providing complex multidisciplinary care involving multiple professionals from different backgrounds, education, and personalities. Sustaining a successful team entails ongoing attention to the team process. This can be accomplished by the development and maintenance of effective decision making, collaboration, communication, clearly defined team roles, conflict management skills, an awareness of the influence of values, and a strong code of ethics (Fox, L. and Stone, P., 2013). Given the pressures of revenue producing units, large patient volumes, and the ability to organize a number of professionals into one place at any given time, team retreats have become a luxury. The A3 business management model is a structured problem-solving approach that is simple to employ. The model uses a strict systematic path towards problem solving, identifying desired outcomes, analyzing situations, pinpointing proposed outcomes, and the development of an action plan. The A3 management system is based on structured opportunities for people to learn in manner that is natural: through experience, by learning from mistakes, and through plan-based trial and error (http;//sloanreview.mit.edu/article/toyatos-secret-the-a3-report/). Cleft and Craniofacial Teams can use principles from this method to identify team dynamic concerns, daily clinical flow issues, performance improvement plans, and patient issues. The optimal goal is to improve team communication and gain interdisciplinary concurrence in prioritizing Craniofacial Team goals for the year (Huth, J. 2017).
Presenters: Sylvie Render
Description: This interactive eye opener will include an overview of the role of videofluoroscopy (VF) in assessment and treatment planning of velopharyngeal dysfunction. It will review the nuts and bolts of how to perform VF to obtain optimal information for diagnostic and surgical planning purposes including set-up, placement of barium, and elicitation of the speech sample. A sample protocol will be presented. Attendees will gain practice with identification of various anatomical and functional findings on sample VFs including asymmetric palate movement, presence of Passavant’s ridge, role of adenoid tissue in velopharyngeal closure, and identification of compensatory misarticulations. Attendees will participate in consensus ratings of palate elevation, posterior pharyngeal wall movement, and lateral wall contributions to velopharyngeal closure. Integration of VF findings with NP and perceptual speech assessment will be discussed.
Presenters: Stacey Francis, Roberto Flores
Description: We will start with an overview of the literature surrounding inpatient vs outpatient cleft lip surgery and epidemiology about the numbers of institutions that do inpatients vs outpatient. if possible we would like to include an audience poll to get an idea of practice patterns in the room. Then based on the recent published studies, each panelist will share different protocols that have been successful for outpatient cleft lip management and how that could be implemented if a center wants to consider outpatient cleft lip surgery. This includes: pre-operative education that can be done by the team or nurse managers, peri-operative management before, during and after the operation, and post-operative care after they go home. All are very key components to a successful outpatient cleft lip management. We will also discuss the barriers to doing outpatient cleft lip surgery as well as having a panelist who consistently does inpatient cleft lip surgery to present the rationale behind their practice management and also their barriers to outpatient cleft lip surgery. I have reached out to a few people and will be discussing with them at the upcoming ASPS meeting to see who may be interested in joining the panel to discuss that. We will discuss the economic impact overall of practice changes to a predominantly outpatient surgery and also potential insurance policy impact. We think this will be a very useful topic for any team member participating in the care of a cleft lip patient.