Cleft Lip/Palate Lecture Series (7 Hours)

Created by Samuel Berkowitz, DDS, MS, FICD and the University of Illinois College of Dentistry/Department of Orthodontics

Table of Contents

 

Welcome

Why is this lecture important?

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.  These errors will be discussed in detail.

There  are numerous types of congenital craniofacial 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 infants have associated malformations, either minor or major, occurring in conjunction with the cleft.  Although the incidence figures for more complex anomalies or syndromes such as Apert Syndrome, Crouzon disease, mandibulofacial dysostosis or hemifacial microsomia are much lower than that for cleft lip and/or palate, the impact of craniofacial birth defects must be viewed in terms of the aggregate effect rather than the impact of any single entity.  The impact is twofold: that on the patient and family and that on society.

As a result of special orthodontic training, the orthodontists’  role includes diagnosis of changing facial morphology and jaw function as a result of the anomaly, followed by its influence on growth. They provide orthodontic/orthopedic treatment and general expertise for consultation with all of the other members of the cleft and craniofacial team.  Orthodontists are involved in one way or another with virtually all of the treatment procedures provided by all of the cleft palate-craniofacial team’s specialists.  Since palatal clefts vary in the extent of osteogenic and muscular deficiencies, surgeons should recognize 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 different for another even with the same cleft type.

The general aim of this audiovisual lecture series to be given to each graduate department is to present recognized treatment concepts from the clinical sciences of dentistry, medicine, speech, audiology, psychology, genetics, 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 lecture 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.  It brings together treatment concepts from clinicians from the United States, Asia and Europe each of whom in their own way have been seeking answers to the multifaceted problem of cleft palate, regarding its embryopathogenesis, craniofacial growth, maxillary orthopedics, surgery, protraction of the maxilla, dental prostheses, secondary alveolar bone grafting, speech, hearing, genetics, psychosocial development and craniofacial surgery.  The conclusions reached are the result of well-documented cases used in well-controlled published clinical research that has withstood the test of review and re-examination.

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 field to be better able to evaluate present-day treatment practices and concepts to better plan their own treatment procedures. By using this audio-visual teaching technique, it is no longer necessary for student/clinical staff to leave their institution.  A two hour lecture per day for three to four days has been designed to cover all of the material.  It would  be beneficial for each residency program to supplement the lecture series with a copy of ‘Cleft Lip and Palate – Diagnosis and Management’  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.

 

About Dr. Berkowitz

Dr. BerkowitzDr. 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.  His main goal is to develop teaching materials in cleft palate for professions in plastic and oral surgery, orthodontics and speech and language pathology.

He is past President of the American Cleft Palate Association Educational Foundation and the Florida Cleft Palate Association.  Dr. Berkowitz was active in the  American Association of Orthodontics and The Edward Angle Society of Orthodontists.  He has been a recipient of the Second International Cleft Palate Foundation Award given in Zurich, Switzerland and received a Distinguished Service Award from the American Cleft Palate-Craniofacial Association.

Dr. Berkowitz has been awarded the title ‘Honoree’ by the Edward Angle Society of Orthodontists for his many contributions to the field of cleft lip and palate treatment.  His extensive serial clinical records of dental cast, lateral cephaloradiographs, panorexes, and facial and intraoral photographs are now in the National Museum of Health and Medicine (associated with Walter Reed Hospital’s Institute of Pathology) in Washington, D.C., where they are available for continued study.

He has published widely in medical cleft palate journals and is the author of Volume I Cleft Lip and Palate Perspectives in Management: he coauthored  Plastic Surgery of the Facial Skeleton with S.A. Wolfe, MD, and wrote The Cleft Palate Story in English and Spanish for parents of a child born with a cleft.  He has also edited Cleft Lip and Palate: Diagnosis and Management – Second Edition, Springer-Verlag, Heidelberg and New York, and is now editing the Third Edition due for publication in spring 2013.

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 focuses on improving surgical-orthodontic treatment planning for cleft lip and palate children as well as those with other craniofacial anomalies. He was project director of a clinical research program that was studying the long-term effects of various surgical treatment procedures on palatal and facial growth and development.  He created a quantitative 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.  This usually occurs between 18 to 24 months but sometimes even later.

 

The Audio Visual Lectures

This web-based lecture series focuses on concepts derived from analysis of treatment cases documented from birth to adolescence with serial casts, lateral cephaloradiographs, panorexes and photographs (facial and intraoral).  Approximately 15 sets of records were obtained per case. The serial palatal casts were analyzed three-dimensionally to show palatal size and form changes at various ages as a result of surgical orthodontic treatment.  These studies are very unique and will cover treatment of most of the cleft types presented in his books  Cleft Lip and Palate Diagnosis and Management, Second  & Third Edition, published by Springer-Verlag and Cleft Palate Treatment: The Road to Normalcy.

It must be stressed that this lecture has been presented and tested by the residents of the Orthodontic Department at the University of Illinois College of Dentistry.

 

Topics Covered 

 

Watch the lecture series NOW

Click on the links below to view each lecture. Please be patient with loading times as each lecture is quite lengthy.

1. Introduction

2. Embryopathogenesis

3. Feeding

4. Variatons in Cleft Types

5. Achievement of Treatment Goals

6. Surgery

7. Complete Unilaterial Cleft Lip and Palate: Conservative Treatment (non-presurgical orthopedics)

8a. Complete Bilaterial Cleft Lip and Palate (Part I)

8b. Complete Bilaterial Cleft Lip and Palate (Part II)

9. Timing of Palatal Surgery

10. Presurgical Orthopedics

11. Protraction Facial Mask

12. Second Stage Surgery

13. Distraction Osteogenesis

14. Teeth Replacement

15. Nasopharyngeal Space

16. Speech Aid Appliances

 

Also available is The Road to Normalcy (200 pages). Contents include:

  1. When a Child is Born with a Cleft
  2. Feeding your Child
  3. The Anatomy of Clefts
  4. The Causes of Clefting
  5. The Cleft Palate Team
  6. Preparing for Surgery
  7. Surgery
  8. Facial and Dental Concerns
  9. Speech Concerns

 

Download The Road to Normalcy now.