Presurgical orthopedics in cleft/craniofacial care

The current state of the art in treatment of cleft lip/palate is using presurgical techniques, in order to allow for a more conservative surgery and better clinical outcomes. However there are currently no groups that provide this in the countries we visit, mostly due to financial, logistic and training limitations. Therefore, at SVI we have decided to make an effort to provide these services in order to increase the quality of care to our patients.

The first part of the protocol will be implemented in Cairo this year

We believe that as a result of providing presurgical orthopedics, we will have:

1. Less invasive surgeries
2. Better healing time
3. Decreased amount of revisions required
4. Decreased amount of complications

Additionally, we are making an effort to improve our patient tracking system. Part of this tracking system will include systematic record taking, which will allow us to conduct outcomes assessments on how we can best serve the local population.

Another area of need is teaching the local health care practitioners the newer techniques in cleft care. We are increasing our emphasis on teaching, and hoping to provide visiting scholarships for local doctors to visit some leading Centers in the U.S.

What exactly is presurgical orthopedics?

There are 3 components of presurgical orthopedics, and depending on the severity of the case, each component may or may not be employed

1. Extra-oral taping. This is done for the cleft lip, and:
Gently guides soft tissues and bone into a better position for a cleft
lip repair under less tension.
Allows one to approximate the soft tissues of a cleft lip
Allows for a controlled force to re-position the prolabium and premaxilla to allow for a less invasive surgery
May eliminate need for early lip adhesion surgery.
Relieves tension on sutures when used post-operatively.

2. Alveolar molding. This is done for the cleft palate, and:
Decreases width of palatal cleft
Decreases amount of scar tissue
Decreases likelihood of oro-nasal fistula
May help in feeding by acting as an obturator

3. Nasal stent. This is done for the nose/columnella, and:
Improves nasal tip, nasal symmetry, and columnella length
Decreases deformity of the nasal cartilage

This information was partially taken from the following website, which also has before and after pictures:
http://www.canica.com/dynacleft.asp

You can also become a sponsor

$40 provides extraoral taping and nasal stent for a patient
$30 provides nasoalveolar molding for a patient

If you would like to help in this effort, or if you have any questions or comments you are welcome to contact:

Mairaj Ahmed, DDS MS
Assistant Professor, Mount Sinai School of Medicine
Section Chief, Orthodontics & Dentofacial Orthopedics
Cleft/Craniofacial Team Orthodontist
Mount Sinai Hospital
One Gustave L. Levy Place, Box 1187
New York, NY 10029-6574
Tel: 212-241-0300
Fax: 212-996-9793
mairaj.ahmed@mountsinai.org

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