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video (7)
Bilateral Cleft Lip Repair
videoContributors: Larry Hartzell Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon. The goals of an acceptable repair must include precise continuity of the cupid's bow, maximizing philtral length, and establishing a mucosa lined sulcus. We present an example of a repair of the bilateral incomplete lip as described by Millard. DOI: http://dx.doi.org/10.17797/qefi9lqbam
Mandibular Distraction for Micrognathia in a Neonate
videoIntroduction Patients with Pierre-Robin Sequence (PRS) suffer from micrognathia, glossoptosis, and upper airway obstruction, which is sometimes associated with cleft palate and feeding issues. To overcome these symptoms in our full-term male neonate patient with PRS, mandibular distraction osteogenesis was performed. Methods The patient was intubated after airway endoscopy. A submandibular incision was carried down to the mandible. A distractor was modified to fit the osteotomy site that we marked, and its pin was pulled through an infrauricular incision. Screws secured the plates and the osteotomy was performed. The mandible was distracted 1.8 mm daily for twelve days. Results During distraction, the patient worked with speech therapy. Eventually, he adequately fed orally. He showed no further glossoptosis or obstruction after distraction was completed. Conclusion In our experience, mandibular distraction is a successful way to avoid a surgical airway and promote oral feeding in children with PRS and obstructive symptoms. By: Ravi W Sun, BE Surgeons: Megan M Gaffey, MD Adam B Johnson, MD, PhD Larry D Hartzell, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD
Superiorly Based Pharyngeal Flap for Velopharyngeal Dysfunction
videoVelopharyngeal dysfunction (VPD) refers to the improper control of airflow through the nasopharynx. The term VPD denotes the clinical finding of incomplete velopharyngeal closure. Other terms used to describe VPD include velopharyngeal insufficiency, inadequacy and incompetence. However, the use of VPD has gained popularity over these terms as they may be used to infer a specific etiology of impaired velopharyngeal closure.1 Control of airflow through the nasopharynx is dependent on the simultaneous elevation of the soft palate and constriction of the lateral and posterior pharyngeal walls. Disruptions of this mechanism caused by structural, muscular or neurologic pathology of the palate or pharyngeal walls can result in VPD. VPD can result in a hypernasal voice with compensatory misarticulations, nasal emissions and aberrant facial movements during speech.2 The assessment of velopharyngeal function is best preformed by a multispecialty team evaluation including speech-language pathologists, prosthodontists, otolaryngologists and plastic surgeons. The initial diagnosis of VPD is typically made with voice and resonance evaluation conducted by a speech-language pathologist. To better characterize the patient’s VPD, video nasopharyngeal endoscopy or speech videofluoroscopy can be used to visualize the velopharyngeal mechanism during speech. VPD may first be managed with speech-language therapy and removable prostheses. For those who are good surgical candidates and do not fully respond to speech-language therapy, surgical intervention may be pursued. Surgical management of VPD is most commonly accomplished by pharyngeal flap procedures or sphincter pharyngoplasty. In this video, a superiorly based pharyngeal flap with a uvular mucosal lining flap was preformed for VPD in a five-year-old patient with 22q11 Deletion Syndrome and aberrantly medial internal carotid arteries.
Lip Pit Excision
videoThis video shows a pediatric patient with Van der Woude syndrome. He has lip pits that are classic for this syndrome and his family desired surgical correction. This video outlines and shows the steps of the modified simple excision technique as well as discussing tips for a successful surgery.
Pre-operative marking for the Fisher technique in unilateral cleft lip repair
videoThis video outlines the steps taken for pre-operative markings that need to be made prior to performing unilateral cleft lip repair using the Fisher anatomic subunit approximation technique. The technique has been written about in detail by Dr. David Fisher in his article "Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique". This video simply outlines the markings that are made prior to performing this technique, which are crucial for correctly carrying out the repair.
Nasal Dermoid Cyst Excision
videoThis is a case of an 8 month old with a midline nasal mass present since birth. Preoperative physical exam and imaging was consistent with a nasal dermoid cyst with no evidence of intracranial extension.
Repair of Tessier 7 Cleft Lip Deformity
videoThe most common of the rare craniofacial clefts, Tessier's No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1) The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion. This case is presented as an example of the repair of the Tessier 7 cleft lip deformity. DOI #: http://dx.doi.org/10.17797/4h2edlts5zz
webinar (8)
Cleft Lip Revision: Tips and Tricks
webinar
Attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to address common challenges and how to address them.
Course Directors


Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.
Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.
Panelists


Dr. Leeper completed her residency training in Otolaryngology--Head & Neck Surgery at the Medical University of South Carolina in 2012 and fellowship training in Pediatric Otolaryngology at Arkansas Children's Hospital in 2014. She returned to the University of North Carolina - Chapel Hill in 2014 on faculty in the Department of Otolaryngology--Head & Neck Surgery. She is the current Fellowship Director and Medical Director of the Children's Cochlear Implant Center. She is married to Bradley and they have one daughter Sutton and a baby boy arriving this month.
Dr. Manlove joined Carle Foundation Hospital in 2016 as a fellowship trained cleft and craniomaxillofacial surgeon. She is the director of the cleft and craniofacial team at Carle. In 2018 she was name “Rising Star Physician” and that same year she also became the residency program director. Outside of work, she loves spending time with her family and she is an avid runner.


Dr. Kacmarynski is a Clinical Associate Professor in the Department of Otolaryngology-Head & Neck Surgery at the University of Iowa, working as a pediatric otolaryngologist and a cleft and craniofacial surgeon with co-directorship for the cleft and craniofacial team at the University of Iowa. Research focus is on biomedical collaborations with oral cleft and craniofacial surgical problems including craniofacial airway, tissue engineering solution development, outcomes research and patient-centered outcomes research collaboratives. I am excited about the long-term impacts of research leading very directly to significant improvements in our patients’ healing and growth.
Jordan Swanson, MD, MSc, is an attending surgeon in the Division of Plastic, Reconstructive and Oral Surgery at Children’s Hospital of Philadelphia with special clinical expertise in cleft, craniofacial, and pediatric plastic surgery. He holds the Linton A. Whitaker Endowed Chair in Plastic, Reconstructive and Oral Surgery.
Alveolar Bone Graft Surgery: Tips and Tricks
webinar
This webinar will focus on the surgical management of alveolar clefts with bone grafting and fistula closure. Our panel of experts will share various techniques and graft source materials including tips and tricks learned along the way. Our guest moderator will lead a panel discussion at the end of the session to discuss some of the controversies and key points in alveolar grafting.






Dr. Larry Hartzell Director of Cleft Lip and Palate / Pediatric ENT Surgeon @ Arkansas Children's Hospital / University of Arkansas for Medical Sciences | Dr. Steven Goudy Professor / Director of Division of Otolaryngology @ Emory University School of Medicine / Children's Healthcare in Atlanta |
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Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA. | Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction. |
Travis T. Tollefson MD MPH FACS Professor & Director of Facial Plastic & Reconstructive Surgery @ University of California Davis | Mark E. Engelstad DDS, MD, MHI Associate Professor of Oral and Maxillofacial Surgery @ Oregon Health & Science University |
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Dr. Tollefson is a Professor and Director of Facial Plastic & Reconstructive Surgery at the University of California Davis, where he specializes in cleft and pediatric craniofacial care, facial reconstruction and facial trauma care. His interest in the emerging field of Global Surgery and improving surgical access in low-resource countries led him to complete an MPH at the Harvard School of Public Health. He helps lead the CMF arm of the AO-Alliance.org, whose goal is to instill AO principles in facial injuries in low resource settings. His current research focuses on clinical outcomes of patients with cleft lip-palate, facial trauma education in Africa, patterns of mandible fracture care, and patient reported outcomes in facial paralysis surgeries. He serves on the Board of Directors of the American Board of Otolaryngology- Head and Neck Surgery, American Academy of Facial Plastic Surgery, and is the Editor-In-Chief for Facial Plastic Surgery and Aesthetic Medicine journal. | Mark Engelstad is Associate Professor and Program Director of Oral and Maxillofacial surgery at Oregon Health & Science University in Portland, Oregon. His clinical practice focuses on the correction of craniofacial skeletal abnormalities, especially orthognathic surgery and alveolar bone grafting. |
John K. Jones, MD, DMD Associate Professor in Oral and Maxillofacial Surgery @ University of Arkansas for Medical Sciences / Arkansas Children’ Hospital | David Joey Chang, DMD, FACS Associate Professor of Oral and Maxillofacial Surgery @ Tufts University/Tufts Medical Center |
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Dr. Jones has over 30 years of experience in the surgical management of cleft lip and palate with particular experience in the area of alveolar ridge grafting and corrective jaw surgery. He has been a member of the Cleft Lip and Palate Team at Arkansas Children’s Hospital for the last six years. During that time he has worked with Dr. Hartzell and his team to introduce and innovate new techniques, many from the realm of Oral and Maxillofacial Surgery and Dentistry, in the interest of improving outcomes for this most challenging patient population. | Dr. Chang is an associate professor at Tufts University School of Medicine and Tufts Medical Center. Dr. Chang is involved in the Cleft Team at Tufts Medical center since 2012. He also focuses on advanced bone grafting procedures, TMJ surgery, and nerve reconstruction. |
Incomplete Cleft Palate Surgery: Tips and Tricks from an Expert Panel
webinar
In this session you will learn about some of the different ways to repair an incomplete cleft palate. A panel of experts will present their techniques through video and didactics and then respond to participants questions.
Cleft Palate Revision Surgery
webinar
This is the fifth in a series of webinars on the Cleft Palate. Our expert panel will discuss the finer details of revising a cleft palate and the different methods of completing the procedure.
Complete Cleft Palate Surgery: Tips and Tricks
webinar
In this session you will learn about some of the different ways to repair an complete cleft palate including unilateral and bilateral. A panel of experts will present their techniques through video and didactics and then respond to participants questions.
Bilateral Cleft Lip Repair: Tips and Tricks from an Expert Panel
webinar
This webinar is geared towards a multi-disciplinary audience including: ENTs, plastics and oral surgeons.
Unilateral Cleft Lip Repair: Tips and Tricks from an Expert Panel
webinar
In the first installment of CSurgeries’ series on cleft surgery, join this wonderful panel of experts as they discuss surgery procedures, complications and more. This webinar is geared towards a multi-disciplinary audience including: ENTs, plastics and oral surgeons.
Cleft Primary and Revision Rhinoplasty: Tips and Tricks
webinar
Tune in for the latest in our series on Cleft Surgery featuring Dr. Raj Vyas from UC Irvine and Dr. Usama Hamdan with the Global Smile Foundation. The discussion will focus on making sure that attendees know proper procedures as well as common complications and how to avoid them.

Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.

Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.

Dr. Hamdan is President and Co-Founder of Global Smile Foundation, a 501C3 Boston-based non-profit foundation that provides comprehensive and integrated pro bono cleft care for underserved patients throughout the world. He has been involved with outreach cleft programs for over three decades. Dr. Hamdan is an Otolaryngologist/Facial Plastic Surgeon with former university appointments at Harvard Medical School, Tufts University School of Medicine and Boston University School of Medicine. For his philanthropic service to the people of Ecuador, he was awarded the Knighthood, “Al Merito Atahualpa” En El Grado De Caballero, by the President of Ecuador in March 2005. He received Honorary Professorship at Universidad de Especialidades Espíritu Santo, School of Medicine, in Ecuador on March 5, 2015 for his contributions in the field of Cleft Lip and Palate.

Dr. Vyas obtained his BS from Stanford and his MD from UCLA before completing integrated plastic surgery residency at Harvard and a fellowship in Craniofacial Surgery at NYU. He is an active clinician, scientist and educator with over 200 peer-reviewed publications and presentations, 20 book chapters, dozens of invited lectures, and multiple NIH and foundational grants. Dr. Vyas is passionate about advancing knowledge and skill for cleft care worldwide, partnering with Global Smile Foundation as both a clinician and Director of Research.

After completing a pediatric craniofacial fellowship at Boston Children’s Hospital, he joined the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis 2011. He is Director of Craniofacial and Medical Director of the Operating Rooms at Saint Louis Children’s Hospital (SLCH). He treats patients with craniosynostosis or other craniofacial abnormalities (congenital or traumatic). He obtained a Master of Science in Clinical Investigation in May 2017 at Washington University to advance his ability to perform high quality clinical research and this program allows him to take advantage of the tremendous resources available for faculty and residents. His research focus is in craniofacial with particular interest in craniosynostosis and cleft lip and palate.

Dr. David Yates MD, DMD, FACS is passionate about serving children with Cranial and Facial deformities and Cleft Lip and Palate. He is a Board Certified Oral and Maxillofacial Surgeon and was recently awarded the inaugural “Physician of the Year” award by El Paso Children’s Hospital. He is the Division Chief of Cranial and Facial Surgery at El Paso Children’s Hospital and has been critical in bringing complex craniofacial surgery to the region. In addition to being a partner with High Desert Oral and Facial Surgery, he directs the craniofacial clinic at El Paso Children’s Hospital and the craniofacial clinic at Providence Memorial Hospital. He has also been integral in starting a clinic for children with Cleft Lip and Palate in Juarez, Mexico at the Hospital De La Familia (FEMAP). He is now happily settled with his wife and four kids serving the greater El Paso/Las Cruces/Juarez region.
news (1)
Introducing our presenters for the upcoming Cleft Lip Revision webinar!
news
This webinar comes as the latest in a long line of installments dealing with the Cleft Palate. In this session, attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to discuss common challenges and how to address them.
Meet the Course Directors


Director of Cleft Lip and Palate / Pediatric ENT Surgeon
Arkansas Children's Hospital / University of Arkansas for Medical Sciences
Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.
Professor / Director of Division of Otolaryngology
Emory University School of Medicine / Children's Healthcare in Atlanta
Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.
Meet the Presenters


Associate Professor of Department of Otolaryngology--Head & Neck Surgery, Division of Pediatric Otolaryngology
University of North Carolina - Chapel Hill
Dr. Leeper completed her residency training in Otolaryngology--Head & Neck Surgery at the Medical University of South Carolina in 2012 and fellowship training in Pediatric Otolaryngology at Arkansas Children's Hospital in 2014. She returned to the University of North Carolina - Chapel Hill in 2014 on faculty in the Department of Otolaryngology--Head & Neck Surgery. She is the current Fellowship Director and Medical Director of the Children's Cochlear Implant Center. She is married to Bradley and they have one daughter Sutton and a baby boy arriving this month.
Residency Program Director / Director Cleft and Craniofacial Team
Carle Foundation Hospital
Dr. Manlove joined Carle Foundation Hospital in 2016 as a fellowship trained cleft and craniomaxillofacial surgeon. She is the director of the cleft and craniofacial team at Carle. In 2018 she was name “Rising Star Physician” and that same year she also became the residency program director. Outside of work, she loves spending time with her family and she is an avid runner.


Associate Professor - Craniofacial Abnormalities & Pediatric Otolaryngology / Co-Director of Cleft and Craniofacial Team
University of Iowa Hospitals & Clinics
Dr. Kacmarynski is a Clinical Associate Professor in the Department of Otolaryngology-Head & Neck Surgery at the University of Iowa, working as a pediatric otolaryngologist and a cleft and craniofacial surgeon with co-directorship for the cleft and craniofacial team at the University of Iowa. Research focus is on biomedical collaborations with oral cleft and craniofacial surgical problems including craniofacial airway, tissue engineering solution development, outcomes research and patient-centered outcomes research collaboratives. I am excited about the long-term impacts of research leading very directly to significant improvements in o
Linton Whitaker Endowed Chair in Craniofacial Surgery
Children’s Hospital of Philadelphia, Division of Plastic Surgery
Jordan Swanson, MD, MSc, is an attending surgeon in the Division of Plastic, Reconstructive and Oral Surgery at Children’s Hospital of Philadelphia with special clinical expertise in cleft, craniofacial, and pediatric plastic surgery. He holds the Linton A. Whitaker Endowed Chair in Plastic, Reconstructive and Oral Surgery.