Congenital Nasal Pyriform Aperture Stenosis (CNPAS): Sublabial Approach to Surgical Correction

Congenital nasal pyriform aperture stenosis (CNPAS) is defined as inadequate formation of the pyriform apertures forming the bony nasal openings resulting in respiratory distress and cyanosis soon after birth. Some clues such as worsening distress during feeding and improvement during crying may indicate a nasal cause of respiratory distress rather than distal airway etiology. Inability or difficulty passing a small tube through the nasal cavities may suggest CNPAS. The presenting clinical features of CNPAS can be similar to other obstructive nasal airway anomalies such as choanal atresia. Diagnosis is confirmed via CT scan with a total nasal aperture less than 11mm. CNPAS may occur in isolation or it may be a sign of other developmental abnormalities such as holoprosencephaly, anterior pituitary abnormalities, or encephalocele. Some physical features of holoprosencephaly include closely spaced eyes, facial clefts, a single maxillary mega incisor, microcephaly, nasal malformations, and brain abnormalities (i.e. incomplete separation of the cerebral hemispheres, absent corpus callosum, and pituitary hormone deficiencies). It is important to rule out other associated abnormalities to ensure optimal treatment and intervention. Conservative treatment of CNPAS includes humidification, nasal steroids, nasal decongestants and reflux control. Failure of conservative treatment defined by respiratory or feeding difficulty necessitates more aggressive intervention. The most definitive treatment for CNPAS is surgical intervention to enlarge the pyriform apertures. Contributors: Adam Johnson MD, PhD Abby Nolder MD

Repair of Tessier 7 Cleft Lip Deformity

The 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

Alveolar Bone Graft Surgery: Tips and Tricks

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.

Pediatric Endoscopic Airway Surgery

This webinar will address common and advanced pediatric airway pathology. There will be a focus on video demonstration of advanced surgical endoscopic management of pediatric airway pathology ranging from laryngomalacia to type 3 laryngeal clefts.

Vikash K. Modi, MD, is an Associate Professor and the Chief of Pediatric Otolaryngology - Head & Neck Surgery at New York Presbyterian Hospital- Weill Cornell Medical Center. After receiving his medical degree from the Rutgers Medical School, Dr. Modi completed his residency in Otolaryngology at the University of Southern California - Keck School of Medicine. Following residency, Dr. Modi completed a Pediatric Otolaryngology fellowship at Northwestern University - Children's Memorial Hospital. He founded the Cornell Aerodigestive Center and has one of the largest series of endoscopic posterior cricoid split with rib grafting (presented at ESPO). He also has presented his work on endoscopic repair of laryngeal clefts at ASPO and CEORL. He has been inducted as a Fellow, into the prestigious Triological Society for his thesis paper on airway balloon dilation and currently serves as a Section Editor-Video Editor of The Laryngoscope and is known for his surgical endoscopic airway videos.

Laryngeal Clefts

Drs. Vikash Modi, Hamdy El Hakim, & Christina Rappazzo talk about the different challenges facing surgeons dealing with laryngeal clefts. They review how to properly assess and manage the situation and even go into some controversies between different styles.

Cleft Primary and Revision Rhinoplasty: Tips and Tricks

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.

How to Rotate and Advance a Lip

This seminar will review the history and surgical technique of the Millard rotation-advancement unilateral cleft lip repair.  Nuances of the technique designed to optimize outcomes will be discussed and will be illustrated in photographic and video format.

Richard E. Kirschner, M.D., F.A.C.S, F.A.A.P.

Chief, Department of Plastic and Reconstructive Surgery / Director, Cleft Lip and Palate Center
Nationwide Children’s Hospital in Columbus, OH

Richard E. Kirschner, M.D., F.A.C.S, F.A.A.P. is Robert and Edgar T. Wolfe Foundation Endowed Chair, Chief of the Section of Plastic and Reconstructive Surgery, Director of the Cleft Lip and Palate Center, and Co-Director of the 22q Center at Nationwide Children’s Hospital.  He serves as Professor of Surgery and Senior Vice Chair of the Department of Plastic Surgery at The Ohio State University College of Medicine.  Dr. Kirschner served as President of the American Cleft Palate-Craniofacial Association in 2016.  He is co-editor of Comprehensive Cleft Care, now in its second edition, and of the upcoming publication Cleft Palate and Velopharyngeal Dysfunction.  He is co-founder of Casa Azul America, Inc., a non-profit organization devoted to providing education to professionals and care to underprivileged children with cleft lip and palate in Latin America and of Magical Moments Foundation, a wish granting charitable organization dedicated to serving children with facial differences.