Current Concept in Cleft Surgery: Moving Toward Excellence of Outcome and Reducing the Burden of Care

Foreword
Preface
Contents
About the Authors
Part I: Key Concepts in Surgical Cleft Care
	1: Epidemiological Features in Cleft Lip and Palate
		1.1	 Introduction
		1.2	 Overview of Incidence and Prevalence
		1.3	 Sex and Ethnicity
		1.4	 Phenotype
		1.5	 Laterality
		1.6	 Recurrence Patterns
		1.7	 Extrafacial Anomalies and Syndromes
		1.8	 The Cleft-Related Epidemiological Data Collection Issue
		References
	2: The Burden of Orofacial Clefts: Global Trends and Focus on Underresourced Regions
		2.1	 Introduction
		2.2	 Understanding the Measurement of Burden of Disease
		2.3	 Appraising the Burden of Orofacial Clefts
		References
	3: The Unmet Need for Primary Cleft Lip and Palate Surgery: Demand for Levering Surgical Cleft Care in Underresourced Settings
		3.1	 Introduction
		3.2	 Understanding the Unmet Need
		3.3	 The Unmet Need for Cleft Lip and Palate Surgery Issue
		References
	4: Treating Cleft-Related Deformities from Initial Diagnosis to Rehabilitation into Society at Maturity: Key Concepts of Burden of Cleft Care
		4.1	 Introduction
		4.2	 Family Caregiver Burden
		4.3	 Psychosocial Burden
		4.4	 Orthodontic Burden
		4.5	 Surgical Burden
		References
	5: Longitudinal Life-Changing Concept Toward Reducing Cleft Stigmata, Dysfunction, and Burden of Surgical Care
		5.1	 Introduction
		5.2	 Understanding How to Reduce Surgical Burden of Care
		5.3	 Longitudinal Life-Changing Concept
		5.4	 Reducing Surgical Burden of Care During the Growing Age
			5.4.1	 Primary Cleft Lip Repair
			5.4.2	 Primary Cleft Palate Repair
			5.4.3	 Secondary Alveolar Bone Grafting
		5.5	 Reducing Surgical Burden of Care After Maturity
		References
	6: Patient-Reported Outcome Measures as Driving Factors to Transform Surgical Cleft Care
		6.1	 Introduction
		6.2	 Cleft-Related Outcome Measures
		6.3	 Employing Patient-Reported Outcome Measures in Practice
		6.4	 Patient-Reported Outcome Measure for Delivering Value-Based Patient-Centered Care
		References
	7: Leveraging Data Collection and Analysis to Optimize Outcomes in Surgical Cleft Care: Deciphering the Quality Improvement Puzzle
		7.1	 Introduction
		7.2	 Understanding the Quality Improvement Movement
		7.3	 Quality Improvement Versus Research Activities
		7.4	 Quality as a Multidimensional Concept in Health Care
		7.5	 Tools for Quality Improvement Projects
		7.6	 Applying Quality Improvement Concepts
		7.7	 Need for Action Toward Excellence of Outcome in Surgical Cleft Care Across the Globe
		References
	8: Classifying the Wide Clinical Spectrum of Cleft Lip and Palate
		8.1	 Introduction
		8.2	 Understanding the Spectrum of Cleft Lip and Palate: From Overt to Subclinical Forms
		8.3	 Cleft Classification Issue
		8.4	 Cleft Classification Systems
		8.5	 Classifying the Lesser-Form Cleft Lip
		8.6	 Further Classifications with Practical Applications
		References
Part II: Surgical Cleft Care in the Growing Age
	9: Modern Unilateral Cleft Lip and Nasal Repair: Controversies from Presurgical Orthopedics to Surgical Techniques to Postoperative Care
		9.1	 Introduction
		9.2	 Characterizing the Unilateral Cleft Lip and Nasal Deformity
		9.3	 Timing of Unilateral Cleft Lip Repair
		9.4	 Reconstructing the Unilateral Cleft Lip and Nasal Deformity
			9.4.1	 Presurgical Orthopedics
			9.4.2	 Cutaneous Repair
			9.4.3	 Gingivoperiosteoplasty
			9.4.4	 Vermilion Repair
			9.4.5	 Nasal Floor Lining
			9.4.6	 Intraoral Lining
			9.4.7	 Muscle Repair
			9.4.8	 Treating the Unilateral Cleft Nasal Deformity
		9.5	 Postoperative Care
			9.5.1	 Hospital Stay
			9.5.2	 Feeding
			9.5.3	 Arm Restraints
		References
	Untitled
	10: Current State of the Art in Unilateral Cleft Lip Repair with Primary Nasal Overcorrection: Lo’s Modified Noordhoff’s Procedure
		10.1	 Introduction
		10.2	 Technical Evolution
		10.3	 Guiding Principles
		10.4	 Lo’s Modified Noordhoff’s Procedure
		10.5	 Lo’s Modified Noordhoff’s Unilateral Complete Cleft Lip Repair with Primary Nasal Overcorrection
			10.5.1	 Presurgical Molding Therapy
			10.5.2	 Achieving the Lip Lengthening
			10.5.3	 Surgical Marking
			10.5.4	 Medial Lip Element
			10.5.5	 Lateral Lip Element
			10.5.6	 Nasal Sill Reconstruction and Alar Base Positioning
			10.5.7	 Nasal Floor Reconstruction
			10.5.8	 Muscle Reconstruction
			10.5.9	 Cupid’s Bow Leveling
			10.5.10	 Vermilion Augmentation
			10.5.11	 Cutaneous Adjustments
			10.5.12	 Intraoral Lining
			10.5.13	 Primary Rhinoplasty with Overcorrection
		10.6	 Lo’s Modified Noordhoff’s Unilateral Incomplete Cleft Lip Repair with Primary Nasal Overcorrection
		10.7	 Lesser-Form Unilateral Incomplete Cleft Lip
		10.8	 Unilateral Cleft Lip in Median Facial Dysplasia
		10.9	 Reproducibility
		10.10	 Postoperative Care
		References
	11: Modern Bilateral Cleft Lip and Nasal Repair: Controversial Features and Guiding Principles
		11.1	 Introduction
		11.2	 Characterizing the Bilateral Cleft Lip and Nasal Deformity
		11.3	 Controversies
			11.3.1	 Managing the Protruding Premaxilla
			11.3.2	 Reconstructing the Upper Gingivolabial Sulcus
			11.3.3	 Reconstructing the Cupid’s Bow and Median Tubercle
			11.3.4	 Reconstructing the Oral Muscle Sling
			11.3.5	 Treating the Bilateral Cleft Nasal Deformity
		11.4	 Modern Surgical Approach
		References
	12: Current State of the Art in Bilateral Cleft Lip Repair with Primary Nasal Overcorrection: Lo’s Modified Noordhoff’s Procedure
		12.1	 Introduction
		12.2	 Technical Evolution
		12.3	 Guiding Principles
		12.4	 Lo’s Modified Noordhoff’s Bilateral Cleft Lip and Nasal Repair
			12.4.1	 Protruding Premaxilla
			12.4.2	 Designing
			12.4.3	 Marking
			12.4.4	 Central Lip Element
			12.4.5	 Lateral Lip Elements
			12.4.6	 Nasal Sill Reconstruction
			12.4.7	 Nasal Floor Reconstruction
			12.4.8	 Muscle Reconstruction
			12.4.9	 Cupid’s Bow and Tubercle Creation
			12.4.10	 Primary Rhinoplasty
		12.5	 Asymmetric Bilateral Cleft Lip
		12.6	 Bilateral Cleft Lip in Median Facial Dysplasia
		12.7	 Reproducibility
		12.8	 Postoperative Care
		References
	13: Modern Cleft Palate Repair: Controversies, Surgical Techniques, and Postoperative Care
		13.1	 Introduction
		13.2	 Timing
		13.3	 Staging
		13.4	 Eustachian Tube Dysfunction
		13.5	 Surgical Approach
			13.5.1	 Hard Palate Reconstruction
			13.5.2	 Soft Palate Reconstruction
		13.6	 Postoperative Management
			13.6.1	 Respiratory Distress
			13.6.2	 Feeding
			13.6.3	 Arm Restraints
			13.6.4	 Oral Antibiotics
			13.6.5	 Postoperative Discharge
		References
	14: Comprehensive Appraisal of Outcome in Cleft Palate Repair
		14.1	 Introduction
		14.2	 Outcome of Cleft Palate Repair
			14.2.1	 Adverse Perioperative Events
			14.2.2	 Oronasal Fistula
			14.2.3	 Velopharyngeal Insufficiency
			14.2.4	 Maxillary Growth
			14.2.5	 Middle Ear Function
			14.2.6	 Respiratory Distress
		References
	15: Current State-of-the-Art in Cleft Palate Repair: Technical Description and Outcome of Lo’s Modified Furlow’s Double-Opposing Z-Plasty Procedure
		15.1	 Introduction
		15.2	 Pursuing Excellence of Outcome and Reduction of the Burden of Care
		15.3	 Preoperative Care
		15.4	 Surgical Rationale
		15.5	 Lo’s Modified Furlow’s Double-Opposing Z-Plasty Palatoplasty
		15.6	 Postoperative Care
		15.7	 Outcome
		References
	16: State of the Art in Surgical Management of Velopharyngeal Insufficiency
		16.1	 Introduction
		16.2	 Understanding the Velopharyngeal Mechanism
		16.3	 The Velopharyngeal Insufficiency Issue
		16.4	 Simplified Algorithm
		16.5	 Diagnosis
		16.6	 Timing
		16.7	 Surgical Approach
			16.7.1	 Furlow Double-Opposing Z-Plasty
			16.7.2	 Lo’s Modified Furlow Double-Opposing Z-Plasty
			16.7.3	 Pharyngeal Flap
			16.7.4	 Superiorly Based Pharyngeal Flap
		16.8	 Postoperative Care
		16.9	 Outcome
		References
	17: Current State-of-the-Art in Alveolar Cleft Reconstruction: Lo’s Modified Secondary Alveolar Bone Grafting
		17.1	 Introduction
		17.2	 Timing
		17.3	 Preoperative Orthodontic Treatment
		17.4	 Bone Source
		17.5	 Lo’s Modified Secondary Alveolar Bone Grafting
			17.5.1	 Graft Harvesting
			17.5.2	 Reconstructing the Alveolar Cleft
			17.5.3	 Outcome
		References
Part III: Surgical Cleft Care After Maturity
	18: Three-Dimensional Computer-Assisted Single-Splint Two-Jaw Cleft Orthognathic Surgery: Revisiting the Traditional Care
		18.1	 Introduction
		18.2	 Understanding the Cleft Dento-Skeletofacial Deformity
		18.3	 Noordhoff’s Principle as a Driven Element for Evolving Cleft Orthognathic Surgery
		18.4	 Dental Occlusion-Focused Period
		18.5	 Facial-Focused Period
		18.6	 Patient-Centered Period
			18.6.1	 Three-Dimensional Computer-Assisted Single-Splint Two-Jaw Cleft Orthognathic Surgery
		References
	19: Outcome of Three-Dimensional Computer-Assisted Single-Splint Two-Jaw Cleft Orthognathic Surgery
		19.1	 Introduction
		19.2	 Outcome
		19.3	 Challenge
		References
	20: Surgical Management of Oronasal Fistula After Primary Cleft Palate Repair: Condition-Specific Protocol and Outcome
		20.1	 Introduction
		20.2	 Classification
		20.3	 Condition-Specific Protocols
			20.3.1	 Postpalatoplasty Oronasal Fistula
			20.3.2	 Persistent Symptomatic Anterior Oronasal Fistula
			20.3.3	 Postoperative Care
		20.4	 Outcome
		References
	21: Treating Secondary Cleft Lip Deformity: Surgical Technique and Outcome
		21.1	 Introduction
		21.2	 Classification
		21.3	 Surgical Treatment
		21.4	 Outcome
		References
	22: State of the Art in Secondary Cleft Rhinoplasty: Comprehensive Technical Details and Deformity-Specific Approach
		22.1	 Introduction
		22.2	 Understanding the Cleft Nose Deformity
		22.3	 History
		22.4	 Surgical-Focused Diagnosis of Nasal Deformity
		22.5	 Surgical Approach
			22.5.1	 Open Approach
			22.5.2	 Nasal Dorsum
			22.5.3	 Nasal Septum
			22.5.4	 Middle Nasal Vault
			22.5.5	 Nasal Tip
			22.5.6	 Alar Base Repositioning
			22.5.7	 Nasal Bone Osteotomy
			22.5.8	 Inferior Turbinate
			22.5.9	 Nasal Airway
			22.5.10 Closure
		22.6	 Ethnic Consideration
			22.6.1	 Nasal Dorsum
			22.6.2	 Nasal Tip
		22.7	 Postoperative Care
		References