Interdisciplinary Cleft Care: Global Perspectives

First Edition

Usama S. Hamdan, Carolyn R. Rogers-Vizena, Raj M. Vyas, Brian C. Sommerlad, David W. Low

Details: 742 pages, Full Color, Hardcover, 8.5" x 11"

ISBN13: 978-1-63550-344-9

© 2023 | Available


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Packed with original color illustrations and videos, Interdisciplinary Cleft Care: Global Perspectives draws from the rich national and international relationships between the Global Smile Foundation and world experts in cleft care to provide comprehensive, clear, and user-friendly content for all cleft care professionals. This text is designed to be an inclusive resource that addresses the educational needs of all cleft care providers, from novice learners looking to develop their area’s first multidisciplinary cleft team to seasoned specialists looking to improve their outcomes.

While most other educational cleft care books on treatments and techniques are relevant in high-resource settings, they may not be applicable in low and middle-income countries where orofacial clefting is most common. Interdisciplinary Cleft Care: Global Perspectives details multiple treatment modalities and surgical techniques that can be applied in low, medium, and high-resource settings alike for all key challenges in cleft care.

This book has a team-based framework with chapters that address pertinent topics in cleft care by national and international authorities on the subject from plastic surgery, facial plastic surgery, pediatric otolaryngology, oral maxillofacial surgery, speech-language pathology, dentistry, orthodontics, psychology, and more.  This text also brings attention to special topics often ill addressed in traditional cleft care resources, including psychosocial issues, safety and preparedness in low-resource settings, and guidance for building a multidisciplinary cleft care team where needed. The book includes access to 60 high-quality surgical videos to support the techniques reviewed in the chapters.


“…Over 700 pages of text, in an A4 sized book, was sure to be comprehensive, but it proved to be far more than “just” a surgical manual. As such it is superb however, helped by coloured operative photography and coloured art-work (Dr Low is truly a gifted artist). Approximately 400 pages do deal with the surgical correction, in an appealing step-wise fashion, of every variety of facial, lip and palate imaginable. I was delighted to see faces pre and post operatively were not spoiled by black rectangles over the eyes and, where cosmesis is as important as function, this beautifully illustrated what could be achieved.
The multidisciplinary approach is emphasised throughout, making this of value to otolaryngologists, dental and maxillofacial surgeons, speech and language pathologists and child (indeed also adult) psychologists.  Many chapters focus on the individual contribution of each to care. The chapter for anaesthetists presents the challenges of the many congenital disorders associated with cleft defects.
Personal favourite chapters included those on primary and secondary rhinoplasty. In the former, photos after decades of follow up show that the earliest surgery need not increase scarring and distort growth, as we once warned.
A major section deals with the provision of care in outreach settings, especially in low-income countries. The text reproduces the Global Smile Foundation (GSF) site survey checklist and staffing requirements, which are quite demanding. Quality Assurance and safety issues in such an environment merit separate chapters, but I was most impressed by the use of simulation training to develop and then assess local expertise. “Teach a man to fish” (I am sure you know the rest) was how the Chinese philosopher Lao Tzu phrased it and this book, with its many videos, with do much to assure that applies to helping children afflicted with such developmental abnormalities."

– Liam M Flood, FRCSEng, FRCSI, in the Journal of Laryngology & Otology (October 2022)

About the Editors


Section I. Early Care of the Infant With Cleft Lip and/or Palate

Chapter 1. Embryology, Anatomy, and Classification of Cleft Lip and Palate
Carolyn R. Rogers-Vizena and Anne M. Burrows

Chapter 2. Assessment and Management of Feeding and Nutrition
Claire Kane Miller, Brenda Thompson, Jennifer Kohler, and Tamara Rhodes

Chapter 3. Early Speech and Language Development in Children with Cleft Lip and/or Palate
Adriane L. Baylis and Caitlin E. Cummings

Chapter 4. Audiological Care of the Infant with Cleft Palate
Briana Kelly Dornan

Chapter 5. Genetic Counseling and Syndromic Considerations
Melissa D. Kanack, Neda Zadeh, Touran Zadeh, and Raj Vyas

Section II. Presurgical Dentofacial Treatment

Chapter 6. DynacleftÒ, Lip Taping, and Passive Molding Appliances
Daniela Y. S. Tanikawa

Chapter 7. Nasoalveolar Molding
Barry H. Grayson, Pedro E. Santiago, Mohammad M. Ahmed, Serena N. Kassam

Chapter 8. Active Dentofacial Orthopedics with Latham-Type Appliances
Elizabeth Ross, Christopher Ma, Carolyn R. Rogers-Vizena, and James K. MacLaine

Chapter 9. Oral Health and Pediatric Dentistry in the Setting of Cleft Lip and Palate
Serena N. Kassam, Mohammed M. Ahmed, and Amr M. Moursi

Section III. Anesthetic and Pediatric Perioperative Considerations

Chapter 10. Cleft Lip and Cleft Palate: Anesthetic Considerations
Dima Daaboul, Pete G. Kovatsis, and Navil F. Sethna

Chapter 11. Perioperative Considerations in Pediatric Cleft Repair
Marie Nader, Suying Lam, Jennifer Co-Vu, and Jennifer Munoz

Section IV. Unilateral Cleft Lip Repair

Chapter 12. Primary Cleft Lip & Nose: Rotation Advancement & V-Cheiloplasty in Unilateral Cleft Lip Repair
Usama S. Hamdan, Rami S. Kantar, and Antonio Melhem

Chapter 13. Rotation Advancement Repair: Mulliken Modification
Raj M. Vyas

Chapter 14. Extended Mohler Repair: Cutting Technique
Kerry A. Morrison and Roberto L. Flores

Chapter 15. Unilateral Cleft Lip Repair: Anatomic Subunit Approximation
Raymond W. Tse, David K. Chong, and David M. Fisher

Chapter 16. Cleft Lip Repair With Vomerine Flap Closure of the Hard Palate
Brian Sommerlad

Section V. Bilateral Cleft Lip Repair

Chapter 17. Synchronous Premaxillary Setback, Vomerine Ostectomy, and Bilateral Lip Repair
Usama S. Hamdan, Adam B. Johnson, Rami S. Kantar, Elsa M. Chahine, and Omar S. Al Abyad

Chapter 18. Mulliken Technique for Bilateral Cleft Lip Repair
Carolyn R. Rogers-Vizena and Alexander C. Allori

Chapter 19. Bilateral Cleft Lip Repair – SOBRAPAR Approach
Cassio Eduardo Raposo-Amaral and Cesar Augusto Raposo-Amaral

Chapter 20. Two Stage Bilateral Cleft Lip and Palate Repair
Brian Sommerlad

Section VI. Cleft Palate Repair

Chapter 21. Cleft Palate Repair With Radical Muscle Dissection
Brian Sommerlad

Chapter 22. Modified Furlow Double-Opposing Z-Plasty With Tissue Augmentation Palatoplasty
Miles J. Pfaff and Joseph E. Losee

Chapter 23. Minimal Incision Palatoplasty Technique
Marcia R. Perez Dosal, America Ayuso Arce, and Rafael Villaseñor Caloca

Chapter 24. Hard Palate Repair With Relaxing Incisions: Two-Flap and Bipedicle Palatoplasty
Carolyn R. Rogers-Vizena and John G. Meara

Chapter 25. The Anatomic Cleft Restoration Philosophy With Buccal Flap Approach
Robert J. Mann

Chapter 26. Staged Palate Repair – Soft Palate First
Hans Mark and Jan Lilja

Section VII. Revision Lip and Palate Surgery

Chapter 27. Oronasal Fistula Repair Surgery
Mahmoud I. Awad and Krishna G. Patel

Chapter 28. Secondary Cleft Lip Deformity
Usama S. Hamdan, Rami S. Kantar, and Omar S. Al Abyad

Section VIII. Secondary Management of Dentoalveolar and Orthognathic Concerns

Chapter 29. Phase I Dental Orthopedic and Orthodontic Treatment for Cleft Lip and Palate
Pedro E. Santiago, Daniel Levy, Tiago Turri de Castro, and Ryan Cody

Chapter 30. Alveolar Bone Grafting and Long-Term Outcomes
Karen Z. Carver and Bonnie L. Padwa

Chapter 31. Phase II Dental and Presurgical Orthodontic Treatment
Douglas Olson and Pradip R. Shetye

Chapter 32. Determinant of Facial Growth in Cleft Lip and Palate
Elçin Esenlik and Laura Mancini

Chapter 33. Orthognatic Correction: Surgery First
Yu-Ray Chen, Yu-Fang Liao, Chuan-Fong Yao, and Tingchen Lu

Chapter 34. Orthognathic Correction: Surgery Last
Connor J. Peck, Joseph Lopez, Jakob Lattanzi, and Derek Steinbacher

Chapter 35. Prosthetic Rehabilitation of the Cleft Alveolar Gap
Stephanie J. Drew, Shelly Abramowicz, James Davis Jr., and Steve Roser

Section IX. Cleft Nasal Deformity

Chapter 36. Primary Rhinoplasty
Usama S. Hamdan, Christopher Brooks, and Omar S. Al Abyad

Chapter 37. Secondary Cleft Tip Rhinoplasty
Beatriz Berenguer, Jesse Taylor, and Anna R. Carlson

Chapter 38. Definitive Septorhinoplasty in the Cleft Lip Patient
Grace Lee Peng, Usama S. Hamdan, and Babak Azizzadeh

Section X. Evaluation and Management of Cleft-Related Speech Disorders

Chapter 39. Evaluation of Speech and Resonance Due to Velopharyngeal Insufficiency (VPI)
Ann W. Kummer and Mikaela M. Bow

Chapter 40. The Role of the Speech-Language Pathologist in Cleft Care
Ann W. Kummer and Mikaela M. Bow

Chapter 41. Measuring Speech Outcomes
Debbie Sell and Valerie Pereira

Section XI. Surgical Management of Velopharyngeal Insufficiency (VPI)

Chapter 42.  Posterior Pharyngeal Flap
Oksana A. Jackson and David W. Low

Chaper 43. Sphincter Pharyngoplasty
David W. Low and Oksana A. Jackson

Chapter 44. Revision Palatoplasty With Intravelar Veloplasty (+/-) Buccinator Flaps
Brian C. Sommerlad

Chapter 45. Revision Palatoplasty With Furlow Double-Opposing Z-Plasty
Philip Kuo-Ting Chen and Vikram S. Pandit

Chapter 46. Palatopharyngeal Augmentation
Monica K. Rossi Meyer and Deborah S.F. Kacmarynski

Section XII. Psychosocial Considerations From Early Childhood to Adulthood

Chapter 47. Provisions of Psychosocial Care in Cleft Lip and/or Palate: A Global Context
Martin Persson and Matthew Ridley

Chapter 48. Promoting Resilience in People With Cleft Lip and/or Palate Around the World
Matthew Ridley and Martin J. Persson

Chapter 49. Patient & Family Community Resources
Gareth Davies, Erin Stieber, Ruben Ayala, Hugh Brewester, Jamie Perry, Serena Kassam, Taylor Snodgrass, and Usama S. Hamdan

Section XIII. Special Considerations for Outreach Settings

Chapter 50. Planning and Execution of Overseas Outreach Programs
Charanya Vijayakumar, Elsa M. Chahine, Rami S. Kantar, Nikhil Shah, Antonio Melhem, Omar Al-Abyad, Daniel Jaffurs, Raj M. Vyas, and Usama S. Hamdan

Chapter 51. Quality Assurance Guidelines for Outreach Cleft Programs
Elsa M. Chahine, Elie P. Ramly, Alexander P. Marston, Raj M. Vyas, and Usama S. Hamdan

Chapter 52. Safety and Emergency Preparedness During Overseas Outreach
Elsa M. Chahine, Antonio Melhem, Raj M. Vyas, and Usama S. Hamdan

Chapter 53. The Future of Cleft Outreach: In Situ Simulation, Task Training, Augmented Reality, and Artificial Intelligence
Jennifer Munoz Pareja, Marie Nader, Antonio Melhem, Omar S. Al Abyad, Usama Hamdan, Rami S. Kantar, J. Peter W. Don Griot, Raj M. Vyas, and Corstiaan Breugem

Chapter 54. Building a Cleft Team
Gaurav Deshpande and Jordan W. Swanson

Section XIV. Rare Facial Clefts

Chapter 55. Rare Facial Clefts
Nivaldo Alonso and Cristiano Tonello

Chapter 56. Macrostomia: Functional & Aesthetic Repair
Usama S. Hamdan, Raj M. Vyas, Rami S. Kantar, and Antonio Melhem

Usama S. Hamdan

Usama S. Hamdan, MD, FICS, 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.

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Carolyn R. Rogers-Vizena

Dr. Rogers-Vizena is a pediatric plastic and craniofacial surgeon at Boston Children's Hospital, Assistant Professor of Surgery at Harvard Medical School, and Associate Clinical Director for Special Effects and Materials Science in the Boston Children's Simulator program.  Her clinical areas of expertise include cleft lip and palate, velopharyngeal dysfunction, facial trauma, adolescent breast surgery, and spina bifida.  Dr. Rogers-Vizena leads Boston Children’s cleft outcomes program with inter-institutional collaborations nationally and internationally through the International Consortium for Health Outcomes Measurement aimed at optimizing the physical and psychosocial impact of cleft lip and palate.  In addition, she has partnered with the Global Smile Foundation to provide cleft care to underserved populations in the Middle East.

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Raj M. Vyas

Raj Vyas earned his B.S. in Biology with Honors and Distinction from Stanford University and completed his M.D. at UCLA where he was awarded the Stafford L. Warren Medal for most outstanding medical student and the Longmire Medal for most outstanding student in surgery. He then completed integrated plastic surgery residency at Harvard and Craniofacial Fellowship at New York University. Dr. Vyas is a professor of plastic surgery at UC Irvine School of Medicine, where he serves as Vice-Chair for the Department of Plastic Surgery and Chief of Pediatric Plastic Surgery at CHOC Children's Hospital. His clinical and research interests include characterizing neonatal sleep and breathing disturbances, enhancing recovery after cleft/craniofacial surgery, understanding patient-reported psychosocial outcomes, and using technology to facilitate knowledge and skill transfer. Aligned with his passion for enhancing global capacity for interdisciplinary cleft care, Dr. Vyas is Co-Director of Global Smile Foundation's International Research Fellowship and Co-Director of Research for Plastic Surgery Foundation's SHARE program (Surgeons in Humanitarian Alliance for Reconstruction Research and Education). Dr. Vyas actively serves on dozens of regional, national and international cleft committees, hospital consortia, and journal editorial boards.

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Brian C. Sommerlad

Brian Sommerlad qualified in medicine in Sydney, Australia. He went to the UK in 1968 to further his training and stayed. He is an honorary consultant plastic surgeon at Great Ormond Street Hospital for Children, London.

He has been caring for children with clefts for 45 years – in the UK and by regularly working with colleagues in many less privileged countries over the last 22 years.

His ongoing research interests have centred around palate anatomy and function and attempting to improve the speech outcomes of palate repair.

He was co-founder in 2007 and is chairman of the UK charity CLEFT which funds research into the causes and treatment of clefts and supports cleft centres in several low-resource countries.

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David W. Low

David W. Low, MD, is Professor of Surgery at the Perelman School of Medicine at the University of Pennsylvania and Attending Surgeon in the Division of Plastic Surgery at the Children’s Hospital of Philadelphia. A graduate of Harvard College and Harvard Medical School, he completed all of his surgical training at Penn and was privileged to learn cleft care under the mentorship of Don LaRossa and Peter Randall. He is the medical director of his CHOP-based international cleft team Smiles for Guatemala.  In addition to his teaching and patient care responsibilities, he is a board-certified medical illustrator whose work appears in many medical journals and textbooks.

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Purchase of Interdisciplinary Cleft Care: Global Perspectives comes with access to supplementary surgical videos on a PluralPlus companion website.

The companion website is located at:

To access the surgical videos, you must register on the companion website and log in using the access code located in the front of your textbook.

*Note for students: If you have purchased this textbook used or have rented it, your access code will not work if it was already redeemed by the original buyer of the book. Plural Publishing does not offer replacement access codes for used or rented textbooks.

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