Poster 42: Visualizing Cleft Defects and Cleft Lip Repair in Three Dimensions: A Prototype Surgical Model for Resident Education

Abstract

Approximately 1 in 700 births worldwide results in children with cleft lip and/or cleft palate. This translates to millions of infants worldwide with feeding problems, children with speech disorders and adults outcast because of their facial deformity. In developing nations with increased incidence of clefts, the demand for this specialized patient care is greater than in developed countries. However, the care of cleft patients may be a distant priority in healthcare systems that struggle to meet its society's basic needs. Compounding this problem is a shortage of surgeons skilled in cleft surgeries. Few oral and maxillofacial surgery training programs in the United States have a strong emphasis in the treatment of primary cleft repair. The lack of training in the treatment of primary cleft lip repair may be due to the complexity of the surgery itself for the novice surgeon or resident. Clearly there is a niche for a cleft model where developing surgeons can practice their skills before entering the operative environment. Improved educational tools for anatomic understanding and surgical simulation of the cleft patient are needed to facilitate surgical training. A recent search of the English scientific literature on non-computerized teaching models for maxillofacial or facial plastic surgery afforded only one article, whereas a search on computer-based cleft lip repair simulation afforded 6 articles. No literature was noted for hands-on cleft lip surgical models for resident teaching purposes. To address this need for resident teaching tools, we have developed a teaching model of a cleft child's craniofacial structures to simulate cleft lip surgery. A CT scan-based stereolithic model of a 7-year-old female cleft patient serves as the “craniofacial skeleton.” A soft tissue representation of the cleft patient's midface is created out of pink wax. The wax model is flasked and burned out, following maxillofacial prosthesis fabrication principles. After wax burnout, a skin-like silicone elastomer material is injected into the resultant “model negative” void and is allowed to cure. The “skeleton” cast duplicate is overlaid with the “soft tissue” representation to complete the cleft surgical simulator. Mentoring faculty members will use the cleft surgical simulators to teach oral and maxillofacial surgery residents cleft anatomy and cleft repair. Teaching sessions will consist of resident seminars, followed by hands-on surgical simulation exercises utilizing the cleft models. We will assess the efficacy and educational impact of the cleft models by administrating surveys before and after the teaching and hands-on sessions. In progress. We propose that the cleft lip surgical model will serve as an excellent tool for visualizing cleft hard tissue and soft tissue defects in 3 dimensions. It will also serve as a reference guide for marking out soft tissue anatomical points and a surgical model for executing lip incisions and the reapproximation of flaps.