Table Of ContentCleft Lip and Palate
Samuel Berkowitz
Editor
Cleft Lip and Palate
Diagnosis and Management
Third Edition
Editor
Samuel Berkowitz , DDS, M.S., FICD
Adjunct Professor
Department of Orthodontics
College of Dentistry
University of Illinois
Chicago, IL
USA
Clinical Professor of Surgery
and Pediatrics (Ret)
Director of Research (Ret)
South Florida Cleft Palate Clinic
University of Miami School
of Medicine
Miami, FL
USA
Consultant (Ret)
Craniofacial Anomalies Program
Miami Children’s Hospital
Miami, FL
USA
ISBN 978-3-642-30769-0 ISBN 978-3-642-30770-6 (eBook)
DOI 10.1007/978-3-642-30770-6
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2012954868
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My professional growth has been nurtured by my
understanding wife, Lynn, who made it possible for me to
spend endless uninterrupted evenings at my desk, while at the
same time encouraging me to “stay with it.” Warm hugs to my
two daughters, Beth and Debra, Ruben and Edward, and my
eight outstanding grandchildren for their endless expressions
of support and love.
Last, but by no means least, I cannot say enough for the
countless children with various palatal and facial clefts whom
I have treated over the past four decades and for their
understanding parents. This book is dedicated to all of them
as a token of my appreciation for their enduring perseverance
and fortitude. My young patients have taught me much about
the human spirit and the joy that can spring from surmounting
nature’s adversities.
Finally, my work was made possible by the support of
D. Ralph Millard, Jr., who appreciated the value of serial
records starting at birth. S.A. Wolfe and I have differed on
a few areas of treatment, but we strongly agreed that only
through the analyses over time of objective growth records
could progress in treatment be accomplished. J.D. Subtelny,
Chairman of the Department of Orthodontics at Eastman
Dental Center and author of many articles on clefts, and
I have been friends for 40 years and at many of our meetings
it was a pleasure to hear of his experience treating children
born with clefts of the lip and palate.
Foreword
I am deeply honored by the opportunity to write the foreword to this new
edition of Dr. Samuel Berkowitz’s classic volume on cleft lip and palate.
As a lifelong student of past and current cleft palate literature on facial
palatal growth and development he is a strong advocate for good record
keeping and carefully conducted clinical studies. He possesses extensive
knowledge and insight in the effects of treatment interventions on cleft lip
and palate patients and their parents which has led to this book.
Samuel Berkowitz wrote his master’s thesis in cleft palate under the super-
vision and guidance of Samuel Pruzansky at the Cleft Palate-Craniofacial
Program at the University of Illinois School of Dentistry in 1959. From there
he went to the University of Miami School of Medicine to help develop, with
Dr. D. Ralph Millard Jr., Chief of Plastic Surgery, a craniofacial anomalies
program and clinic (1960–1998). They collaborated in developing an exten-
sive collection of longitudinal clinical records of dental casts, cephaloradio-
graphs, panorexes and photographs from birth to adolescence. These records
are now housed at the Museum of Health and Medicine associated with
the Institute of Pathology at Walter Reed Hospital in Washington, D.C.
Dr. Berkowitz’s main goal was to create lasting treatment concepts based on
a better understanding of the natural history of cleft palate and facial growth
and development. This book discusses in detail the resulting treatment con-
cepts, which are supported by in-depth case analyses.
During his and my time as clinician providers committed to care of chil-
dren with congenital facial differences, we have seen major improvements in
the overall long-term outcomes in the young adult with a cleft, managed from
infancy in an interdisciplinary team setting. Our expectations for the fi nal
outcome are normal speech, harmonious facial features, well and stable occlu-
sion and good self esteem. The improvements are due to several factors, many
of which are the result of careful clinical studies, long-term observations and
the learning and experience that the providers obtain by working together in
a team. We have also experienced waves of new clinicians professing new
insights into how tissues will respond to certain new or reinvented techniques
or manipulations, only many years later to fi nd no improvement in outcomes
or even detrimental effects on growth and development. The clinical records,
long memory and experience that are found in an established team can have a
moderating effect on new members without curbing enthusiasm and creative
thinking. It remains a fact that treatment interventions must proceed stepwise
vii
viii Foreword
according to biologic development and that there are wide individual varia-
tions among individuals with clefts.
In this new edition, Sam Berkowitz has assembled the most outstanding
specialists in their speci fi c area of experience and expertise and some new
talents. The student of this text will fi nd solid data where that exists and well
founded theories where data is not yet available. This text and the teaching
materials that Sam has produced to be used in orthodontic specialty programs,
attest to his burning desire and commitment to educate future clinical special-
ists in the care of individuals born with a cleft. He strongly believes that all
specialists should know each others problems to better design a meaningful
solution.
San Francisco, USA Karin Vargervik
About the Editor
Dr. Berkowitz , an orthodontist, was a Clinical Professor of Pediatrics and
Surgery associated with the South Florida Craniofacial Anomalies Program
at the University of Miami School of Medicine. He was also Adjunct Clinical
Professor at Nova Southeastern University College of Dentistry – Orthodontic
Department, and Adjunct Clinical Professor of Orthodontics at the University
of Illinois College of Dentistry. His main goal is to develop teaching materi-
als in cleft palate for professionals in plastic and oral surgery, orthodontics,
and speech language pathology. He is a past President of the American
Cleft Palate Association Educational Foundation, the Florida Cleft Palate
Association, was President of the Miami Craniofacial Anomalies Foundation.
Dr. Berkowitz was active in the American Association of Orthodontics,
Florida Cleft Palate Association, and The Edward Angle Society of
Orthodontists. He has published widely in medical and cleft palate journals
and is the author of Volume I and the editor of Volume II of Cleft Lip and
ix
x About the Editor
Palate Perspectives in Management – First Edition; he coauthored Plastic
Surgery of the Facial Skeleton with S. A. Wolfe, M. D, and wrote The Cleft Palate
Story for parents of a child born with a cleft. Dr. Berkowitz is a popular
speaker on cleft lip/palate topics and has presented many workshops and
seminars in the USA and abroad.
His research interest focused on improving surgical-orthodontic treatment
planning for cleft lip and palate children as well as those with other craniofa-
cial anomalies. Dr. Berkowitz was project director of a clinical research pro-
gram that was studying the long-term effects of various surgical treatment
procedures on palatal and facial growth and development. He created a quan-
titative method for determining when to close the palatal cleft space, based on
the 10 % ratio of the cleft space to the area of the surrounding palatal surface
medial to the alveolar ridges. He has created an audiovisual PowerPoint lec-
ture series for surgeons and orthodontists to enable them to better understand
and teach others the effects of surgery on the face from birth through
adolescence.
Dr. Berkowitz has been awarded the title “Honoree” by the Edward Angle
Society of Orthodontists, and “Honoree” by the First World Congress of the
International Cleft Lip and Palate Foundation for his many contributions to
the fi eld of cleft lip and palate treatment. His extensive serial clinical records
of dental casts, lateral cephaloradiographs, facial and intraoral photographs,
and panorexes are in the National Museum of Health and Medicine (associ-
ated with Walter Reed Hospital’s Institute of Pathology in Washington DC),
where they will be available for continued study.
