From Bottles to Models: Addressing the Gaps in Cleft Palate Research

Cleft palate (CP) is one of the most common birth defects that affects approximately 1 in 700 newborns worldwide. CP occurs when the tissues that make up the soft and hard palates fail to fuse together. Prior to cleft repair surgery at around one year of age, infants with CP cannot generate any suction and have to rely on the use of specialized feeding systems due to the lack of separation between the oral and nasal cavity. Even with the existing feeding interventions, many critical issues remain including extended feeding times and complications (i.e. nasal regurgitation). These issues have negative impacts on the infants’ weight gain, growth, and social-emotional development. Furthermore, even after the primary reconstructive surgery, approximately 25% of children born with CP require additional speech-corrective surgery due to surgical complications such as velopharyngeal dysfunction (VPD). Sphincter pharyngoplasty is a common surgical treatment for patients with VPD, in which surgeons create an augmentation on the posterior wall to reduce the gap that hinders VP closure. Current surgical planning for CP reconstructive surgery and corrective surgery depends on the surgeon’s training and preference, rather than pre-surgical assessment of the patient’s anatomical structures and VP functions. To improve the development of treatment plans for children with CP, we must understand the influence of anatomical variation on VP closure pattern, function, and surgical success. The goal of my thesis is to apply biomedical design principles and computational modeling to improve the quality of life for children with CP. In Aim 1, I designed a patented nipple feeding system specialized for infants born with cleft palate. The effectiveness of the new feeding system was tested through a clinical trial and a flow rate assessment system designed specifically to simulate the feeding mechanism of infants with CP. In Aim 2, I developed 3D subject-specific finite element models based on healthy anatomy to investigate the relationships between anatomical variation, VP closure patterns, and levator muscle function. In Aim 3, I created a computational modeling framework to simulate the first subject specific models of VP anatomy post-sphincter pharyngoplasty based on MRI data of subjects with different surgical outcomes. These models were then used to determine the factors that impact surgical outcomes and to simulated different hypothetical sphincter placements to optimize surgical outcomes. Taken together, this research leverages a unique combination of biomedical engineering innovations to improve the quality of life for individuals born with cleft palate.