Clefts are no match for this Hillsdale doctor

Dr. Judah Garfinkle in trained in the application of NAM

By Shasta Kearns Moore

The Southwest Community Connection, May 1, 2009, Updated Oct 30, 2009

Dr. Judah Garfinkle checks the adjustment of a nasoalviolar molding (NAM) in nine-week-old Liam Smith. The NAM molds his young cartilage so that surgery to close his cleft is easier and more successful.

Shasta Kearns Moore / The Southwest Community Connection

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HILLSDALE – When Jessica Smith gave birth to baby Liam at home in Vancouver, she had no idea that he would be born with a cleft.

The facial deformity is usually noticed during the 20-week ultrasound, but Smith’s sonographer didn’t catch it.

“I think ‘stunned’ would be the word,” Smith said. “This was just a total shock.”

Within hours, Smith and her husband were searching online and calling friends to find the best specialist, even making an appointment with a doctor in Phoenix, Ariz.

But they soon discovered that just over the Columbia River was one of the best craniofacial orthodontists in the nation.

“We would’ve gone anywhere,” Smith said at a recent appointment with Dr. Judah Garfinkle. “We’re not here because of default. We’re here because we want him. He’s the expert. He’s the person to go to.”

Garfinkle spends most of his time sharing space with his father, Dr. Richard Garfinkle, at a private clinic off Sunset Boulevard in Hillsdale. But one day a week he is the director of Craniofacial Orthodontics at Oregon Health and Science University, where he treats clefts and other facial deformities.

A third-generation dentist and a Portland native, Garfinkle is one of about 10 people in the nation who have had a fellowship at New York University Medical Center in the application of nasoalveolar molding. Called NAM for short, the process developed by doctors there in the 1990s is revolutionizing the way clefts are treated around the world.

Causes of clefts

First, let’s talk about what a cleft is.

By the time the fetus is 10 to 12 weeks old, the palate and lip should have formed, creating the typical divot on the upper lip. If that tissue fusion gets interrupted, it stops, leaving the face, gums or palate open.

“It’s kind of like a zipper going backwards, so it can get interrupted at any point,” Garfinkle said.

Cleft palates occur when the roof of the mouth is open and cleft lips occur when a gap is left beneath one or both of the nostrils, sometimes extending through the gums. These deformities are not inherently painful, but can lead to difficulty breathing, eating and speaking. Not to mention difficulty socializing.

“Normalizing faces means normalizing (social) interaction,” Garfinkle said. “Those early formative times make quite an impact.”

Scientists are still debating what causes clefts, but some of the factors are thought to be insufficient prenatal care, the mother’s substance abuse and plain-old genetics.

Clefts appear in one in 700 Caucasian babies, occurring more frequently in those with Asian or Native American backgrounds and less frequently in those with African heritage, Garfinkle said.

Instead of just surgery, ‘doing something’ about it

Clefts require about two decades of surgeries, orthodontics and other management, but the NAM procedure makes the process easier by essentially molding the baby’s nose and gums.

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