July 2018 • Volume 11, No. 7

From the Editor

July is National Cleft & Craniofacial Awareness & Prevention Month (NCCAPM). This month-long observance was established by two advocacy organizations: AmeriFace and CleftAdvocate. It shines a light on individuals with facial differences and their families, whether those differences are present at birth or a result of illness, disease or trauma, working to increase public understanding through awareness programs and education.

For this issue, we focus on cleft lips and cleft palates, known as orofacial clefts—birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. According to the Centers for Disease Control and Prevention, about 2,650 babies are born with a cleft palate and 4,440 babies are born with a cleft lip (with or without a cleft palate) in the US annually. Clefts that occur with no other major birth defects are among the most common types of birth defects in the United States.

They are also very common internationally: see Operation Smile and Smile Train. Untreated, clefts can cause great suffering through difficulties in eating, speaking, hearing, breathing and/or tooth development, not to mention being ostracized for being “different.”

A wealth of information about these orofacial clefts and the related surgical techniques can be found in this series of articles on Medscape (registration is required, but it’s free). We also present news, videos and an all-new crossword puzzle on the topic.

Our Student in the Spotlight is Sara Rummelhoff, APN, of Chicago. And scroll down for RNFA job listings and NIFA’s favorite links.



Julie Lancaster, Editor


Photo of children playing by MI PHAM on Unsplash

Surgical News

3D Mapping Technology Used to Evaluate Face Symmetry after Surgery

Glasgow University is teaming up with Smile Train, an international charity that conducts cleft lip / cleft palate surgeries, to “revolutionize the standard of surgery for youngsters with cleft lip and palate problems” by using 3D mapping technology to evaluate facial symmetry after surgery. The technology uses an algorithm to measure post-operation facial symmetry to within one thousandth of a millimetre for greater assessment of surgeons’ work, flagging cases where the surgeon needs more training to improve standards.
Read more . . . | photo:   The National

Breakthrough in Cleft Lip / Cleft Palate Research 

Researchers have isolated four genes that may be responsible for increased incidences of cleft palate. According to the announcement, from the University of New South Wales, “the study provides the first evidence that a significant number of non-syndromic clefts have a single gene basis and not a complex basis as previously thought.”  
Read more . . . | photo: University of New South Wales

Search for Cleft Palate’s Cause Reveals a Map of the Facial Genome 

For other types of clefts, researchers at the University of Connecticut Health are studying not the genes that tell the body what proteins to make but rather regulators, parts of the DNA that tell genes when and where to act.

“The researchers examined tissue from human facial development in the very early stages, just four to eight weeks after conception. The human face doesn’t look like much at that point, just a collection of folds and bulges, but these structures have vital jobs to do. If they do not move and fuse at the proper time in development, clefts can occur.”
Read more . . .


Here’s a video by a surgeon on a medical mission trip in Guatemala. It shows step-by-step close ups of a cleft palate surgery performed on a baby. 
Watch video . . .

Cleft Lip/Palate Crossword Puzzle

RNFA NIFA Crossword Puzzle Cleft Lip/Palate
Test your knowledge of Cleft Lip/Palate procedures with this month’s all-new crossword puzzle.

When you’re ready to check your answers, follow this link to see how well you did. Good luck!


Student Spotlight: Sara Rummelhoff

Sara Rummeholff wearing a hoodie, and surgical gloves. She's smiling and practicing surgery on a foam dummy.Credentials:   APN
City & State:  Chicago IL
Current Position:
Neurosurgery Nurse Practitioner, Swedish Covenant Hospital

Where did you get your RN degree?  
Associate: Truman College
BSN: Western Governor’s University
MSN: North Park University

How did you come to choose perioperative nursing?
I completed my nurse practitioner program and was hired to work with a neurosurgeon. The hospital wanted me to take this course for competency training in the OR.

What is the weirdest moment you’ve ever seen at the table? 
We recently had a patient with neurocysticercosi and removed the worm from the fourth ventricle.

What is one technique or RNFA trick you’ve learned from NIFA this week that you will use for life?
I will be doing the closing in the OR, so this course was critical to my skill set with suturing and tying. My surgeon told me 99% of the time we will be doing one-handed tying so the team (NIFA) was amazing at helping me perfect my skills.

Jobs Front

Click here for the RNFA job postings we’ve collected for you this month.

NIFA – Office Hours


Monday-Friday, 8:00am – 4:00pm

Practice Resources

Here are several of the most-in-demand sites for our students, prospective students and grads:

ACS Surgery News: Specialty News and Commentaries, Videos and More
RNFA Scope of Practice by State (PDF excerpt from AORN.org)
ACS List of Cases that Require an Assistant at Surgery, 2016 (PDF)
Perioperative Nurse Links (state nursing boards & professional associations)
APRN Nurse Links

Disclaimer: The views expressed in this newsletter are strictly those of their respective authors and do not necessarily represent the views of NIFA. NIFA does not give any express or implied warranty as to the accuracy of statements made by our contributors and does not accept any liability for error or omission. It is the responsibility of all perioperative personnel to work within and adhere to their facility bylaws and individual scope of practice.

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