THIS PATIENT with a cleft lip and palate shows how the deformity can be reduced with Nasoalveolar Molds to optimize surgical results. The patient is shown from left at initial exam, and at right, after surgery.

Garfinkle brings cleft treatment to NW

By Deborah Moon

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Babies born with clefts of the lip and palate in the Pacific Northwest now have access to state-of-the-art treatment thanks to the lure of Portland’s lifestyle.

Third-generation dentist and Portland native Dr. Judah Garfinkle has returned to his hometown to serve as Director of Craniofacial Orthodontics at Oregon Health and Science University/Doernbecher Children’s Hospital and to practice orthodontics alongside his father Dr. Richard Garfinkle.

Garfinkle returned to Portland after spending two years in New York City, learning from and working with his mentor Dr. Barry Grayson, who invented Nasoalveolar Molding in 1990. NAM, which now is used worldwide to treat infants with clefts of the lip and palate, is used to minimize the deformity prior to surgery with the aim of improving the surgical outcome. Formerly many babies with clefting disorders had to undergo multiple surgeries to adequately correct the deformity.

“The goal is to make the outcome of the primary surgery superior,” said Garfinkle. “One great surgery can be better than multiple good surgeries.” Further, Garfinkle believes in the importance of improving a child’s early social interactions by nearly eliminating the early stigma that comes along with having a cleft deformity.

Infants treated with NAM visit Garfinkle every week or two. At each appointment, he adjusts the intraoral portion and nasal stent to approximate the alveolus (gum pads) and improve the symmetry of the nose.

“NAM is a gradual process, taking three to four months to prepare the infant for surgery,”said Garfinkle. “The device must be perfect and smooth, otherwise it would not be tolerated in the baby’s mouth.”

Garfinkle said his decision to perform NAM is based on scientific research, much of which he has been involved with. Garfinkle regularly presents at scientific meetings and recently authored a chapter on NAM with Dr. Barry Grayson, which is due out later this year.

“The study with the longest follow up tells us that at the age of 12, children born with bilateral cleft lip and palate had near normal nasal anatomy after just one surgery in infancy. What’s exciting, is that their noses grew on parallel growth curves,” he said.

Since his return to Portland last summer, Garfinkle has treated more than a dozen infants, some coming from as far as Eugene or Grants Pass for their weekly adjustments. In addition to his work at OHSU, Garfinkle serves as a consultant to the other three craniofacial/cleft palate teams in Portland and maintains a private practice at Garfinkle Orthodontics in the Hillsdale community in Southwest Portland.

He said he believes that both he and his patients benefit from his varied work.

“It’s all comers for me,” said Garfinkle. “I’ve noticed in treating patients with craniofacial anomalies, when I see how growth is disturbed, I’m able to appreciate and predict normal development better. Conversely, when I’m treating patients that develop more normally, it helps me keep my mind on the goal for the patient with a craniofacial anomaly.”

He said he also hopes that by treating this diverse patient base, “both children and adults can learn more openly about facial deformities and ultimately appreciate that inside each of us are more similar than different.”

Garfinkle graduated from Lincoln High School and the University of Oregon before he moved to the other coast to attend Harvard. He said he chose to study dental medicine at Harvard because of the school’s approach of treating dentistry as a subspecialty of medicine, which concurs with his own philosophy. Dental students spend the first two years in the medical school before focusing on dentistry in the third and fourth year.

Garfinkle’s interest in craniofacial anomalies was fostered early in his training. While in dental school, Garfinkle served on the board of the Boston Chapter of Operation Smile. He went to Bolivia in 2002 on a medical mission to treat children with cleft deformities.

While at Harvard, Garfinkle reconnected with his old girlfriend Ali Gerard from Camp Swig (the Reform Movement summer camp in California where his parents had met). She also was attending graduate school in Boston. They had met at age 14 and dated at age 17. They reconnected as close friends for most of their four years in Boston. It wasn’t until Garfinkle was leaving to do his residency in orthodontics at the University of Kentucky, that the romance was rekindled. The couple now has been married five years.

Garfinkle said that during his three years in Kentucky, “I sought out as many complicated craniofacial cases as I could, but there just wasn’t time to get comfortable treating the very complex cases. I did research and surgical treatment planning, but was still motivated to learn more.”

Garfinkle then applied for and was accepted to the only craniofacial orthodontic fellowship position in the country—at the New York University Medical Center, Institute of Reconstructive Plastic Surgery.

“It was such a great fit for me,” said Garfinkle. “I found the mentor I was always looking for. It was such an amazing time professionally and personally. Working and learning with the people who wrote the textbooks; pushing the boundaries of art and science; it was an electric and fun work environment.”

“We (Ali and I) were loving it,” said Garfinkle. “It was great to be able to contribute and learn as such a high level.”

“In New York City, life is great, but the lifestyle…,” said Garfinkle, noting he and Ali did not feel it was the right place to raise their family. “While the thought of staying there was seductive, it was time to go. For me, treating one patient and one smile is as satisfying as trying to treat 1,000.”

So the Garfinkles arrived in Portland soon after daughter Madeline Rose was born and bought a house, which now just needs a dog, quipped Garfinkle.

“It’s fun getting to come home and be part of the community,” he said. “We (my wife and I) moved so much, it’s nice to be able to lay roots down, and I feel fortunate it’s where I grew up.”