The craniofacial team is composed of nursing and physician specialists with particular interest and training in the care of children with cleft deformities (Table 2). One of the first consultations is with the feeding specialist, who assists families with managing the special feeding needs of cleft newborns. The geneticist serves to diagnose associated syndromes and can counsel families regarding genetic risks and future possibilities. A specialty nurse coordinator acts as a liaison between the patient and family and the craniofacial team. There may be some variability in the specific roles of the surgeons on the team, but these usually consist of a plastic surgeon, otolaryngologist, and oral surgeon. Most of the surgical needs are met with this team, including speech surgery and management of middle ear fluid. The dentist is responsible for dental restorations and encouraging good dental hygiene. The orthodontist manages tooth alignment and palatal expansion, often in preparation for orthognathic procedures. Both may be involved in presurgical molding of the cleft lip prior to surgical repair. The speech pathologist assesses language skills and performs diagnostic assessment of velopharyngeal function. A local children's hospital is critical as a source of surgical inpatient facilities and staffing and as a resource for community education and awareness. If possible, a dedicated clinic space with examination rooms, dental examination and treatment areas, dental laboratory, radiology capabilities, photography area or studio, adequate waiting area for children, staff offices, and electronic record keeping (a craniofacial home base, if you will) is optimal. Although not an intimate part of the craniofacial team, the patient's local pediatrician and community dentist also play a critical role in coordination and dispersal of primary care needs. If the craniofacial center, of which there are about 50 in the United States, is located far away from a patient, local physician care is even more important.
Complete Cleft Care: Cleft and Velopharyngeal Insuffiency Treatment in Children books pdf file
Velopharyngeal insufficiency (VPI) occurs in cleft and noncleft children. VPI can be the consequence of anatomic or functional problems within the velum and nasopharynx. On last review of our population of patients, about 15 to 20% of our cleft palate patients were diagnosed with VPI. The diagnosis can be made with either direct or indirect methods, the difference being whether the structures acting in velopharyngeal closure are directly seen or not. Common indirect methods include listener judgments, pressure-flow measurements, and the nasalance score as measured by a nasometer device. Common direct measurements include lateral phonation cephalography and oral and nasal endoscopy.
Once the initial lip and palate procedures are completed, the focus shifts to the teeth. Dental preventive care visits are done at a minimum of every 6 months. A very effective means of determining the preventive interval is to perform a specific risk analysis. Dental caries and other dental problems have a much higher prevalence in cleft patients, and early intervention reduces treatment needs as well as cost of treatment.14
Complete Cleft Care is a comprehensive, step-by-step guide to the assessment and treatment of patients suffering from cleft and velopharyngeal disorders. It covers multiple treatment modalities such as unilateral and bilateral cleft lip repair, secondary speech assessment and surgery, cleft rhinoplasty, gingivoperiosteoplasty, and alveolar bone grafting. The book includes videos, available online at Thiemes Media Center, that demonstrate specific techniques used in each treatment procedure.
Orofacial clefting is the most common developmental abnormality of the face and it has been studied extensively. There are numerous books and volumes of textbooks that have been published describing the diagnosis and surgical treatment of facial clefts, especially cleft lip and palate. This entry will attempt to provide an overview of the genetics/embryology, clinical features, and surgical treatment of cleft lip deformities. We encourage the reader to explore the referenced texts for a more complete description of cleft lip deformities and other types of...
A retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency.
The data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor.
Jonathan Suarez, MS, CCC-SLP, is a clinic lead and staff speech language pathologist who has worked at Cook Children's since 2012. He has a strong passion for treating children with cleft palate/VPI, expressive language delay and autism. He has also enjoyed his experience working in the Cook Children's Neighborhood Clinics. There, he completes speech and language screenings while also collaborating with physicians and families to improve outcomes of children with a variety of speech and language disorders. He finds joy in learning new therapy strategies to aid in his patient's success.
The management of Cleft Palate needs involvement of a multidisciplinary team which includes Plastic surgeons, otolaryngologists, orthodontists and speech language therapists. Surgical repair of cleft palate is important for feeding, normal speech mechanism and hearing. The recommended age for palate repair is between 6 - 12 months [1] and repair at 18 months of age is practiced by some [2] . The surgical goals for palate repair are complete palatal closure, velopharyngeal competence, and near normal maxillary growth. There are various factors that may contribute in the prevention of palatal fistula includes adequate mobilization and tension free closure especially in wide clefts (wider the cleft, higher the fistula rate), good three layer closure irrespective of the technique used, proper realignment of the muscle of the soft palate in the mid line, and postoperative management.
Higher incidence of fistulae was demonstrated in cases of bilateral cleft lip and palate [3] . A study done in New Zealand reported fistula rate of 12.8% (27 out of 211 children) [3] . Another study done in Canada at University of Toronto and University of Alberta showed a fistula rate of 0% (out of 148 and 34 operated cases respectively). They used Modified Von Langenbeck technique in their study [21] . A study compared one-flap with two-flap palatoplasty showed no statistical significance in terms of fistula development [22] . A study which focused on studying delayed cleft palate repair after 18 months in adopted patients showed 33 % incidence of velopharyngeal insufficiency compared with 13% in the group repaired between 6 to 12 months of age [1] . 2ff7e9595c