Craniofacial team - A cleft lip help

Cleft lip+/- palate may affect early feeding, speech , dentition, hearing, velopharyngeal function and psychosocial development. Due to the multifaceted nature of this disorder, a timely coordinated approach by an interdisciplinary cleft palate or craniofacial team is essential to the management and care of this population. According to the American Cleft Palate-Craniofacial Association (ACPA), a cleft palate team provides assessment and treatment for cleft lip +/- palate only, while a craniofacial team provides assessment and treatment for craniofacial anomalies and associated syndromes (Strauss et al., 1998).

The minimal requirement for a cleft palate team is a surgeon (see below), an orthodontist, and a speech-language pathologist (Strauss et al., 1998). Involvement of other professionals such as audiologists, psychologists (or other mental health professionals), otolaryngologists, pediatric and general dentists, audiologists, pediatricians, geneticists, social workers, pediatric nurse practitioners; radiologists, and otolaryngologists is not uncommon. Most children with a cleft palate evidence early, and usually treatable middle ear disease (otitis media).

The Surgeon, an oral and maxillofacial surgeon or a plastic and reconstructive surgeon, is critical member of the cleft palate team. Their role is to create a functional lip and palate that appears as normal as possible and provides support for the lip and base of the nose. This may, in some cases, require more than one surgery, including initial closure of the lip, initial closure of the palate, lip and nose revision, alveolar bone grafting, and if necessary, closure of oronasal fistula, and/or further palatal or pharyngeal surgery to eliminate hypernasal speech (Peterson-Falzone, Hardin-Jones, Karnell, 2001). Orthognathic Surgery to align the upper and lower jaws may also be performed when the child is in their teens. The timing of these surgeries range from birth to the teenage years, and is based upon discussions with the orthodontist and surgeon.

The Orthodontist, whose specialty is the growth and development of the craniofacial complex, is one of the first cleft palate team members the family may encounter. The orthodontist’s evaluation of the newborn will help determine the timing of required surgeries as the child develops. The Speech-Language Pathologist is also an essential member of the cleft palate team. Children with cleft palate often have delayed speech and language development. The speech-language pathologist will be involved in parent education, newborn feeding instruction, and evaluation and treatment of speech, language, voice and resonance disorders. The evaluation and treatment of a child with cleft lip +/- palate requires ongoing services from a team of various professionals in a coordinated timely manner. Successful rehabilitation of the child is dependent on continued care by these professionals. Note that not all children with orofacial anomalies will require the care of a cleft palate team. For example, some children with submucous, or occult clefts of the palate, who do not have an impairment of speech/hearing may not need this service.