TEAM APPROACH
Management of a cleft lip/cleft palate involves more than surgical repair of the defect. Services of other professionals such as a dentist, orthodontist, otolaryngologist, audiologist, speech-language pathologist and pediatrician are usually required to identify and treat associated problems. In addition, the care provided by each specialist should be carefully timed and coordinated in an individualized overall treatment plan. For these reasons, interdisciplinary Cleft Palate Teams have been established to provide comprehensive evaluations for individuals with cleft lip/cleft palate, to design a coordinated treatment plan to meet the specific needs of the patient and to help the family obtain appropriate care. The team approach is more economical in time and money for the individual and family because the examinations by all the specialists may be completed in one central place in the same visit.
INTERDISCIPLINARY CARE
Pediatrics
The pediatrician provides primary care to the child, with special attention to the individual feeding needs in the infancy period. The child is followed for treatment of colds and ear infections and his/her overall emotional, growth and development. The pediatrician also provides parent counseling pertaining to the coordination of the care by other professional consultants
Plastic & Reconstructive Surgery
The plastic surgeon is responsible for surgical repair of the cleft lip/cleft palate. Cleft lip repair is usually done at about 3 months of age. The cleft palate is usually repaired by 12 months of age. Repair of the lip and palate constitutes the major procedures required in the first year of life. As the childs speech and language develop, the need for further surgery on the soft palate to improve function for speech, may be necessary. Additional surgical procedures to correct nasal deformities and lip scars, and sometimes to improve the relationship of the jaws in coordination with orthodontic care, may be done at different periods of the childs growth and development.
Hearing, Language, & Speech
Children born with cleft lip/cleft palate are at higher risk for hearing, language and speech problems. However, many may develop normal speech and language skills with little or no special help. Some children may have speech/language problems unrelated to the cleft palate. Children born with cleft lip/cleft palate should be evaluated periodically by a speech-language pathologist, beginning before one year of age, to be certain that speech and language skills are developing satisfactorily, and to assess how well the palate functions for speech production.
Normal hearing is essential for the development of age appropriate speech and language skills. Periodic hearing testing should be provided by an audiologist, starting before the child is 6 months of age.
Dental
Regular visits to the dentist should begin when the child is about 2 years of age. It is important to maintain healthy teeth and gums. Primary or baby teeth are usually restored rather than pulled in order to prevent greater problems as the permanent teeth erupt. Dental X-rays are needed periodically to check for teeth that may be missing or erupting in the wrong place. Because children with cleft lip/cleft palate often present unique dental needs, families may want to consider care with a pediatric dentist.
Orthodontics
Most children with cleft lip/cleft palate will need orthodontic treatment to correct spacing and/or alignment of teeth. Sometimes treatment is begun in mixed dentition (before all permanent teeth are present). In other instances, the orthodontist may check the development of the childs teeth and jaws periodically and then start active treatment when most of the permanent teeth are erupted. A child receiving orthodontic care must be seen regularly by his/her dentist to prevent dental decay.
Surgical procedures to expose unerupted teeth, to provide a bone graft in the cleft site of the upper dental arch, or to improve the alignment of the upper and lower arches are coordinated by the orthodontist with the plastic surgeon or oral surgeon.
Otolaryngology (Ear, Nose & Throat)
Children with cleft lip/cleft palate are very susceptible to ear infections. These children need to be followed closely by a specialist in Ear, Nose, and Throat care, to prevent and treat ear infections that could lead to serious complications. This care is often needed shortly after birth, and continued into teenage years. Frequently ventilating tubes (PE tubes) are required before one year of age, or at the time of lip or palate repair. Caution: If a tonsillectomy and/or adenoidectomy (T&A) is suggested for a child with a cleft lip/cleft palate, the specialists (including the speech-language pathologist) involved in the child's treatment should be consulted.
Psycho-Social Support
Individuals with cleft lip/cleft palate and their families may benefit from guidance and counseling to help them understand and cope with stress and/or problems at different stages of treatment. Discussing problems or concerns with a social worker may enable the patient and/or family to overcome feelings or difficulties that could interfere with the successful outcome of care. Helping families to locate funding for some aspects of treatment is often the responsibility of social work personnel in hospitals, on teams or at clinics.
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