The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Review Article

The Multidisciplinary Evaluation and Management of Cleft Lip and Palate

Authors: Nathaniel H. Robin, MD, Heather Baty, MS, Judith Franklin, RN, Fran C. Guyton, MS, Judith Mann, MS, Audie L. Woolley, MD, Peter D. Waite, MPH, DMD, MD, John Grant, MD

Abstract

Cleft lip with or without a cleft palate (CLP) and cleft palate alone (CPA) are common birth defects, with a combined birth prevalence of about 1 to 2/1,000.1 Affected children have a number of medical issues and potential complications, and therefore require a wide variety of healthcare specialists beyond plastic surgeons and dental specialists. For this reason, the best environment in which to deliver this care is a multidisciplinary cleft clinic (MCC) that features a team of healthcare providers, including audiology, pediatric otolaryngology, speech pathology, occupational/feeding therapy, and genetics. In this setting, the many medical issues that these children face are comprehensively addressed in the most convenient manner, as all the specialists can be seen in a single busy day. Furthermore, the referring primary care provider (PCP) will receive a concise letter that documents the team evaluation, including future management plans and recommendations for therapy. Unfortunately, few papers are available in the literature that review the workings of these clinics. In this paper we will provide such an overview, discussing the management issues for children with CLP/CPA, and how these are addressed by members of the MCC.


Key Points


* Cleft lip and palate (CLP) is a common birth defect, but one that requires a multidisciplinary approach to optimize the chance of successful outcome.


* The multidisciplinary cleft team includes members from many different medical specialties and branches. Understanding the roles of these professionals is important for the primary care provider to facilitate the best outcome for these patients.


* There are a variety of causes of CLP, including genetic and nongenetic causes. Identifying the cause for a given patient is important to patient, their family as well as the healthcare team.


* Planning the surgical repairs must take into account many different considerations and must balance functional and aesthetic outcomes in the developing child. These include speech production, dental health, and facial growth.


* A child with CLP faces many potential associated complications, including feeding problems, hearing loss, and speech problems. These are monitored and treated by various professionals in the CLP team.

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References

1. Cox TC. Taking it to the max: The genetic and developmental mechanisms coordinating midfacial morphogenesis and dysmorphology. Clin Genet 2004;65:163–176.
 
2. Young JL, O’Riordan MA, Goldstein JA, Robin NH. What information do parents of newborns with cleft lip, palate or both want to know. Cleft Palate Craniofac J 2001;38:55–58.
 
3. American Cleft Palate-Craniofacial Association. Revised April 2000. Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies, April 2000 (available athttp://www.cleftline.org/).
 
4. Falk MJ, Robin NH. The primary care physician’s approach to congenital anomalies. Prim Care2004;31:605–619.
 
5. Shprintzen RJ. Velocardiofacial syndrome. Otolaryngol Clin North Am. 2000;33:1217–1240.
 
6. Wyszynski DF, Zeiger J, Tilli MT, et al. Survey of genetic counselors and clinical geneticists regarding recurrence risks for families with nonsyndromic cleft lip with or without cleft palate. Am J Med Genet 1998;79:184–190.
 
7. Larsen WJ. Human Embryology, 2nd ed. Philadelphia: Churchill Livingstone 1997.
8. Grayson BH, Santiago PE, Brecht LE, et al. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999 Nov;36:486–498.
9. Cleft Craft: The evolution of Its Surgery, Vol. III: Alveolar and Palatal Deformaties. Boston, H Little, Brown & Co., 1976.
10. Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair: a 33-year experience. J Craniofac Surg. 2003;14:549–558.
11. Rohrich RJ, Love EJ, Byrd, et al Optimal timing of cleft palate closure. Plast Reconstr Surg.2000;106:413–421; quiz 422; discussion 423–425.
12. Thaller SR. Staged repair of secondary cleft palate deformities. J Craniofac Surg. 1995 6:375–380; discussion 381.
13. Witt PD, Myckatyn T, Marsh JL, et al. Need for velopharyngeal management following palatoplasty: an outcome analysis of syndromic and nonsyndromic patients with Robin sequence. Plast Reconstr Surg. 1997 99:1522–1529; discussion 1530–1534.
14. Blakely R. Palate Dysfunction and Speech Disorders: Evaluation and Treatment Planning Programs for Children and Adults. Austin, PRO-ED, Inc, 2000.
15. Shipley KG, McAfee JG. Assessment in Speech-Language Pathology: A Resource Manual, 3rd ed. Clifton Park, Delmar Publishing, 2002..
16. Anastassov GE, Joos U. Comprehensive management of cleft lip and palate deformities. J Oral Maxillofac Surg 2001;59:1062–1075; discussion 1075–1077.
17. Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J 1987;24:5–77.
18. Georgiade NG, Latham RA. Maxillary arch alignment in the bilateral cleft lip and palate infant, using pinned coaxial screw appliance. Plast Reconstr Surg. 1975 56:52–60.
19. Precious DS. Alveolar bone grafting. Oral and Maxillofacial Clinics of North America 2000;12:501–513.
20. Waite PD, Waite DE. Bone grafting for the alveolar cleft defect. Semin Orthod 1996;2:192–196.
21. Paradise JL, Bluestone CD, Felder H. The universality of otitis media in 50 infants with cleft palate.Pediatrics 1969;44:35–42.
22. Paradise JL, Bluestone CD. Early treatment of the universal otitis media of infants with cleft palate.Pediatrics 1974;53:48–54.
23. Downs M. Contribution of Mild Hearing Loss to Auditory Language Learning Problems, in Roser R, Downs M (eds): Auditory Disorders in School Children. New York, Thieme Medical Publishers, 1995, pp 198.
24. Hunt GM, Oakeshott P. Outcome in people with open spina bifida at age 35: prospective community based cohort study. BMJ 2003;326:1365–1366.
25. Christensen K, Juel K, Herskind AM, et al. Long term follow up study of survival associated with the left lip and the palate at birth. Br Med J 2004; 238:1405.
26. Ramstad T, Ottem E, Shaw WC. Psychosocial adjustment in Norwegian adults who had undergone standardised treatment of complete cleft lip and palate. II. Self-reported problems and concerns with appearance. Scand J Plast Reconstr Surg Hand Surg 1995;29:329–336.
27. Christensen K, Mortensen PB. Facial clefting and psychiatric diseases: a follow-up of the Danish 1936-1987 Facial Cleft cohort. Cleft Palate Craniofac J 2002;39:392–396.
28. Zhu JL, Basso O, Hasle, et al. Do parents of children with congenital malformations have a higher cancer risk? A nationwide study in Denmark. Br J Cancer 2002;87:524–528.
29. Zack M, Adami HO, Ericson A. Maternal and perinatal risk factors for childhood leukemia. Cancer Res 1991;51:3696–3701.