Team of Professionals in the Management of Cleft Lip and Palate: Individuals with cleft lip and palate, typically demonstrate multiple complex issues may include,
- Early feeding and nutritional problems
- Developmental delay or learning disabilities
- Hearing loss
- Obstructive sleep apnea
- Neurological problems
- Dentofacial and orthodontic abnormalities
- Aesthetic concerns
- Psychosocial problems
- Communication disorder
Because of these various concerns, these patients usually have the need for medical, surgical, dental, and allied health (including speech pathology) services that requires a team of professionals.
Team of Professionals and their Roles
Audiologist: Responsible for testing the child’s hearing and middle ear function because individuals with craniofacial anomalies are at high risk for structural ear anomalies.
Craniofacial surgeon: The role of this surgeon is to correct the congenital deformities of the head, skull, face, neck, jaws, and associated structures for an improvement in both aesthetics and function.
Dentist (pediatric): Responsible for general care of the child’s teeth, prevention and treatment of the tooth decay, develops habits of good oral hygiene, management of misaligned cleft segments prior to the lip closure.
Geneticist: Responsible for assessing patients with a history of cleft, velopharyngeal dysfunction, or craniofacial anomalies for a pattern that indicates a known syndrome or cause.
Nurse: The nurse’s role on the team is to assess the child’s overall physical development, assists
the family in developing compensatory feeding techniques and counsels the family regarding surgical procedures and answers their specific questions.
Oral/maxillofacial surgeon: Responsible for bone grafts to the alveolar cleft area when there is deficient bone in the line of the cleft, performs the orthognathic surgeries to normalize the occlusion between the maxillary and mandibular arches.
Orthodontist: The orthodontist is responsible for aligning misplaced teeth in addition to correcting dental and skeletal malocclusion.
Otolaryngologist: Responsible for monitoring middle ear function and hearing and treating middle ear disease, assesses the structural aspects of the oral cavity, oropharynx, nasal cavity, and upper airway and treats conditions such as adenotonsillar hypertrophy, pharyngeal masses, and vocal fold abnormalities, perform the nasopharyngoscopy evaluations, and some do surgeries for velopharyngeal insufficiency/incompetence (VPI)
Pediatrician: Responsible for assessing the patient’s overall medical health, growth, and development.
Plastic surgeon: Responsible for the surgical repair of the lip and palate and surgical reconstruction of facial and cranial anomalies. Surgery for correction of VPI is usually done by the plastic surgeon
Prosthodontist: The prosthodontist is involved with the restoration of natural teeth or the replacement of missing teeth, manufacture and fit devices to assist with velopharyngeal closure if surgery is not an option.
Psychologist: assesses the patient’s psychosocial needs and assists the patient and family in dealing with the medical, social, and emotional challenges that occur from the patient’s anomalies and other medical conditions.
Pulmonologist: Responsible for airway issues and sleep problems, monitors the patient’s airway and sleep. If obstructive sleep apnea (OSA) is suspected, the pulmonologist will order a sleep study.
Social worker: Helps families to manage the child’s special needs, coordinates appointments and assists the families in dealing with insurance and other funding sources, may help the family to manage their stress and emotional reactions to the many problems and issues associated with the child’s treatment.
Speech-language pathologist: Counsels the parents regarding what to expect with communication development and how to work with the child at home. The speech-language pathologist evaluates feeding and swallowing, general development, speech, language, resonance, and velopharyngeal function. The speech-language pathologist provides therapy for communication problems and disorders of feeding or swallowing. Some speech-language pathologists perform nasopharyngoscopy evaluations.
Team coordinator: Represents the team in any interactions with parents, other healthcare professionals, and the community and responsible for scheduling patients for each team meeting and compiling the recommendations from each team member for comprehensive team reports.
Advantages of the Team Approach
- Patients have access to multiple professionals who specialize in their condition.
- Multiple professionals can evaluate the child in one visit, usually at a lower cost than individual evaluations.
- Care is provided in a coordinated and consistent manner with consideration for the patient’s overall medical, developmental, and psychological needs.
- Teams often provide parent groups, special camps, and pamphlets and other educational materials
- To keep good serial records and collect data for quality assurance and collaboration in research and publications
⇒ Cleft Palate and Craniofacial Conditions A Comprehensive Guide to Clinical Management – Ann W. Kummer, PhD, CCC-SLP, FASHA (Book)
⇒ Cleft Lip and Palate – ASHA