Multidisciplinary Team Back

Most individuals with cleft lip, cleft palate, or both (and many individuals with other craniofacial anomalies) require the coordinated care of providers in many fields of medicine and dentistry, as well as those in speech pathology, otolaryngology, audiology, genetics, nursing, mental health, and social medicine.

Treatment of cleft lip and palate anomalies requires years of specialized care. Although successful treatment of the cosmetic and functional aspects of orofacial cleft anomalies is now possible, it is still challenging, lengthy and dependent on the skills and experience of a medical team. This especially applies to surgical, dental, and speech therapies.

Because otitis media with effusion is very common among children with cleft palates, involvement of an otolaryngologist in the multidisciplinary treatment plan is very important. The otolaryngologist performs placement of ventilation tubes in conjunction with the cleft palate repair.[32] If a concurrent cleft lip is present, the ventilation tubes are placed during that repair. Many of these children see otolaryngologists well beyond the time they see many of the other specialists because some children continue to have eustachian tube dysfunction after their palates are closed. A team for the multidisciplinary treatment of a child with an orofacial cleft includes the following specialists:

  • Pediatrician
  • Nurse practitioner
  • Plastic surgeon
  • Pediatric dentist
  • Otolaryngologist
  • Geneticist
  • Genetic counselor
  • Speech pathologist
  • Orthodontist
  • Maxillofacial surgeon
  • Social worker
  • Psychologist

No single treatment concept has been identified, especially for a cleft lip and palate. The timing of the individual procedures varies in different centers and with different specialists.

Below is the most common treatment protocol presently used in most cleft treatment centers:

  • Newborn - Diagnostic examination, general counseling of parents, feeding instructions, palatal obturator (if necessary); genetic evaluation and specification of diagnosis; empiric risk of recurrence of cleft calculated; recommendation of a protocol for the prevention of a cleft recurrence in the family
  • Age 3 months - Repair of cleft lip (and placement of ventilation tubes)
  • Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation
  • Age 9 months - Speech therapy begins
  • Age 9-12 months - Repair of cleft palate (placement of ventilation tubes if not done at the time of cleft lip repair)
  • Age 1-7 years - Orthodontic treatment
  • Age 7-8 years - Alveolar bone graft
  • Older than 8 years - Orthodontic treatment continues
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