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R. Mark Ray, M.D. Director: Children’s Hospital Cleft and Craniofacial Team East Tennessee Children’s Hospital Evaluation and Treatment of the Child With Cleft Lip and Palate – Team Care Disclosure Statement of Financial Interest I, R. Mark Ray M.D., DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Pediatric Facial Anomalies Team Surgeon Speech Therapist Audiologist Nursing Pediatrician Orthodontist Social Work Nutritionist Classification- Cleft Lip Median clefts Mandibular Cleft Unilateral Lip Revision Insufficient Advancement Prenatal Diagonosis Provide information to families and answer questions Prepare family for feeding their baby Link family to resources Orthodontic Treatment Alveolar Ridge Bone Grafting Bardach, Janusz Salyer & Bardach’s Atlas of Craniofacial & Cleft Surgery. Volume II. Lippincott – Raven ; Philadelphia 1999 Palate Expansion Subtle Alveolar Defect Alveolar Ridge Bone Grafting Alveolar Ridge Bone Grafting Alveolar Ridge Bone Grafting Speech Issues Velopharyngeal Insufficiency Articulation Disorder Compensatory errors Velocardiofacial Syndrome Rhinoplasty Cleft and Craniofacial Surgeries: 2009 & 2010 29 30 25 22 20 2009 15 12 11 11 10 6 5 6 7 4 2 2 0 1 0 0 Lip Adhesion Cleft Lip Cleft Palate VPI (cleft) VPI (non-cleft) Definitive Cleft Rhinoplasty Other 2010 Pierre Robin Sequence and Distraction Osteogenesis in the Neonatal Period Nager Syndrome Overview Retrognathia, Glossoptosis, Cleft Palate 1 in 9000 live births Mortality 5-30% Airway and feeding difficulties are presenting problems Management is not uniform Tongue base obstruction Positioning Positioning Tracheostomy: Disadvantages Complications: Cannula obstruction Accidental decannulation Mortality significant Average age atdecannulation: 3.1 years! Functional Impairment Distraction Osteogenesis Distraction Osteogenesis Distraction Osteogenesis Internal Device Distraction Osteogenesis Airway Before and After Occlusion Distraction Osteogenesis Judy Marciel Cleft Team Coordinator Feeding and Nutrition Specialist Provider and Family Education Outcomes Evaluation and Analysis Research Coordinator Contact : 865-541-8510 Questions