R. Mark Ray, M.D. Director: Children’s Hospital Cleft and Craniofacial Team East Tennessee Children’s Hospital.

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Presentation transcript:

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., 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. 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.

Airway Management

Subglottic Stenosis

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

Speech Issues Velopharyngeal Insufficiency Compensatory errors Articulation Disorder Velocardiofacial Syndrome

Rhinoplasty

Cleft and Craniofacial Surgeries: 2009 & 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

Tracheostomy: Disadvantages Complications: Cannula obstruction Accidental decannulation Mortality significant Average age atdecannulation: 3.1 years! Functional Impairment

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 :

Questions