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