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

2. Evaluation and Treatment of the Child With Cleft Lip and Palate – Team Care

3. 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.

4. Airway Management

5. Subglottic Stenosis

6. Pediatric Facial Anomalies Team Surgeon Speech Therapist Audiologist Nursing Pediatrician Orthodontist Social Work Nutritionist

7. Classification- Cleft Lip

8. Median clefts

9. Mandibular Cleft

13. Unilateral Lip Revision Insufficient Advancement

16. Prenatal Diagonosis Provide information to families and answer questions Prepare family for feeding their baby Link family to resources

17. Orthodontic Treatment

18. Alveolar Ridge Bone Grafting

19. Bardach, Janusz Salyer & Bardach’s Atlas of Craniofacial & Cleft Surgery. Volume II. Lippincott – Raven ; Philadelphia 1999

20. Palate Expansion

21. Subtle Alveolar Defect

22. Alveolar Ridge Bone Grafting

25. Speech Issues Velopharyngeal Insufficiency Compensatory errors Articulation Disorder Velocardiofacial Syndrome

27. Rhinoplasty

29. Cleft and Craniofacial Surgeries: 2009 & 2010

31. Pierre Robin Sequence and Distraction Osteogenesis in the Neonatal Period

32. Nager Syndrome

33. Overview Retrognathia, Glossoptosis, Cleft Palate 1 in 9000 live births Mortality 5-30% Airway and feeding difficulties are presenting problems Management is not uniform

34. Tongue base obstruction

35. Positioning

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

38. Distraction Osteogenesis

40. Distraction Osteogenesis Internal Device

42. Distraction Osteogenesis

44. Airway Before and After

45. Occlusion

48. Distraction Osteogenesis

49. Judy Marciel Cleft Team Coordinator Feeding and Nutrition Specialist Provider and Family Education Outcomes Evaluation and Analysis Research Coordinator Contact : 865-541-8510

50. Questions