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Complete Cleft Care: Cleft And Velopharyngeal Insuffiency Treatment In Children Books Pdf File


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The craniofacial team is composed of nursing and physician specialists with particular interest and training in the care of children with cleft deformities (Table 2). One of the first consultations is with the feeding specialist, who assists families with managing the special feeding needs of cleft newborns. The geneticist serves to diagnose associated syndromes and can counsel families regarding genetic risks and future possibilities. A specialty nurse coordinator acts as a liaison between the patient and family and the craniofacial team. There may be some variability in the specific roles of the surgeons on the team, but these usually consist of a plastic surgeon, otolaryngologist, and oral surgeon. Most of the surgical needs are met with this team, including speech surgery and management of middle ear fluid. The dentist is responsible for dental restorations and encouraging good dental hygiene. The orthodontist manages tooth alignment and palatal expansion, often in preparation for orthognathic procedures. Both may be involved in presurgical molding of the cleft lip prior to surgical repair. The speech pathologist assesses language skills and performs diagnostic assessment of velopharyngeal function. A local children's hospital is critical as a source of surgical inpatient facilities and staffing and as a resource for community education and awareness. If possible, a dedicated clinic space with examination rooms, dental examination and treatment areas, dental laboratory, radiology capabilities, photography area or studio, adequate waiting area for children, staff offices, and electronic record keeping (a craniofacial home base, if you will) is optimal. Although not an intimate part of the craniofacial team, the patient's local pediatrician and community dentist also play a critical role in coordination and dispersal of primary care needs. If the craniofacial center, of which there are about 50 in the United States, is located far away from a patient, local physician care is even more important.


Velopharyngeal insufficiency (VPI) occurs in cleft and noncleft children. VPI can be the consequence of anatomic or functional problems within the velum and nasopharynx. On last review of our population of patients, about 15 to 20% of our cleft palate patients were diagnosed with VPI. The diagnosis can be made with either direct or indirect methods, the difference being whether the structures acting in velopharyngeal closure are directly seen or not. Common indirect methods include listener judgments, pressure-flow measurements, and the nasalance score as measured by a nasometer device. Common direct measurements include lateral phonation cephalography and oral and nasal endoscopy.


Once the initial lip and palate procedures are completed, the focus shifts to the teeth. Dental preventive care visits are done at a minimum of every 6 months. A very effective means of determining the preventive interval is to perform a specific risk analysis. Dental caries and other dental problems have a much higher prevalence in cleft patients, and early intervention reduces treatment needs as well as cost of treatment.14


Complete Cleft Care is a comprehensive, step-by-step guide to the assessment and treatment of patients suffering from cleft and velopharyngeal disorders. It covers multiple treatment modalities such as unilateral and bilateral cleft lip repair, secondary speech assessment and surgery, cleft rhinoplasty, gingivoperiosteoplasty, and alveolar bone grafting. The book includes videos, available online at Thiemes Media Center, that demonstrate specific techniques used in each treatment procedure.


Orofacial clefting is the most common developmental abnormality of the face and it has been studied extensively. There are numerous books and volumes of textbooks that have been published describing the diagnosis and surgical treatment of facial clefts, especially cleft lip and palate. This entry will attempt to provide an overview of the gene




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