Center Provides Team Approach To Cleft Palate and Cleft Lip Treatment

No expectant mother likes to consider the possibility that her baby might be born with a disability. Yet when parents in South Carolina learn that their infant has a cleft lip and/or cleft palate, they are fortunate to have a wealth of resources available through the S.C. Center for Cleft Palate/Craniofacial Disorders.

Staffed by a team of specialists that address every facet of cleft lip and palate, the center is part of the Department of Surgery’s Division of Plastic Surgery. Because a cleft lip or palate impacts a child in a multitude of ways, physicians on the team include plastic and oral surgeons, ophthalmologists, otolaryngologists, a neurosurgeon, and geneticists. The team is also comprised of orthodontists, a speech-language pathologist, audiologist, nurse coordinator, nutritionist, and a social worker. Child psychology and pediatric dentistry services are also available by referral when needed.

Most children are initially seen at the S.C. Center for Cleft Palate/Craniofacial Disorders shortly after birth. Parents spend a full day as their child is evaluated by each of the team members. “Our role is to answer their questions and tell them what will be done for their child over the course of a lifetime. We explain the series of interventions that will occur over time,” said Dr. Jean-Francois Lefaivre, Assistant Professor to Associate Professor of Surgeryand the center’s co-director. At the end of the day, the team holds a conference to discuss the child and decide on an individualized treatment plan.

While corrective surgery for cleft lip and palate is generally done very early on (around three months of age for a cleft lip and about 12 months of age for a cleft palate), Dr. Lefaivre emphasizes to parents that plastic surgery is just the beginning of the process. “We are going to continue to follow the child for a long time,” he said. Children are seen by the various specialists as necessary, such as for insertion of tubes in the ears to address recurrent ear infections and orthodontic work to realign teeth. Since the palate is an essential component of good speech, Mary Aitchison, Ph.D. plays a key role in assessing the competency of the velopharyngeal mechanism and helping children improve their articulation abilities. A speech-language pathologist, Dr. Aitchison is the center’s other co-director.

Using highly specialized diagnostic instrumentation, such as nasometry and nasendoscopy, Dr. Aitchison assesses a child’s ability to speak properly. “With a cleft palate, there is the possibility of velopharyngeal incompetence, meaning that the child cannot adequately separate their mouth and nose during speech. If the child does not have the anatomy to make this separation, then too much air and acoustic energy can escape through the nose, creating a hypernasal resonance quality,” she explained. Within the next couple of months Dr. Aitchison will be acquiring a diagnostic tool that will provide additional information in the assessment of velopharyngeal function. One of the functions of the Perci-SARS system is measuring the size of the gap in the separation between the mouth and nose. This will help determine if a child may need additional corrective surgery or speech therapy in order to talk normally. "Normal speech is the most important factor for these children in adaptation," said Dr. Lefaivre, adding, "Kids that don't speak well can be made fun of, and end up becoming isolated and shy."

Children are referred from throughout the state to S.C. Center for Cleft Palate/ Craniofacial Disorders for its multidisciplinary team approach to cleft lip and palate treatment, as well as treatment for a variety of craniofacial conditions. "All the providers at the center have a mutual respect for each other, and value what each other does," said Dr. Aitchison of the team members. "We are all very much partners," she said. Through the efforts of the team, both Dr. Aitchison and Dr. Lefaivre have seen children and families transformed. "Kids come in with their prom pictures and you see that they have lived a normal life and that you have given them the quality of life they deserve," said Dr. Lefaivre. Dr. Aitchison added, "I feel blessed that we can offer them this center. It makes such a huge difference in their lives."

Reprinted from Connections newsletter, April 2003

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