Treatment profile for cleft lip and palate

Approximately one child in 600 live births is born with a cleft of lip, palate, or both structures. These deformities have a profound emotional effect both on parents and child and also seriously compromise physical and psychological wellbeing of the child affected with the deformity. Treatment procedures and regimes for the repair of cleft lip and palate have long been available, but special cleft palate clinics, offering multidisciplinary services, have been established only in last two decades. The treatment of cleft lip and palate patients requires multidisciplinary cooperation. The spectrum of outcomes of the surgical interventions for the repair is considerable and may be related to the type of surgical technique performed, timing sequence and skill of the individual surgeon. This study aimed to describe and analyse the multidisciplinary approach in correction of cleft lip and palate at The Australian Cranio Facial Unit based at the Adelaide Children's Hospital. Case notes of children admitted at the Adelaide Children's Hospital over last 25 years for treatment of cleft lip and palate were examined. This thesis is centred on the types of surgical technique performed on the child and special emphasis is given to the age of patient at the time of each surgical intervention and thereby analysis of the treatment regime followed. Different types of cleft classifications are listed. The aetiological background for facial clefts are described. Associated malformations or syndromes are listed. Descriptions are provided for many of the commonly associated syndromes or malformations. Sex predominance, blood grouping, maternal age and problems related to pregnancy are noted. The results of the study are outlined and graphically represented. However, the main findings obtained from the data showed 48.6Vo of the study population had combined cleft of anterior and posterior palate (Group II). Female: male ratio was found to be 1:1.71. Mean age of fust intervention of various surgical interventions by cohort, was seen to be decreasing with a relatively small deviation around the mean in more recent times. The mean age of intervention for speech therapy has decreased considerably, but the standard deviation has increased considerably for the 1990s cohort showing the intervention has been carried out from less than one year to five years of age. Analysis done to obtain the of age distribution of the study sample for various surgical interventions showed 87.97o of the study sample had repair of cleft lip at the age of 3-4 months. Age of first intervention for repair of cleft palate showed 74.9Vo of the study subjects had it at the age of 6-12 months. For alveolar bone grafting 32Vo of the sample had it at the age of 12 years. Pharyngoplasty showed a bimodal distribution: the first peak was at 4 years of age and second at 7 years of age. The distribution for nasal tip revision showed 34.8Vo of the study subjects had it at 12 years of age. 27.4Vo of the study sample had their first bilateral myringotomy at the age of 1-5 years and osteotomies were done at an age of 15 years of age for 44Vo of the study subjects. The complete distribution for the various surgical interventions are described and comparison is made between the various birth cohorts in the study. The results stress the value of a coordinated treatment plan involving many people and disciplines as illustrated in the operation of Australian Cranio Facial Unit .The results also indicated the worth of objective speech and facial growth evaluation. The limitations of the present study are discussed and continued research into the field of facial clefts is encouraged.

Author dc:creator

• Sanghvi, Sonali

Advisor dc:contributor.advisor

• Spencer, John

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/2440/128541

OAI identifier oai:identifier

oai:digital.library.adelaide.edu.au:2440/128541