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 Disclosure Statement of Financial InterestFinancial Interest
I, R. Mark Ray M.D.I, R. Mark Ray M.D.,,
DO NOT DO NOT have a financial have a financial interest/arrangement or affiliation with interest/arrangement or affiliation with one or more organizations that could one or more organizations that could be perceived as a real or apparent be perceived as a real or apparent
conflict of interest in the context of the conflict of interest in the context of the subject of this presentation. subject of this presentation.
Pediatric Facial Anomalies Team Surgeon Speech Therapist Audiologist Nursing Pediatrician Orthodontist Social Work Nutritionist
Classification- Cleft Lip
Median clefts
Mandibular Cleft
Unilateral Lip RevisionInsufficient 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
Alveolar Ridge Bone Grafting
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
Positioning
Tracheostomy: Disadvantages
Complications: Cannula obstruction Accidental
decannulation Mortality significant Average age
atdecannulation: 3.1 years!
Functional Impairment
Distraction Osteogenesis
Distraction Osteogenesis
Distraction OsteogenesisInternal 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 :
865-541-8510
Questions
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