r. mark ray, m.d. director: children’s hospital cleft and craniofacial team east tennessee...

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