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R. Mark Ray, M.D.
Director: Children’s Hospital Cleft and Craniofacial Team
East Tennessee Children’s Hospital
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Evaluation and Treatment of the Child With Cleft Lip and
Palate – Team Care
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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.
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Pediatric Facial Anomalies Team Surgeon Speech Therapist Audiologist Nursing Pediatrician Orthodontist Social Work Nutritionist
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Classification- Cleft Lip
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Median clefts
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Mandibular Cleft
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Unilateral Lip RevisionInsufficient Advancement
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Prenatal Diagonosis Provide information
to families and answer questions
Prepare family for feeding their baby
Link family to resources
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Orthodontic Treatment
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Alveolar Ridge Bone Grafting
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Bardach, Janusz Salyer & Bardach’s Atlas of Craniofacial & Cleft Surgery. Volume II. Lippincott – Raven ; Philadelphia 1999
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Palate Expansion
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Subtle Alveolar Defect
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Alveolar Ridge Bone Grafting
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Alveolar Ridge Bone Grafting
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Alveolar Ridge Bone Grafting
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Speech Issues Velopharyngeal
Insufficiency
Compensatory errors
Articulation Disorder
Velocardiofacial Syndrome
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Rhinoplasty
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Cleft and Craniofacial Surgeries: 2009 & 2010
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Pierre Robin Sequence and Distraction Osteogenesis in the Neonatal Period
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Nager Syndrome
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Overview Retrognathia, Glossoptosis, Cleft Palate 1 in 9000 live births Mortality 5-30% Airway and feeding difficulties are
presenting problems Management is not uniform
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Tongue base obstruction
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Positioning
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Positioning
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Tracheostomy: Disadvantages
Complications: Cannula obstruction Accidental
decannulation Mortality significant Average age
atdecannulation: 3.1 years!
Functional Impairment
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Distraction Osteogenesis
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Distraction Osteogenesis
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Distraction OsteogenesisInternal Device
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Distraction Osteogenesis
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Airway Before and After
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Occlusion
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Distraction Osteogenesis
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Judy Marciel Cleft Team Coordinator Feeding and Nutrition Specialist Provider and Family Education Outcomes Evaluation and Analysis Research Coordinator Contact :
865-541-8510
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Questions