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Cleft Lip & Palate Service (HP)

Cleft Lip & Palate Services
Temple Street Children’s University Hospital
Temple Street
Dublin 1

Tel: (01) 878 4701/ 878 4882

Fax: (01) 892  1820


Hours: Monday –Friday 9am -5pm

Cleft Lip & palate is a variable condition with a spectrum of severity ranging from minor cleft of lip only or a cleft of the soft palate to a major cleft affecting the lip, nose & palate and causes disruption of growth of the face. Treatment will vary according to the degree of severity of the cleft. The child’s care requires team management, and the core team comprises the following disciplines ie. Plastic Surgeon, Speech & Language Therapist(s), Ear, Nose & Throat Surgeon, Audiologist, Paediatric Dentist, Orthodontist, Maxillofacial Surgeon, Clinical Nurse Specialist, Social Worker, Clinical Photographer, Administrative Assistant and the Cleft & Craniofacial Services Manager.

Mission Statement:

The Cleft Lip and Palate team aim to provide a comprehensive multi– disciplinary service for children with Cleft Lip and Palate and Velopharyrngeal Dysfunction (non cleft palatal anomalies), and their families.

Service overview:

The Cleft Service is a national public service providing care from antenatal to adulthood. Referrals are received from the medical profession & or speech & language therapists. Our unit protocol on receipt of referrals for a newly diagnosed baby with cleft lip &/ or palate is to establish contact with families within 48 hours either by phone contact or maternity hospital visit.

Prioritisations:

Cleft team consultations are arranged by the Cleft Services manager & protocols are in place for ongoing reviews throughout the child’s care pathway. Service priorities are based on the needs of the child and family presenting at the time of assessment.

Description of team function:

The team manages the assessment and diagnosis of referrals and provides intervention from all team members (staffing levels permitting) as required to remediate the child’s difficulty to maximise their potential development. Patients and parents are considered an integral part of the team.

A diagnosis will be made following, the core team’s clinical assessment and a request from peripheral team members. Intervention will include follow up from each discipline involved in the child’s new plan of care, and will include parental support and links to local services.

Preferred style of working:

The team approach to working with these children is holistic and child-centered based on an accepted care pathway within the Dublin Cleft Centre. This sets out clear guidelines on the protocols for managing the child with Cleft Lip &/or palate.

Since the year 2000 the Cleft Units of the Temple St, Children’s University Hospital & Our Lady’s Children Hospital, St James’s Hospital and the Mater Misericordiae Hospital have developed working links for the exchange of information & techniques and agreed standardised practice and jointly developed a Cleft Database. Together we refer to the units as the Dublin Cleft Centre and have as a mission statement the following;

“The Dublin Cleft Centre comprises of a multidisciplinary group from the Dublin Cleft teams working to develop and implement standardized best practice guidelines and care in cleft management”

Services

The Cleft Lip and Palate team at TSCUH is part of a national service for children born with cleft lip and palate and children with speech problems associated with palatal problems when there is no obvious cleft palate (Non cleft velopharyrngeal dysfunction). The speech department is recognised both nationally and internationally as a centre of excellence for the management of these speech disorders. The SLT assesses feeding skills in babies born with cleft palate and offers advice to parents/caregivers in relation to feeding an infant with a cleft palate. The SLT is also involved in assessing, diagnosing and treating communication disorders related to the cleft palate as well as decision making regarding future team management and non-cleft velopharyrngeal dysfunction management. The therapist liaises with SLTs in Community Care regarding treatment of children with velopharyrngeal dysfunction or cleft palate.

The following assessments may be carried out:

  • Early monitoring of speech production and resonance
  • Regular speech reviews at MDT Cleft clinics
  • Perceptual Assessment of articulation, resonance and nasal escape of air during speech.
  • Instrumental Assessment:
  1. Computer-based assessment of nasal acoustic energy (Nasometry) and measurements of airflow through the nasal cavity ( Pressure Flow Assessments)
  2. Direct assessment of palatal function during speech using Videofluoroscopy (continuous x-ray recording of the movement of the palate while the child is producing speech samples.) and Nasendoscopy: (insertion of a small scope (nasendoscope) into the child’s nose to observe palatal movement)

Results of the above assessments are reviewed with the PS and/or other team members to decide on future management. SLTs accept referrals from outside agencies/ professionals for second opinion assessments of resonance disorders, as the department is a recognised specialist centre for such assessments. As a centre of excellence, the cleft SLTs provide ongoing training nationally on assessment and management of cleft palate and VPD speech disorder. Referrals may be directed to:

The Speech and Language Therapy Manager,
St Frances’ Clinic,
Children’s University Hospital,
Temple Street,
Dublin1.

Sligo Satellite Service:

Core team members from Temple St, Children’s University hospital in conjunction with the Orthodontic team based in Sligo General Hospital have established combined cleft clinic which takes place twice a year. This facilitates families from the Sligo, Donegal & surrounding regions to attend for multidisciplinary team assessments at appropriate times. It assists in reducing the burden of care for families travelling to Dublin for clinic assessments. Speech & language Therapists (SLT) from local services have received specialist Cleft speech training and are link cleft SLT’s for the area. They provide local assessment and guidance and attend the satellite clinic with at least one Temple Street SLT. This service is based on the “Hub & Spoke” model which is a recognised successful model for cleft care management

Antenatal Cleft Consultation:

This service is available to couples following an antenatal diagnosis of cleft lip & or palate & who are refereed by professionals in the area of Foetal medicine. Cleft team consultations are arranged on an individual bases & appointments are confirmed by the Cleft & Craniofacial Services Manager. Parents are seen by CNS, Cleft manager and SLT where indicated.

Psychosocial Support:

Provided by the Child and Adolescent Mental Health team in St. Frances Clinic

Orthodontic Service:

The orthodontist attends combined clinic on a monthly bases. Orthodontic assessments & treatments are carried out in St James Hospital. The orthodontist acts as a link with the Maxillafacial Services & the Maxillafacial Surgeons.

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