Fall 2010

Team Care Essential for Treatment of Cleft Lip and Palate

When California's SB 630 took effect in July 2010, William Hoffman, M.D., chief of Plastic and Reconstructive Surgery at UCSF Benioff Children's Hospital, was among those who breathed a sigh of relief.

Dr. William HoffmanHoffman is chair of the Coalition of California Cleft and Craniofacial Teams and a member of the executive council of the California Society of Plastic Surgeons (CSPS). He encouraged the CSPS to fight for the bill, which requires health insurers to cover medically necessary dental or orthodontic services for children with cleft lips or palates.

"The bill highlights the importance of ongoing, interdisciplinary care for the treatment of these conditions," says Hoffman, who works with the Craniofacial Center at UCSF, a team that includes surgeons, dentists, a nurse practitioner, a speech pathologist, a social worker and genetic counselors. A team approach is essential because it results in the least number of operations and the best outcomes.

A Sequence from the Womb Through Early Adulthood

"These patients are vulnerable to so many things that affect basic function — breathing, eating, talking, hearing — that we tend to see them according to a set protocol that often runs right into adulthood," says Hoffman.

  • Because the conditions can be diagnosed by ultrasound during pregnancy, UCSF team members often see parents before the child is born. They use these opportunities to counsel families and set their expectations.
  • Immediately after birth, a nurse practitioner, who is an expert on feeding issues, helps families navigate what can be a difficult initial hurdle.
  • Plastic surgeons ideally operate on cleft lips when children are about 3 months, and on cleft palates at 9 or 10 months.
  • As the children grow, dental development and facial growth issues often arise; hence the need for orthodontics and oral and maxillofacial surgery. The UCSF team is part of the UCSF School of Dentistry and works closely with community orthodontists and other professionals to coordinate services and ensure continuity of care.
  • A similar approach is used for speech, hearing, socialization and genetic concerns.
    • A speech pathologist evaluates each patient and, where appropriate, coordinates care with local speech therapists.
    • The team includes UCSF audiologists and pediatric otolaryngologists because children with cleft lips and palates tend to experience chronic ear infections and hearing difficulty.
    • A social worker helps families address concerns such as school, availability of resources and insurance.
    • Genetic counselors work with the families to look for associated genetic syndromes and to answer questions that arise about the potential for cleft lips and palates occurring in siblings or in the next generation.

"The reward is that you build relationships with these families and get to see the children grow into the healthy adults they were meant to be," says Hoffman.

For more information, contact Dr. Hoffman at (415) 353–4287.

 

Fall 2010 Table of Contents

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