Craniofacial team
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A craniofacial team is a team of medical specialists that treat children and adults who have facial deformities such as Cleft Lip with or without Palate and Cleft Palate alone.
Upon diagnosis the patient should be referred to a craniofacial team. In practice often it is the pediatrician who diagnoses the child immediately after birth. Within the craniofacial team the child is referred to the ENT-specialist in case of hearing problems, to the speech pathologist in case of speech problems etc. Mutual consensus on treatment by different specialists is important.
After referral the child may be seen by a plastic surgeon or craniofacial surgeon, who will recommend appropriate surgical procedures. X-rays and lab research may be necessary.
Team meetings and smaller team consultations are held, mostly involving one or two specialists who monitor and supervise a child for a longer period of time. Mutual team consultation results in a more optimal treatment since often more than one target area is treated at once.
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[edit] Team members
Facial deformities require various specialist treatments. These range from surgery to psychology. A typical team:
- Reconstructive/Plastic surgeon. A plastic surgeon with specific training and experience in surgery of the craniofacial skeleton and of the so-called soft tissues being skin, muscles, nerves, blood vessels and organs like the nose, eyelids, mouth and ears.
- Oral/Maxillofacial surgeon. He/she is co-responsible for the surgical correction of the malformation of the upper and lower jaws.
- Otolaryngologist (ENT). Ear, Nose and Throat Specialist. Many malformations involve defects in the airway passage, inflammation of the middle ear and/or hearing and speech defects. Such complaints are treated by the ENT-Specialist. He/she is also responsible for the hearing tests and examination of the speech defect.
- Audiologist.
- Pediatrician.
- Pediatric dentist.
- Orthodontist. As member of the craniofacial team the orthodontist takes care of the non-surgical treatment of the malposition of the jaws. He/she is responsible for the pre and post operative treatment of jaw surgery and monitors growth by means of X-rays and plaster casts.
- Orthodontic Technician. Responsible for the design and fabrication of fixed and removable orthopaedic and orthodontic appliances for the cleft patient from birth through to adulthood. He/she also fabricates dental study models that are used to monitor growth.
- Prosthodontist. Plans and fabricates an obturator to close defects that surgery is not capable of closing. Many patients with congenital deformities are missing teeth or have poorly shaped teeth and require a denture prosthesis.
- Speech pathologist. Evaluate and monitor speech development to help determine if speech therapy, prosthetic devices, or surgery are needed to improve speech skills.
- Psychologist. He/she monitors the child's development and teaches the child how to deal with the social aspects of a facial deformity. The psychologist also aids the parents when needed.
- Clinical Genetist. After thorough family research he/she will advise on heredity with regard to a syndrome. Sometimes a final diagnosis can be defined only after genetic examination (see also Genetic linkage).
- Social Worker. He/she is counsellor of the parents and family when there are problems resulting from the syndrome, treatment and/or hospitalisation. She/he acts as an advisor and is able to contact various official authorities, in and outside the hospital.
- Nursing Officer. From hospitalisation till discharge the nursing officer is responsible for the daily health care and nurture of the child. The nursing officer also advised the parents with feeding difficulties due to cleft.
All team members have deputies in order to guarantee continuity.
[edit] Duties of the Team
- Craniofacial Team (CFT) evaluates at least 20 individuals with congenital anomalies or syndromes aside from Cleft.
- Prior to surgery, CFT assures that the patient has been scheduled or seen for a health evaluation by a primary care physician.
- Craniofacial surgery is provided in a facility with a pediatric intensive care unit. Facility has CT and MRI capability.
- Members must participate in continuing education programs for craniofacial evaluations and treatment.
[edit] External links
- American Cleft Palate - Craniofacial Association Team information.
- European Collaboration in Craniofacial Anomalies (EUROCRAN) for professional workers in medicine and / or dentistry.
[edit] Craniofacial teams in the United States
- Craniofacial team, Seattle
- Craniofacial team, Connecticut Children's Medical Center
- Craniofacial team, Medical College of Georgia
- Loma Linda University Children's Hospital
[edit] Craniofacial teams in Europe
- Schisisteam UMC St. Radboud Nijmegen, the Netherlands
[edit] References
- Team Standards Comittee. (1996). The Cleft and Craniofacial Team. American Cleft Palate Craniofacial Association <http://www.acpa-cpf.org/teamcare/ccteam.htm>.
