SUMMARY

SUMMARY

Cleft care has been the subject of significant reorganisation in recent years. Coordinated care is provided in most countries by MDTs. Specific training pathways exist in many countries for cleft surgery . Better collection and collation of outcome data will drive evidence-based improvements in care and service development. Summary box 50.6 - Summary of care for patients with cleft lip and/or palate /uni25CF s /uni25CF /uni25CF /uni25CF - /uni25CF

Cleft surgery in infants is time sensitive Aesthetic and functional outcomes are important and are measured Surgery involves restoration of muscle position to as close to normal as possible Planned surgery includes bone grafting in children with alveolar involvement Revision/secondary surgery optimises aesthetic and functional outcomes

(b) Figure 50.11 (a) Pro /f_i le of a class III skeletal relationship and maxillary hypoplasia and mandibular prognathism. (b) Lateral skull radiograph. (c) Pro /f_i le following bimaxillary osteotomy. (d) Postoperative radio graph following bimaxillary osteotomy demonstrating internal /f_i xation. (e) Schematic representation of bimaxillary osteotomy with maxillary advancement and mandibular retrusion (courtesy of William P Smith). (d) (e)

Bearn D, Mildinhall S, Murphy T et al . Cleft lip and palate care in the United Kingdom – the Clinical Standards Advisory Group (CSAG) study . Part 4: outcome comparisons, training, and conclusions. Palate Craniofac J 2001; 38 (1): 38–43. Bongaarts CA, Prahl-Andersen B, Bronkhorst EM et al . Infant ortho pedics and facial growth in complete unilateral cleft lip and pal ate until six years of age (Dutchcleft). Cleft Palate Craniofac J 46 (6): 654–63. Boorman JG, Sommerlad BC. Levator palati and palatal dimples: their anatomy , relationship and clinical significance. Br J Plast Surg 38 (3): 326–32. Boorman JG, Sommerlad BC. Musculus uvulae and levator palati: their anatomical and functional relationship in velopharyngeal clo sure. Br J Plast Surg 1985; 38 (3): 333–8. Boyne PJ, Sands NR. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg 1972; 30 (2): 87–92. Boyne PJ, Sands NR. Combined orthodontic-surgical management of residual palato-alveolar cleft defects. Am J Orthod 1976; 20–37. Fudalej PS, Wegrodzka E, Semb G, Hortis-Dzierzbicka M. One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: craniofacial outcomes. J Craniomaxillofac Surg 2015; 1224–31. Furlow Jr LT . Cleft palate repair by double opposing Z-plasty . Reconstr Surg 1986; 78 (6): 724–38. Harville EW , Wilcox AJ, Lie RT et al . Cleft lip and palate versus cleft lip only: are they distinct defects? Am J Epidemiol 2005; 448–53. Harville EW , Wilcox AJ, Lie RT et al . Epidemiology of cleft palate alone and cleft palate with accompanying defects. Eur J Epidemiol 2007; 22 (6): 389–95. McBride WA, McIntyre GT , Carroll K, Mossey PA. Subphenotyping and classification of orofacial clefts: need for orofacial cleft subphe notyping calls for revised classification. Cleft Palate Craniofac J 53 (5): 539–49. cleft classification and recommendations for standardized nomen - clature. Cleft Palate Craniofac J 2017; 54 (6): 726–33. Noverraz RL, Disse MA, Ongkosuwito EM et al . Transverse dental Cleft arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clini - - cal trial (DUTCHCLEFT). Clin Oral Investig 2015; 19 (9): 2255–65. - Sandy J, Williams A, Mildinhall S et al . The Clinical Standards Advi - 2009; sory Group (CSAG) cleft lip and palate study . Br J Orthod 1998; 25 (1): 21–30. Sandy JR, Williams AC, Bearn D et al . Cleft lip and palate care in the 1985; United Kingdom – the Clinical Standards Advisory Group (CSAG) study . Part 1: background and methodology . Cleft Palate Craniofac J 2001; 38 (1): 20–3. - Sell D, Grunwell P , Mildinhall S et al . Cleft lip and palate care in the United Kingdom – the Clinical Standards Advisory Group (CSAG) study . Part 3: speech outcomes. Cleft Palate Craniofac J 2001; 38 (1): 30–7. Sitzman TJ, Mara CA, Long Jr RE et al . The Americleft Project: bur - 70 (1): den of care from secondary surgery . Plast Reconstr Surg Glob Open 2015; 3 (7): e442. Sommerlad BC. Surgical management of cleft palate: a review . J R Soc Med 1989; 82 (11): 677–8. 43 (7): Sommerlad BC. The use of the operating microscope for cleft pal - ate repair and pharyngoplasty . Plast Reconstr Surg 2003; 112 (6): Plast 1540–1. Sommerlad BC. A technique for cleft palate repair. Plast Reconstr Surg 2003; 112 (6): 1542–8. 162 (5): Sommerlad BC, Fenn C, Harland K et al . Submucous cleft palate: a grading system and review of 40 consecutive submucous cleft pal - ate repairs. Cleft Palate Craniofac J 2004; 41 (2): 114–23. Wilcox AJ, Lie RT , Solvoll K et al . Folic acid supplements and risk of facial clefts: national population based case-control study . BMJ 2007; 334 (7591): 464. - Williams AC, Bearn D, Mildinhall S et al . Cleft lip and palate care in 2016; the United Kingdom – the Clinical Standards Advisory Group (CSAG) study . Part 2: dentofacial outcomes and patient satisfaction. Cleft Palate Craniofac J 2001; 38 (1): 24–9.