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Because of the high incidence of hearing loss associated with cleft palate and other craniofacial anomalies, the audiologist is concerned with prevention, early detection, and intervention. As hearing impairment is often episodic, routine hearing evaluations are desirable. These evaluations include various measurements of hearing, sensitivity, and ear function.
The UF Craniofacial Center’s psychologist provides consultation to parents and children regarding normal child development. For children with facial disorders, consultation is also available to help the child and family cope with the disorder and the required medical treatment. Additional diagnostic assessment is available for the evaluation of emotional, cognitive, behavioral, and educational problems or concerns.
Occasionally patients with speech and/or swallowing problems related to velopharyngeal insufficiency are not candidates for intraoral surgery or they do not wish to undergo surgery. Many of these patients can benefit from an oral prosthesis such as a palatal lift or a speech-bulb obturator. In these cases the UF Craniofacial Center’s prosthodontist works closely with the other team members, particularly the speech-language pathologist, in order to obtain maximum improvement in the patient’s speech and resonance quality.
Pediatric Health Care/Nursing
Our nurse is interested in the general health of the child. The nurse is responsible for coordinating appointments and referrals for patients and providing information about feeding strategies and general care before and after surgery. The nurse helps families access resources such as Children’s Medical Services for financial assistance as needed.
Oral and Maxillofacial Surgery
The UF Craniofacial Center’s oral and maxillofacial surgeon specializes in the diagnosis of oral diseases as well as reconstruction of the face and jaws. This includes treatment for skeletal malformations which may be congenital, developmental, syndromic, or traumatic. Some of the procedures include orthognathic surgery, alveolar cleft bone grafting, extraction of teeth, and placement of dental implants.
Orthodontics is a discipline in dentistry that is involved with the diagnosis and treatment of positional and growth problems involving the teeth and jawbones. The center’s orthodontist collaborates with other team members to formulate the nature and sequence of treatment which will achieve optimal esthetic and functional results for the individual after facial growth and treatment is completed. To achieve these goals, certain considerations are made to integrate treatment in a timely manner with the dynamics of ongoing craniofacial growth and development during the younger and adolescent years. Treatment may begin during the primary dentition (baby teeth) although most of orthodontic care begins after the permanent teeth have evolved.
The University of Florida otolaryngology team is particularly concerned with the health and function of children’s ears and the control of otitis media. Chronic middle ear infection (otitis media) can impair the development certain speech and intellectual skills. If ear and hearing rehabilitation is to have maximum benefit, it needs to begin before six months of age. Our efforts focus on early restoration of normal hearing and preventing middle ear infections from progressing to more serious problems.
The Department of Pediatric Dentistry at the University of Florida provides dental care to children with cleft lip and palate and other craniofacial anomalies. These services include: (1) preventive dentistry through diet counseling, oral hygiene instructions, and fluoride therapies; (2) restorative dental treatment to restore decayed, injured, or malformed teeth; (3) prosthodontic replacement of missing teeth with transitional fixed or removable partials; and (4) preventive or interceptive orthodontic care through identification, referral, or treatment of orthodontic problems at an early age.
The center’s pediatrician and pediatric nurse practitioner are interested in the special needs of children with facial differences. They monitor the child’s growth and development and help address any feeding or nutritional concerns. One of their roles is to develop a comprehensive clinical impression incorporating health, developmental, and psychosocial domains. The pediatric team’s goal is to provide health promotion, illness prevention, and screening for existing health problems common to children with craniofacial malformation through physical and developemental screening, education of the patient, family, and health care staff. Additionally, the team will help identify resources within the community that will best serve each family.
Plastic and Reconstructive Surgery/Craniofacial Surgery
Our team evaluates and treats children with multiple craniofacial anomalies which include, cleft lip, cleft palate, velopharyngeal incompetence, craniosynostosis, Treacher Collins, microtia, as well as other cranial vault conditions. These children frequently require secondary operations in order to refine facial aesthetics and correct malocclusion. Nasoalveolar molding is used for patients with cleft lip and cleft palate to create a better aesthetic outcome. Cranial molding is conducted in conjunction with orthotics for patients in need with cranial anomalies. Additionally, we provide ear reconstruction in patients born with microtia and patients with traumatic injury.
The Craniofacial Center’s Social Worker provides supportive psychosocial services to the patient and the family to include financial, educational, social, and emotional support. The Social Worker also helps coordinate appointments and referrals for patients. Political advocacy, bullying prevention/response, and social media for families are also discussed. Because we know that having a child with a chronic condition affects all facets of life, the social worker makes certain that the needs of the patient and family are being met.
The role of the speech-language pathologist is to evaluate how well the patient is able to communicate. At a very early age, we are interested in the child’s language development, both receptive and expressive language skills. We evaluate, with the parent’s help, how the child responds to speech and what kinds of sounds or words the child is producing. The inability to make certain sounds my be the result of abnormalities of certain oral, nasal, or pharyngeal structures.
Not all children who have a cleft lip/palate or other facial disorder will need speech therapy. For those who do, our goal is to begin therapy as early as is practical and beneficial to the child. The objective is to eliminate as many of speech problems as possible before the child enters school.
Some speech problems, such as consistent hypernasality and loss of air through the nose, require special instrumentation such as videofluoroscopy (x-ray) and fiberoptic nasendoscopy (small scope inserted into the nose) to enable the speech pathologist to fully diagnose the problem and identify a treatment plan.