Cleft Lip and Palate Team

Each Wednesday, our team sees patients in the Duke Children’s Health Center Plastic Surgery Clinic. Visits may include:

• A hearing test (audiogram).
• A feeding, speech, and language assessment.
• Assessments by orthodontics, otolaryngology, plastic surgery, social work, and nursing.
• A CT scan or other imaging.

Visits may occur annually or less frequently as children grow and their needs decrease.

Family-Centered Atmosphere
Your family will spend most of the morning with our team, and we treat your family like our guests.

Our clinic is a warm, friendly, and welcoming atmosphere. A music teacher may entertain the children, and arts and crafts may be available. We encourage children to walk around and explore the area. 

After the clinic, our team gathers to discuss your child's status. We create a report and send a detailed plan, including information about your child's next visit.

Anesthesia
Most operations involve the pediatric anesthetists at Duke University Hospital. Their expertise ensures your child undergoes a safe procedure and experiences an excellent recovery. The anesthesia team uses meticulously planned combinations of agents specific to infants. For this reason, most cleft surgeries only require an overnight stay in the hospital. Post-surgical medications include liquid pain medication and a preventive antibiotic.

Audiology
Children born with a cleft may have a hearing impairment. It is common for fluid to build behind the eardrum because of the child’s different anatomy. The audiologist performs regular hearing assessments to ensure your child’s hearing is adequate for communication and development. 

Behavioral hearing tests occur in one of our two soundproof hearing booths during your visit. The audiologist determines if the eardrums and middle ear space work properly and provide hearing amplification to children with hearing loss. They work closely with the otolaryngologist to ensure your child receives the best hearing care.

Craniofacial Orthodontics
Our craniofacial orthodontists are involved in your child's care from birth to adulthood. We are one of the nation’s leaders in performing Nasoalveolar Molding (NAM). Duke craniofacial orthodontist, Pedro Santiago, MD, was one of NAM’s inventors in the 1980s. 

NAM is a pre-surgical orthodontic treatment for infants that can bring the two sides of a wide cleft together and create symmetry with the nose before surgery. This reduces the complexity of the surgery and improves outcomes. 

Our orthodontists are essential in monitoring your child’s development and skeletal growth. Dental issues, such as missing or extra teeth, may occur when a cleft involves the gum line or palate. Good dental hygiene and management of these special teeth is essential for children and young adults with clefts. 

When children become teenagers and young adults, most will benefit from orthodontic appliances to straighten and align the teeth. These appliances can also help plan (or prevent) jaw surgery when the upper and lower jaws are unbalanced.

Medical Genetics
In many children with a cleft, there is no specific cause. A consultation with the medical genetics team can provide information and genetic analyses to determine if conditions associated with a cleft are present or if the cleft is part of a syndrome. This information may be important if you plan to have more children. A medical genetics consultation is available for interested families, but it is not part of the routine assessment.

Otolaryngology - Ear, Nose, and Throat
Specialists in head and neck surgery are critical team members for comprehensive cleft and craniofacial care. They combine the hearing information obtained by the audiologists with a clinical exam to ensure the ears are healthy and functioning well. They also manage airway and breathing issues such as laryngomalacia, tracheostomy, and sleep apnea with medical or surgical intervention.

Oral and Maxillofacial Surgery
Duke oral and maxillofacial surgeons often work with the plastic surgeons and orthodontists to ensure a patient-specific approach to dental and cleft care.

Pediatric Craniofacial Plastic and Reconstructive Surgery
Our pediatric craniofacial plastic and reconstructive surgeons are involved with all aspects of your child’s care. Advanced techniques include surgery for the lip and palate, speech surgery, bone grafting, orthognathic (jaw) surgery, and rhinoplasty (nasal surgery). 

The surgeon examines your child in the clinic, provides counseling and education, helps your family formulate a treatment and surgical plan, then carries out the post-surgical care. Our surgeons have decades of experience and are dedicated to providing compassionate and individualized care for your child and family.

Nursing Services
Our cleft team nurses are the glue that holds the team together. Whether in the operating room, in your child's hospital room, scheduling surgery, or in the clinic, the nursing team provides a holistic approach to your child’s care.

Social Work
The social worker is a valuable member of the cleft and craniofacial team. They provide education about financial and social-emotional resources in the hospital and community. They also educate your family about the emotional and developmental needs of a child with cleft and craniofacial differences. 

In addition, the social worker provides counseling to help you and your child learn to cope with a new diagnosis, chronic illness, and psychosocial issues. Our social worker listens to your child’s thoughts, interests, and hobbies, and offers praise, supports unique talents, and builds their confidence.

Speech-Language Pathology
Our speech-language pathologists have years of training and experience working with children with cleft and craniofacial differences. They evaluate feeding in infants and older children to ensure proper weight gain and nutrition. They provide education to families on products, such as specialty cleft bottles, and strategies to assist with successful feeding/eating. Our team prioritizes quick access to feeding sessions for infants with clefts, so families have immediate support for feeding challenges.

The speech-language pathologist also evaluates and treats speech, language, and communication issues, as well as velopharyngeal function, meaning how the palate moves to make sounds during speech. This is particularly important for children with a cleft palate. 

If needed, our speech-language therapists perform nasoendoscopy (viewing palate function with a small camera) to assess speech production. They work with the team to decide if additional surgeries are needed.

If you do not live close to Duke, our therapists can perform an evaluation, then collaborate with your local speech therapist to ensure your child receives consistent and appropriate speech therapy.

Team Coordinator
The team coordinator is a liaison for the entire team, providing education, information, and arranging appointments so that your child sees the right healthcare providers at the right age. The team coordinator also organizes events and services for your child and your family. She supports your family and answers your questions. She is available through a direct phone line to help connect you to team members promptly.