Craniofacial team

A craniofacial team is a multi-disciplinary team (MDT) which provides multidisciplinary consultations, diagnosis, treatment planning and procedures for a range of craniofacial anomalies and syndromes.

According to the American Cleft Palate-Craniofacial Association (ACPA), the minimum requirements for a team are: Plastic Surgeon, Speech Language Pathologist, Craniofacial Orthodontist.

Craniofacial anomalies or syndromes are defined as congenital conditions other than cleft lip/palate, unless cleft lip/palate is a feature of another condition, anomaly or syndrome.

ACPA basic criteria

The following list outlines 8 basic criteria as defined by the American Cleft Palate-Craniofacial Association, (ACPA) Committee on Team Standards.^[1]

Standards for Listing the Craniofacial TeamThe Craniofacial Team (CFT) meets all of the following criteria defined by the ACPA Committee on Team Standards:

1. The Operation Surgeon(s), Mental Health Professional(s) and Speech-Language Pathologist(s) on the CFT meet face-toface at a scheduled team meeting or conference to evaluate patients with craniofacial anomalies or syndromes at least 6 times per year. The meeting may or may not coincide with CPT meetings.
2. The CFT evaluated at least 20 patients with craniofacial anomalies or syndromes in the past year.
3. The CFT assures that each child has health evaluation by a primary care Physician (Pediatrician, Family Physician or General Internist) in the community or on the team. The CPT uses the findings from the health evaluation to guide its treatment planning and team meeting deliberations. A community or team-based primary care Physician evaluates all patients prior to craniofacial surgery.
4. Craniofacial surgical treatments are adequately documented with facial and intraoral photographs, and appropriate radiographs.
5. Craniofacial treatment plans and treatment outcomes (results) for patients with craniofacial anomalies or syndromes are discussed at CFT meetings.
6. The CFT has a Surgeon(s) who attends team meetings and whose education, training and experience have adequately prepared him/her for the diagnosis and treatment of patients requiring craniofacial surgery.
7. At least one Surgeon on the CFT provided craniofacial surgical treatment (surgical procedures in which the intracranial approach to the midfacial segment—includes the orbit and/or supraorbital rim—is used) for a minimum of 10 patients with craniofacial anomalies or syndromes in the past year.
8. The CFT has an Orthodontist(s) who attends team meetings and whose education, training and experience have adequately prepared him/her for the orthodontic diagnosis and treatment of patients with craniofacial anomalies or syndromes.
9. At least one Orthodontis on the CFT provided orthodontic evaluation or treatment for a minimum of 10 patients with craniofacial anomalies or syndromes in the past year.
10. The CRT has a Speech-Language Pathologist(s) who attends team meetings and whose education, training and experience have adequately prepared him/her for speech and language diagnosis and treatment of patients with craniofacial anomalies or syndromes.
11. At least one Speech-Language Pathologist on the CFT provided speech therapy and/or a complete speech and language evaluation to a minimum of 10 patients (team or other patients) with craniofacial anomalies or syndromes (or cleft lip/palate) in the past year. The CFT Speech-Language Pathologist performs a structured speech assessment during team evaluations.
12. The CFT uses clinical speech instrumentation (such as endoscopy, pressure flow, videofluoroscopy, etc.) to assess velopharyngeal function, when indicated.
13. The CFT has a Mental Health Professional(s) (Psychologist, Social Worker, Developmental Pediatrician, Psychiatrist) who attends team meetings and whose education, training and experience have adequately prepared him/her for the psychological and psychosocial diagnosis and treatment of patients with craniofacial anomalies or syndromes.
14. The CFT has a Mental Health Professional(s) who evaluates all patients on a regular basis.
15. The CFT routinely tests or screens patients for learning disabilities and developmental, psychological, and language skills.
16. The CFT collects school reports and other information relative to learning in school-age patients, when indicated.
17. The CFT has a nurse or other trained professional whoUpon 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.^[2]

Team meetings and smaller team consultations are held, by specialists who monitor and supervise a patient for a long period of time or until the team is no longer needed. Multidisciplinary team consultations provide comprehensive and coordinated treatment for an extended period of time (some cleft lip and palate patients require the Craniofacial Team from birth to age 21 years of age.

Craniofacial Team members

A typical team:

• Craniofacial Surgeon. Commonly trained initially as a Plastic surgeon, Oral and Maxillofacial Surgeon or Otolaryngologist, all of whom usually pursue training beyond their core residency. He/She has specific training and experience in corrective/reconstructive surgery of the craniofacial complex (Skull, face, Neck, jaws, etc.)
• Speech pathologist. Evaluate and monitor speech development to help determine if speech therapy, prosthetic devices, or surgery are needed to improve speech skills.
• Craniofacial Orthodontist. As member of the craniofacial team the craniofacial 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.
• Audiologist. Hearing Specialist* 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.
• Pediatrician. Familiar with all aspects of the child’s condition, the team pediatrician provides diagnostic evaluations, management of medical problems, and coordinates team care. An important role of the team pediatrician is communication with the primary care provider to monitor the child's overall health and development.
• Pediatric dentist. Dental Specialist who treats children.
• 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.
• 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. Strauss, R. P. (1998). Cleft palate and craniofacial teams in the United States and Canada: A national survey of team organization and standards of care. The Cleft Palate-Craniofacial Journal, 35(6), 473-480.

Craniofacial Charities

Facing the World is a British charity that was founded to provide facial reconstructive surgery to children with severe facial disfigurements who are not able to receive treatments in their own countries. The entire Craniofacial Team donate their services and the charity fundraises to cover hospital, travel and accommodation costs.

In November 2006, there was an hour-long documentary on the British television network Channel 4 about Facing the World.

Bibliography

• Peterson-Falzone, S.J., Hardin-Jones, M.A., & Karnell, M.P. (2001). Cleft Palate Speech (3rd ed.). St. Louis, MO: Mosby.
• Strauss et al. (1998). Cleft Palate and Craniofacial Teams in the United States and Canada: National Survey of Team Organization and Standards of Care. Cleft Palate-Craniofacial Journal, 35, 473-480.
• The Cleft and Craniofacial Team, (1996) prepared by the Team Standards Committee, American Cleft Palate Craniofacial Association.
• Parameters for the Evaluation and Treatment of Patients with Clefts and other Craniofacial Anomalies, (2007) prepared by the Team Standards Committee, American Cleft Palate Craniofacial Association.

References

1. Strauss, R. P. (1998). Cleft palate and craniofacial teams in the united states and canada: A national survey of team organization and standards of care. The Cleft Palate-Craniofacial Journal, 35(6), 473-480
2. Strauss, R. P. (1998). Cleft palate and craniofacial teams in the united states and canada: A national survey of team organization and standards of care. The Cleft Palate-Craniofacial Journal, 35(6), 473-480

Strauss, R. P. (1998). Cleft palate and craniofacial teams in the United States and Canada: A national survey of team organization and standards of care. The Cleft Palate-Craniofacial Journal, 35(6), 473-480.

External links

• American Cleft Palate - Craniofacial Association Team information.
• European Collaboration in Craniofacial Anomalies (EUROCRAN) for professional workers in medicine and / or dentistry.
• Step-by-step photo examples of a New Jersey craniofacial team at work
• Cleft Lip and Palatum in Indonesia

Craniofacial teams in the United States

• Primary Children's Hospital, Salt Lake City, UT
• UCSF Center for Craniofacial Anomalies, San Francisco, CA
• http://surgery.med.nyu.edu/plastic/
• Saint Peter's University Hospital New Brunswick, NJ
• Hasbro Children's Hospital of Rhode Island Cleft and Craniofacial Center
• Dallas Craniofacial Center at Medical City Children's Hospital, Dallas, TX
• Fourth Dimension Orthodontics & Craniofacial Orthopedics, Dallas, TX
• Children's Hospital Boston
• Driscoll Children’s Craniofacial and Cleft Center, Corpus Christi, Texas
• Seattle Children's Craniofacial Center
• Craniofacial/Cleft Surgery Center in Pittsburgh
• Craniofacial team, Connecticut Children's Medical Center
• Craniofacial team, Medical College of Georgia
• Loma Linda University Children's Hospital

Craniofacial teams in Europe

• Schisisteam UMC St. Radboud Nijmegen, the Netherlands