What disciplines are involved in correcting cleft lip and palate (CLP)?

Multidisciplinary Team Approach for Cleft Lip and Palate (CLP) Correction

Children with cleft lip and palate should be managed by a comprehensive multidisciplinary team that includes head and neck surgeons, speech-language pathologists, audiologists, dentists, orthodontists, pediatric plastic surgeons, and other rehabilitation specialists to ensure optimal functional and aesthetic outcomes. 1, 2

Core Disciplines Required for CLP Management

Surgical Specialists

• Pediatric plastic surgeons are essential for surgical repair of cleft lip (typically around 3 months) and cleft palate (typically around 1 year of age) 1, 2
• Otolaryngologists (ENT specialists) for management of recurrent otitis media, hearing assessment, and potential tympanostomy tube placement 1
• Oral and maxillofacial surgeons for later-stage reconstructive procedures and management of dental-related issues 1, 3

Speech and Hearing Specialists

• Speech-language pathologists for assessment and therapy of velopharyngeal dysfunction and articulation disorders 1, 2
• Audiologists for hearing assessment and monitoring, as children with cleft palate have high rates of otitis media with effusion and potential hearing loss 1

Dental Specialists

• Pediatric dentists for early dental care, prevention, and management of dental anomalies 4
• Orthodontists for management of dental arch development and malocclusion 2, 5
• Prosthodontists for dental prostheses when needed 5

Other Essential Team Members

• Geneticists for evaluation of potential syndromic associations (especially when CLP is associated with conditions like 22q11.2 deletion syndrome) 1
• Pediatricians for overall health monitoring and coordination of care 3
• Nutritionists/feeding specialists to address feeding difficulties common in infants with CLP 1, 2
• Social workers to help families navigate healthcare systems and access resources 1, 3

Timing and Coordination of Care

Initial Assessment and Early Intervention

• At diagnosis (often prenatal or at birth), immediate referral to a multidisciplinary cleft palate team is essential 2, 3
• Early feeding assessment and intervention is critical as infants with CLP often have difficulty with suction and may require specialized feeding techniques 1, 2
• Pre-surgical assessment by plastic surgeons and other team members to plan timing of interventions 1, 6

Ongoing Management Through Development

• Regular speech and language assessments beginning at 6-18 months and continuing throughout childhood 2, 3
• Hearing assessments every 6 months in early childhood, with ongoing monitoring for otitis media with effusion 1
• Dental and orthodontic care beginning with primary dentition and continuing through adolescence 4, 5

Special Considerations and Common Pitfalls

• Failure to address hearing issues can lead to speech development problems beyond those caused by the cleft itself 1, 2
• Inadequate speech therapy follow-up may result in persistent speech disorders despite successful surgical repair 2, 7
• Children with cleft palate require continued monitoring for otitis media with effusion and hearing loss throughout childhood, even after palate repair 1
• Coordination between multiple specialists is critical to prevent treatment gaps or conflicting interventions 3, 7
• Adult patients with history of CLP often report ongoing concerns with lip/nose aesthetics, nasal obstruction, malocclusion, and speech issues, highlighting the importance of long-term follow-up 7

Evidence-Based Outcomes

• Centers with established multidisciplinary teams report better outcomes with lower complication rates and higher parent satisfaction 6, 7
• Coordinated care through a single multidisciplinary team appears more effective than care provided by multiple separate teams or no formal team 7
• Early implementation of comprehensive care leads to better functional and aesthetic outcomes 2, 3

The multidisciplinary approach ensures that all aspects of care—structural, functional, developmental, and psychosocial—are addressed in a coordinated manner, maximizing the potential for optimal outcomes in children with cleft lip and palate 3, 5.