HJAR Mar/Apr 2022

48 MAR / APR 2022 I  HEALTHCARE JOURNAL OF ARKANSAS CHILDREN’S HEALTH COLUMN CHILDREN’S HEALTH COMPLEXITIES OF CLEFT CARE Patients with cleft lip and palate have presented a complex challenge to sur- geons for years. Patients can be born with unilateral or bilateral cleft lip and/or pal- ate and are subject to multiple surgeries throughout their lifetime. Over the years, different techniques have evolved in the management of this complex patient pop- ulation. Some of these techniques have improved the surgical outcomes and standardized management of clefts glob- ally. Other techniques have evolved to improve the patient experience and allow for a more considerate management strat- egy for an ultimately young patient pop- ulation who deserve a special amount of compassion in their care. The latter plays an important role in patient and family compliance and the ability for the young children to live their lives and place their best foot forward. THE TRADITIONAL APPROACH For many years, there has been an es- tablished algorithm to manage this patient population. At birth, infants are referred to the cleft surgical team with an initial goal to ensure the patient is feeding and gaining weight appropriately. Once the patient is approximately 3 months of age and starts to develop their social smile, the cleft lip surgery is performed. At the beginning of speech development (approximately 9 to 12 months of age), the patient undergoes a cleft palate repair. At approximately 7 to 10 years of age, the patient undergoes bone grafting to the upper jaw (alveolar cleft repair) to allow for good descent of the dentition, usually with bone harvest- ed from the hip. In late adolescence when facial growth starts to taper, the patient undergoes jaw surgery, if necessary, and a definitive rhinoplasty. PARADIGM SHIFTS IN CLEFT CARE