Evaluation of Discipline-Specific Outcomes Through a Multidisciplinary Team Clinic for Patients With Isolated Cleft Palate.

Abstract

OBJECTIVE:

To describe the incidence and timing of provider-specific interventions for children with isolated cleft palate.

DESIGN:

This was a retrospective cohort study involving review of medical records.

SETTING:

Multidisciplinary team care clinic at a tertiary academic children's hospital between January 2000 and July 2019.

PATIENTS:

Patients with isolated nonsyndromic cleft palate seen by an American Cleft Palate-Craniofacial Association-approved team; 138 children were included.

MAIN OUTCOME MEASURES:

Study outcomes included incidence of secondary velopharyngeal management, tympanostomy tube insertion, speech therapy, hearing loss, dental/orthodontic treatment, and psychology interventions. Provider-specific outcomes were calculated for patients at ages 0 to 3, 3 to 5, and >5 years.

RESULTS:

Median follow-up time was 7.0 years (interquartile range: 3.3-11.8 years). At their last team assessment, 42% of patients still had conductive hearing loss. The rate of tympanostomy tube insertions not done alongside a palatoplasty was highest for ages 3 to 5 and dropped after new American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines in 2013 (P = .015); 54% of patients received speech-language therapy during follow-up. Palatoplasty, psychology, and dental/orthodontic treatment were all less common than speech or ENT treatment (P < .01). Secondary palatoplasty was performed in 31 patients (22%). Patients who received speech, dental/orthodontic, or psychology intervention followed up longer than those who did not (9.8 vs 2.1 years, P < .001).

CONCLUSION:

Half of the patients terminated team follow-up by age 7, suggesting that burden of care outweighed perceived benefits of continued follow-up for many families. These results can be used to adjust protocols for children with isolated cleft palate.

• Authors: Prerak B Trivedi, William M Padovano, Gary B Skolnick, Maithilee D Menezes, Lynn M Grames, Susan Cheung, Andrew M Kim, Mary M Cradock, Sybill D Naidoo, Alison K Snyder-Warwick, Kamlesh B Patel
• Journal: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association (Cleft Palate Craniofac J) Vol. 58 Issue 12 Pg. 1517-1525 (12 2021) ISSN: 1545-1569 [Electronic] United States
• PMID: 33535807 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Child
• Child, Preschool
• Cleft Palate (surgery)
• Humans
• Infant, Newborn
• Middle Ear Ventilation
• Patient Care Team
• Retrospective Studies
• Speech
• Treatment Outcome
• Velopharyngeal Insufficiency (surgery)