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Evaluation of Discipline-Specific Outcomes Through a Multidisciplinary Team Clinic for Patients With Isolated Cleft
Prerak B Trivedi1, William M Padovano1, Gary B Skolnick1
1Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Insights
Interventions for isolated cleft palate vary by age, with speech and ENT treatments most common. Many families discontinue care by age 7, indicating a need to re-evaluate follow-up protocols.
Area of Science:
- Pediatric medicine
- Craniofacial surgery
- Speech-language pathology
Background:
- Children with isolated cleft palate require multidisciplinary team care.
- Understanding the timing and incidence of interventions is crucial for optimizing care pathways.
Purpose of the Study:
- To describe the incidence and timing of provider-specific interventions for children with isolated cleft palate.
- To analyze outcomes based on age groups (0-3, 3-5, >5 years).
Main Methods:
- Retrospective cohort study of 138 children with isolated nonsyndromic cleft palate.
- Review of medical records from a tertiary academic children's hospital (2000-2019).
Main Results:
- 42% had persistent conductive hearing loss; tympanostomy tube insertion rates varied by age, decreasing after 2013 guidelines.
- 54% received speech-language therapy; palatoplasty, psychology, and dental/orthodontic treatments were less frequent than speech or ENT interventions.
- Patients receiving speech, dental/orthodontic, or psychology interventions had longer follow-up (9.8 vs 2.1 years).
Conclusions:
- Half of patients terminated team follow-up by age 7, suggesting the burden of care may outweigh perceived benefits.
- Results can inform adjustments to care protocols for children with isolated cleft palate.
- Optimizing intervention timing and family support is essential for long-term management.
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.
