ndividuals born with clefts of the Up and palate or palate only will face a number of interrelated problems. In the earliest days of team management of clefts, clinical observations led to the recognition that children with cleft lip and palate (including a cleft of the maxillary alveolar arch) required the services of a reconstructive surgeon to repair the clefts, a speech pathologist to address issue of velopharyngeal function and articulation, and a dental specialist to address problems associated with occlasion and congenitally missing teeth.
Centers were often built around these treatment specialists because of their long-term involvement with patients with clefts. Many teams did not have pediatricians (even though the majority of patients were children), or otolaryngdogists (even though most patients had chronic middle ear disease). In its early advocacy of teams, the American cleft palate Association (ACPA) indicated that a proper team must have at a minimum a plastic surgeon, a speech pathologist, and an orthodontist. Would a team that had only these specialties be able to qualify as a comprehensive center? As the
Medical, dental, and behavioral sciences expanded, new subspecialties were born to address problems that could not even be detected four decades ago. Subspecialties such as human genetics and neuroradiology are recent additions to medicine, and specialty tests such as nasopharyngoscopy, multiview videofluoroscopy, and 3-D CT scans were not widely available before the 1980s. As a result, organizations such as ACPA have recognized that minimal standards may no longer be valid, and centers will need to be more comprehensive in order to meet a patient' s needs. How comprehensive should a team be?
Table l lists the specialists who would have an interest in children with clefting or craniofacial anomalies along with the reason for that interest. Would patient care be compromised if any of these specialists were omitted? Correct diagnoses could go undetected. Proper treatments known only by certain specialists could go unadministered.
Table l Specialists who should be included on a craniofacial team and the reason for their presence. When "pediatric" appears in parentheses, the implication is that the majority of patients are pediatric cases and should require pediatric subspecialization.
Specialty reason for inclusion
Medical specialists
Plastic Surgery Reconstruction of cleft and structural management of VPI
Pediatrics "Medical manager" for the child
Neurology (Pediatric) At least 10% of children with clefts have CNS anomalies
Endocrinology Approximately 20% of children with clefts are of short stature
Ophthalmology (Pediatric) Frequent eye anomalies, especially in Stickler syndrome (5% of cleft palate)
Cardiology (Pediatric) Frequent heart anomalies (at last 10% of children with clefs)
Otolaryngology (Pediatric) Very frequent association of middle ear disease and airway disorder
Radiology/Neuoradiology Videofluoroscopy, CT, MR as frequent diagnostic modalitis
Neurosurgery (Pediatric) Frequency of craniosynostosis and need for intracranial surgery
Pulmonology (Pediatric) Frequent association of airway related problems
Anesthesiology (Pediatric) Difficult intubations common in children with craniofacial anomalies
Genetics/Dysmorphology
本论文由英语论文网提供整理,提供论文代写,英语论文代写,代写论文,代写英语论文,代写留学生论文,代写英文论文,留学生论文代写相关核心关键词搜索。