4. 2
Table of content
A word from cleft lip and palate team chairmen 2
Mission and values 3
Objectives 4
Achievements 5
Future views 6
Team members roles 7-18
Haberman bottle 19
2013 statistics 20
Types of operations 21-26
Clefts calendar activities 27-34
Future Events 35
5. Cleft Lip & Palate
Program
3
The Cleft Lip and Palate program ( CLP ) has been officially
launched in king abdulaziz medical city MNGHA – Riyadh in 2008
comprising of a professional association of highly qualified spe-
cialist recognized experts in their fields .
The “ rainbow of hope “ cleft lip and palate team ultimate goal
is to create a patient—centered friendly medical environment
dedicated to treat , improve health status and support social and
psychological needs of our patients and their families adhering to
the highest medical and ethical standards .
Our integrity is our cornerstone character and together with our
religious identity , social responsibilities and traditional believes
we built a culture of transparency, ethics , honesty and trust .
Our mission is to heal their smiles and make their lives better !
6. 4
MiSSION
Our values define who we are ...
1. patient—centered care
2. prioritizing religious Identity and traditional believes
3. patients safety & assurance .
4. promoting collaborations.
5. social responsibilities
6. professional—trustworthy reputation .
1. To provide optimum care to all craniofacial anomalies and
cleft lip and palate ( CFA & CLP ) patients in a patient—
centered environment through a team oriented approach .
2. To address all the needs and demands in the CFA & CLP
center of excellence that provides all range of services
gathered under one roof .
3. To improve the quality of life of our patients and their families
.
VALUES
7. Objectives
5
Several objectives were traced to reach our goals :
1. To reach internationally care standards and become an
international accredited CFA &CLP Center.
2. To assess the quality of life of our patients and their
families and delineate their needs and demand that
will represent the baseline from which our treatment
strategy will be build .
3. To establish a CFA & CLP Center in King Abdulaziz
Medical City that will provide all needs and d emands
in an efficient and timely organized treatment protocol.
4 . To spread knowledge to patients and practitioners
through all media-oriented channels.
5. To conduct a national survey assessing the incidence
of occurrence of the CFA & CLP and to plan future needs .
8. 6
Achievements
1. National Guard CLP team was accredited by the American
cleft palate association in a conformity to the international
standard of care .
2. The creation of CFA & CLP Center of Excellence has been
approved by the national Guard health affairs high
authorities to be nested in the children hospital KASCH .
3. CLP awareness day was conducted in October 2013.
4. Instructional informative brochures were successfully
completed and made available in all patients frequently
visited sites and waiting areas
9. Future Views
1. We are dedicated to continue upgrading the quality of care
provided to our patients.
2. To build an evidence based experience and to excel .
3. We are aiming to build a research data base and to stimulate
and support researches that will open before as new
scientific horizons.
And most of all our future goals will become an
internationally well-known Center of Excellence .
7
11. Plastic Surgery
• Surgically restore the normal functional and anatomical
features of cleft lip, which is usually done at age of 3-6
months.
• Cleft palate closure by the age of 12-18 months in order to
achieve normal function such as of speech and swallowing.
• Perform surgical intervention if needed following
velopharyngeal inadequacy (VPI) assessment done by a
speech therapist between the age of 5 to 6 years.
7
12. 8
General Pediatrics
General Duties
• Assess all common Pediatric issues including nutrition,
growth development, immunization and psycho-social
issues.
• When special needs are identified, referral to appropriate
specialists will be necessary.
• Frequent monitoring of children who may be at risk of growth
failure, delayed development, neglect, psycho-social
disturbance or any other significant problem.
• Evaluate and discuss with team members the health status
of patients prior to any surgery or needed procedures.
13. Prosthetic Dentistry
9
General Duties
• Deliver Prosthetic therapy
aids to CLP patients that
will allow developing normal
speech , promoting deglutition
and mastication and closing
the oral cavity separating
it from the nasal cavity .
• During childhood, to overcome speech difficulties an obtura tor
is needed that will close the palatal gap and prevent air escape
and liquid regurgitation .
• Post alveolar bone graft in the clefted area, a tooth implant is
done .
• The final touch of the prosthodontist will be directed toward
working remaining little occlusal imperfections to reach the
perfect esthetic and functional balance which play a role in the
psychological and social acceptance of the cleft lip and palate
patients .
14. 10
General Duties
• As primary dentition erupts, a full dental evaluation will be
done in order to provide control, preventive measures, and
space management.
• Congenitally missing teeth may be replaced with removable
or fixed appliance.
• Provide follow up to monitor oral hygiene and develop
appropriate preventive program.
Pediatric Dentistry
15. 11
Oral & Maxillofacial
Surgery
General Duties
• Pre-surgical use of an orthopedic device (Latham appliance)
to align the maxillary segments prior to initial Cleft lip closure
• Maxillary distractor during the pre-school, mixed dentition
stage.
• Early orthognathic procedures to correct the occlusal
discrepancies.
16. 12
General Duties
• At birth pre surgical orthodontics prior to lip closure .
• During growth :
1. Redirect maxillary and mandibular growth via (maxillary
expansion and retraction)
2. align the maxillary dentition if teeth irregularities appearance
causes the child psychological discomfort or if teeth are
traumatizing surrounding soft tissues .
3. Prepare the clefted site to receive the alveolar bone graft .
• During adolescence :
1. Align maxillary and mandibular teeth using fixed appliances =
full comprehensive orthodontic treatment.
2. Prepare for orthognathic surgery if needed .
3. Detail the occlusion post-operatively.
Orthodontics
17. 13
General Duties
• Collecting medical information including family history and
physical examination.
• Looking for associated genetic syndrome or related
hereditary disorder.
• discuss recurrence risks and give parents and adult patients
detailed genetic counseling.
• Evaluate patients at least once in the neonatal period and
the second visit at 5-6 years of age if needed while the last
visit is post adolescent or premarital period.
Medical Genetics
18. 14
Otolaryngology
General Duties
• Physical examination of the ears and appropriate
assessment of hearing sensitivity.
• Audio logical evaluation to monitor middle ear status
include audio logical and hearing assessment by
Acoustic-immittance emission (Oto- Acoustic Emissions
test) and tympanometry measures .
• Evaluate all children undergoing myringotomies and
ventilating tubes placement pre and two weeks
postoperatively .
19. 15
Social Worker
General Duties
Patients and families pass through several stages of social
stress with coping. Social worker will play major role and will:
• Provide information about family support, assess patients
and families resources, needs, and understanding of
patients developmental needs.
• Social skills training to help children and adolescents learn
how to handle stressful social situation.
20. 16
General Duties
Psychological stress related to coping with cleft leads to many
difficulties such as developmental, behavioral and emotional.
This causes inconvenience to patients and families.
The psychologist will :
• Provide full support through assessment of the psychological
environment as well as the impact of the condition on patients
and families.
• Perform psychological and social screening on parents and
the child at regular period starting from the neonatal.
Psychology
21. 17
Speech Therapy
General Duties
• Screen all CP patients for speech and language, assess
expressive language development, evaluate vocal quality
and maintain records including the treatment plan.
• Even if speech-language development has been
appropriate, screenings will take place on a regular basis
and at least every three years until dental and skeletal
maturity are reached.
• Perform Pre and post-treatment speech assessments, as
they are needed for determining outcomes of surgical
management of the velopharyngeal system.
22. 18
Clinical Dietitian
General Duties
Feeding is the highest concern for babies born with cleft .
Therefore, clinical dietitian will :
• Assess nutritional status and growth.
• Closely monitor children who may be at risk due to
malnutrition.
• Evaluate babies When born, before discharge and one
week later.
23. 19
Nurse Coordinator
General Duties
• Meets CLP families, obtain medical history and introduce the
program.
• Explain to family/caregiver beyond the abnormality the
other possible complications that may be associated with
CLCP.
• Coordinate the activities of the multidisciplinary team and
facilitate the patient care.
• Booked appointments and following an integrated specialties
time table according to the adopted treatment protocol.
24. 20
Babies with cleft lip alone usually do
not have feeding troubles. However,
this occurs in cleft palate patients. A
cleft in the roof of the mouth makes it
difficult for the baby to suck forcefully
enough to draw milk through a nipple.
In addition, some babies have problems
with gagging, chocking or milk coming
out through the nose while feeding. To
overcome these difficulties, we deliver
special teat designed to make feeding
easier for babies. (Haberman Feeder).
25. 21
2013 Statistics
From January 2013 till December 2013 , 29 patients
were accepted and enrolled in cleft lip and palate
multidisciplinary program . Cleft classifications ,
gender , family history , eligibility and living places
all are presented and explained within the few next
pages ..
26. 22
Cleft Classification and
Occurence Rate (2013)
Over twelve months period, the number of unilateral cleft
lip cases were twelve cases which represent 41.4% of all
cases . Next in ranking , total cleft hard and soft palate
cases were seven cases equals to 24.1%(Table 1).
Unilateral Cleft lip 12 41.4
Bilateral cleft lip 3 10.3
Cleft soft palate ( incomplete) 2 7
Cleft hard and soft palate ( complete ) 7 24.1
Unilateral cleft lip and palate 5 17.2
Bilateral cleft lip and palate 0 0
Total 29 100%
27. 23
Eligibility
Eligible 15 51.7
Non eligible 14 48.3
Tota 29 100%
KAMC is a tertiary referral institution therefore accepting a non-
NGHA cases based on diagnosis. A total of fourteen patients
(48.3%) were referred from other organizations while 51.7% of
patients were NGHA eligible patients( Table2 and Figure1 )
28. 24
Inside (Riyadh) 17 59
Out side 12 41
Total 29 100%
our data showed that twelve families were living outside
Riyadh (41%) such as Qassim , Hael , Jazan etc . For those
patients , the arrangement for surgery, admission or follow
up require more time and efforts (Table 3 and Figure 2)
Living places
29. 25
Family History
+ve family history 4 13.8
-ve family history 21 72.4
unknown 4 13.8
Total 29 100%
Four Families from a total of twenty nine had histories of clefting
regardless of the type, while twenty one which represent (72.4% )
from the total number of our patients had no family history of any
type of cleft. Four families they were not aware of any history of
cleft in their families .
Table 4 and figure 3
30. 26
Male 19 65.5
Female 10 34.5
Total 29 100%
The percentage of male / female CLP patients was found 9 to 10
regardless of the type of cleft .(Table 5 and Figure 4).
Cleft
31. 27
Cleft Lip 14
Cleft Palate 14
Alveolar Bone Graft 7
Palatal Fistula 3
Lip Revision 5
Z Plasty 1
Surgical performed procedures
in CLP patients 2013
33. 29
On the 5th of December 2012 , during the CLP monthly meeting
a collaboration proposal with king Faisal Specialist Hospital
presented by our guest Dr.AzizaAl Johar the Head of Cleft Lip and
Palate in KFSH who invited us to participate in the national CLP
registry initiated by King Faisal Hospital .
34. 30
October 3rd 2013
The CLP “ Rainbow of Hope “ team organized an awareness
day designed to patients , their families and interested care
givers .
The great number of the attendees marked the success of the
event
