Transcript R. Mark Ray, MD

R. Mark Ray, M.D.
Director: Children’s Hospital Cleft and
Craniofacial Team
East Tennessee Children’s
Hospital
Evaluation and Treatment of
the Child With Cleft Lip and
Palate – Team Care
Disclosure Statement of
Financial Interest
 I,
R. Mark Ray M.D.,
DO NOT have a financial
interest/arrangement or affiliation with
one or more organizations that could
be perceived as a real or apparent
conflict of interest in the context of the
subject of this presentation.
Pediatric Facial Anomalies Team
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Surgeon
Speech Therapist
Audiologist
Nursing
Pediatrician
Orthodontist
Social Work
Nutritionist
Classification- Cleft Lip
Median clefts
Mandibular Cleft
Unilateral Lip Revision
Insufficient Advancement
Prenatal Diagonosis
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Provide information
to families and
answer questions
Prepare family for
feeding their baby
Link family to
resources
Orthodontic Treatment
Alveolar Ridge Bone Grafting
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Bardach, Janusz Salyer & Bardach’s Atlas of
Craniofacial & Cleft Surgery. Volume II. Lippincott –
Raven ; Philadelphia 1999
Palate Expansion
Subtle Alveolar Defect
Alveolar Ridge Bone Grafting
Alveolar Ridge Bone Grafting
Alveolar Ridge Bone Grafting
Speech Issues
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Velopharyngeal
Insufficiency
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Articulation Disorder
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Compensatory errors
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Velocardiofacial
Syndrome
Rhinoplasty
Cleft and Craniofacial Surgeries: 2009 & 2010
29
30
25
22
20
2009
15
12
11
11
10
6
5
6
7
4
2
2
0
1
0
0
Lip Adhesion
Cleft Lip
Cleft Palate
VPI (cleft)
VPI (non-cleft)
Definitive Cleft
Rhinoplasty
Other
2010
Pierre Robin Sequence and Distraction
Osteogenesis in the Neonatal Period
Nager Syndrome
Overview
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Retrognathia, Glossoptosis, Cleft Palate
1 in 9000 live births
Mortality 5-30%
Airway and feeding difficulties are
presenting problems
Management is not uniform
Tongue base obstruction
Positioning
Positioning
Tracheostomy: Disadvantages
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Complications:
 Cannula obstruction
 Accidental
decannulation
 Mortality significant
 Average age
atdecannulation: 3.1
years!
 Functional
Impairment
Distraction Osteogenesis
Distraction Osteogenesis
Distraction Osteogenesis
Internal Device
Distraction Osteogenesis
Airway Before and After
Occlusion
Distraction Osteogenesis
Judy Marciel
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Cleft Team Coordinator
Feeding and Nutrition Specialist
Provider and Family Education
Outcomes Evaluation and Analysis
Research Coordinator
Contact :
865-541-8510
Questions