Cleft Lip and Palate/Craniofacial Panel
Sutter Medical Center, Sacramento / Children's Outpatient Services
Cleft Lip and Palate/Craniofacial Panel
Preliminary Appointments with the Core Team
1. Nursing Evaluation: This appointment will take approximately 30‑45 minutes. You and your child will meet with a Registered Nurse to collect a detailed medical history, assessment of both condition and need, and developmental screening. Referrals and education are a focus of this meeting. Assistance with on‑going follow‑up and case management for immediate and long‑term care is also provided. During this visit you will have the opportunity to discuss any questions or concerns you specifically want addressed on Panel Day.
2. Nutrition Evaluation: This appointment will take approximately 30 minutes. Your child will be weighed and measured and their diet will be reviewed by a Registered Dietitian. Growth and nutritional status will be assessed and evaluated and recommendations for optimal nutritional intake will be discussed.
3. Social Work Evaluation: This appointment will take approximately 30‑45 minutes. A Clinical Social Worker is available to explore any concerns that the child or family may be experiencing. Parents and children may have intense feelings surrounding the need for hospitalization and surgery. The Social Worker can help guide the family in the emotional and behavioral adjustments of the child and offer resources to help manage the situation. Referrals for developmental, emotional, educational and financial resources are also explored as needed.
4. Speech/Language Evaluation: This appointment will take approximately 45 minutes. Your child will be evaluated by a Speech/Language Pathologist to screen for speech and feeding problems that are often times associated with children with clefting. This should be done in the first year of life and then as often as necessary to maintain optimal speech and feeding progress as well as provide adequate documentation of your child's overall progress. Speech recommendations provide information that is necessary to the team for the development of an overall treatment plan including surgical and dental/orthodontic interventions.
Speech evaluations will therefore need to be ongoing as your child progresses throughout the developmental stages.
Additional Preliminary Appointments
1. Audiology Evaluation : This appointment will take approximately 30 minutes. The hearing test preformed on your child will provide information to the panel regarding their hearing status and middle ear function.
Children with clefting can experience hearing loss related to frequent ear infections and/or chronic fluid in the middle ear. Interval hearing exams can monitor, and limit, the long‑term effects of hearing loss and prevent such loss from going untreated.
2. Dental x‑rays: This appointment will take approximately 15 minutes‑1 hour. Children 3 years and older will be required to have a "Panorex" a "PA and lateral cephalometric" x‑ray done prior to their panel visit. These x‑rays are different than the ones taken by your dentist and they are necessary in the development of both an orthodontic as well as a surgical plan. They are very helpful to the panel members for establishing a time frame for surgery and to help establish the sequence of procedures.
3. Genetics Evaluation: This appointment will take approximately 1 hour. A comprehensive genetic evaluation is a key component in the management of any child with a congenital anomaly.. This evaluation will include diagnosis, recurrence risk counseling, and discussion regarding prognosis. For most families a genetic evaluation will not be necessary with each panel visit. However, for those children with complex syndromes and those whose clinical manifestations may not be recognized early in life, additional genetic follow‑up will be required.
Panel Day
The Panel meets on the first Wednesday of each month. This appointment will take approximately 1 to 2 hours to complete. Please understand that some of this time will be spent waiting between specialists.
Please feel free to bring books, toys, or snacks for your child during their wait.
Each Panel consists of two or more of the following medical and dental specialists: Plastic and Reconstructive Surgery, Oral Surgery, Orthodontia, Pediatric Dentistry, Genetics, Otolaryngology and Pediatrics. These specialists will see your child in small groups in an exam room. Please feel free to ask any questions that you may have of the specialists during your child's visit. The Panel Nurse Coordinator will meet with you and your child before you leave and bring any additional questions or concerns that you may have to the Panel case conference held by the specialists later that day. Only the medical specialists are present at the case conference.
The Panel of medical and dental specialists as well as the clinicians will hold a case conference to discuss each individual case. At this time findings and recommendations are discussed and a treatment plan is established. The Panel Coordinator will discuss the Panel's findings with the child's parents approximately 2 weeks after the case conference is held. Each family, as well as the child's specialists and primary care physician, will receive a written copy of the report approximately one month after the visit. Reports are expedited on cases needing immediate attention.
