Multidisciplinary management for cleft lip and palate patients: A team approach from Tohoku University

Our multidisciplinary team for cleft lip/palate repair is composed of specialists from both Tohoku University Hospital and Tohoku University Dental Hospital, who are plastic surgeons, otorhinolaryngologists, anesthesiologists, orthodontists, speech pathologists and pedodontists. The aim of the management program is to help the patients to support themselves as normal individuals, and the actual treatment goals are aesthetic improvement, normal occlusion, normal speech, and prevention of middle ear diseases. In order to achieve such results, the treatment should be carefully planned in regard to the patient's physical growth and psychosocial development. Our management concept has some unique characteristics. First, we do not use any presurgical orthodontics because we do not see any advantage in such invasive and intensive treatment methods. Second, we limit the number of surgical interventions, and employ less invasive procedures so that adverse effects on growth are avoided. We usually perform cheiloplasty at the age of 3-months, palatoplasty at the age of 15 to 18-months, alveolar bone grafting at different ages according to the patient's needs and dentition, and finally, rhinoplasty and lip revision in adulthood. Third, we prefer to perform tympanotomy concurrently with palatoplasty. Although many cleft palate patients suffer from otitis media, the above procedure prevents middle ear diseases and improves the patient's hearing ability.