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R. Mark Ray, M.D.

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. ,

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R. Mark Ray, M.D.

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  1. R. Mark Ray, M.D. Director: Children’s Hospital Cleft and Craniofacial Team East Tennessee Children’s Hospital

  2. Evaluation and Treatment of the Child With Cleft Lip and Palate – Team Care

  3. 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.

  4. Pediatric Facial Anomalies Team • Surgeon • Speech Therapist • Audiologist • Nursing • Pediatrician • Orthodontist • Social Work • Nutritionist

  5. Classification- Cleft Lip

  6. Median clefts

  7. Mandibular Cleft

  8. Unilateral Lip RevisionInsufficient Advancement

  9. Prenatal Diagonosis • Provide information to families and answer questions • Prepare family for feeding their baby • Link family to resources

  10. Orthodontic Treatment

  11. Alveolar Ridge Bone Grafting

  12. Bardach, Janusz Salyer & Bardach’s Atlas of Craniofacial & Cleft Surgery.Volume II. Lippincott – Raven ; Philadelphia 1999

  13. Palate Expansion

  14. Subtle Alveolar Defect

  15. Alveolar Ridge Bone Grafting

  16. Alveolar Ridge Bone Grafting

  17. Alveolar Ridge Bone Grafting

  18. Speech Issues • Velopharyngeal Insufficiency • Compensatory errors • Articulation Disorder • Velocardiofacial Syndrome

  19. Rhinoplasty

  20. Cleft and Craniofacial Surgeries: 2009 & 2010

  21. Pierre Robin Sequence and Distraction Osteogenesis in the Neonatal Period

  22. Nager Syndrome

  23. Overview • Retrognathia, Glossoptosis, Cleft Palate • 1 in 9000 live births • Mortality 5-30% • Airway and feeding difficulties are presenting problems • Management is not uniform

  24. Tongue base obstruction

  25. Positioning

  26. Positioning

  27. Tracheostomy: Disadvantages • Complications: • Cannula obstruction • Accidental decannulation • Mortality significant • Average age atdecannulation: 3.1 years! • Functional Impairment

  28. Distraction Osteogenesis

  29. Distraction Osteogenesis

  30. Distraction OsteogenesisInternal Device

  31. Distraction Osteogenesis

  32. Airway Before and After

  33. Occlusion

  34. Distraction Osteogenesis

  35. Judy Marciel • Cleft Team Coordinator • Feeding and Nutrition Specialist • Provider and Family Education • Outcomes Evaluation and Analysis • Research Coordinator • Contact : 865-541-8510

  36. Questions

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