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Building Your Multidisciplinary Cleft Team

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The gold standard for cleft palate care is a multidisciplinary team accredited by the ACPA. These teams include craniofacial surgeons, speech therapists, and orthodontists who coordinate treatment plans. This approach reduces the number of surgeries and improves speech and feeding outcomes.

Key Takeaways

  • • A multidisciplinary cleft team provides the gold standard of coordinated care for children with cleft palate.
  • • Children treated at ACPA-accredited centers often need fewer surgeries and experience a lower overall burden of care.
  • • Core team members include a coordinator, craniofacial surgeon, speech-language pathologist, and orthodontist.
  • • High-volume surgeons with craniofacial fellowship training typically have the lowest surgical complication rates.
  • • Coordinated team care improves the early detection and treatment of issues like veloparyngeal insufficiency (VPI) and hearing loss.

Choosing where your child receives care is one of the most important decisions you will make. Because a cleft palate affects feeding, hearing, dental health, and speech, it cannot be treated by a single doctor in isolation. The gold standard of care is a Multidisciplinary Cleft Team—a group of specialists who work together to create a single, coordinated plan for your child [1][2].

Why Team Care Matters

Research consistently shows that children treated at centers accredited by the American Cleft Palate-Craniofacial Association (ACPA) have a lower “burden of care.” This means they often require fewer total surgeries and receive more timely interventions compared to those treated by independent community providers [3][4].

  • Coordinated Planning: Instead of you shuttling between different offices, the team meets regularly to discuss your child’s progress. This ensures that the surgeon, orthodontist, and speech therapist are all on the same page regarding the timing of treatments [1][5].
  • Better Outcomes: Specialized teams are more accurate at detecting subtle issues, like veloparyngeal insufficiency (VPI), which can affect speech. Early and accurate detection leads to more successful corrections [6].

The Core Team Members

An ACPA-approved team must include at least four core roles, though many teams are much larger [1][7]:

  1. Team Coordinator: Usually a nurse or social worker, this is your primary point of contact. They manage the complex schedule of appointments and ensure communication flows between you and the doctors [7][8].
  2. Cleft/Craniofacial Surgeon: Performs the primary and secondary repairs. Look for a surgeon with craniofacial fellowship training, as specialized training is linked to lower rates of complications like fistulas [9][10].
  3. Speech-Language Pathologist (SLP): Monitors speech and feeding from infancy through adulthood. They are critical for determining if and when a child might need speech therapy or secondary surgery [11][12].
  4. Orthodontist: Manages the growth of the jaws and the alignment of teeth. They play a key role in preparing the mouth for procedures like alveolar bone grafting later in childhood [13][14].

Additional Specialists

Your child will also likely see other experts who are either embedded in the team or work closely with them:

  • Audiologist & ENT: To monitor hearing and manage “glue ear” or ear tubes [12].
  • Pediatric Dentist: To maintain oral health in a mouth that may have unique dental challenges [15].
  • Social Worker/Psychologist: To provide emotional support and help navigate the psychosocial aspects of growing up with a cleft [5][16].

Vetting Your Care Team

When meeting a potential team, don’t be afraid to ask about their experience. High-volume surgeons—those who perform the most palate repairs annually—typically have the lowest complication rates [9]. A truly multidisciplinary team won’t just focus on the next surgery; they will talk to you about your child’s long-term quality of life, including their speech, hearing, and self-esteem [1][5].

You can find a list of accredited teams in your area by visiting the ACPA website and searching their directory of approved teams.

Frequently Asked Questions

Why does my child need a multidisciplinary cleft team?
A multidisciplinary cleft team provides coordinated care across multiple specialties like surgery, speech therapy, and orthodontics. This unified approach reduces the total number of surgeries needed and ensures timely, collaborative treatments.
Who are the core members of a cleft palate care team?
An accredited cleft team typically includes a team coordinator, a craniofacial surgeon, a speech-language pathologist, and an orthodontist. Your child may also see an audiologist, ENT, pediatric dentist, and social worker.
What is an ACPA-approved cleft team?
The American Cleft Palate-Craniofacial Association (ACPA) accredits teams that meet specific standards of multidisciplinary care. Children treated at ACPA-approved centers generally experience better overall outcomes and fewer complications.
What should I ask when choosing a cleft surgeon?
Ask if the surgeon has specialized craniofacial fellowship training and how many primary palate repairs they perform each year. High-volume surgeons with specialized training typically have the lowest complication rates, such as fistulas.
How does the team coordinator help my family?
The team coordinator, often a nurse or social worker, serves as your primary point of contact. They manage complex appointment schedules and ensure clear communication between your family and all the specialists on the team.

Questions for Your Doctor

  • • Is this team formally approved by the American Cleft Palate-Craniofacial Association (ACPA)?
  • • Who is our designated Team Coordinator, and what is the best way to contact them when we have a concern?
  • • Does our lead surgeon have specialized fellowship training in craniofacial surgery, and how many primary palate repairs do they perform each year?
  • • Will our child see the speech-language pathologist, orthodontist, and audiologist at every team visit, or are those separate appointments?
  • • How does the team make collaborative decisions about the timing of my child's next surgery or orthodontic treatment?
  • • What psychosocial support or social work services are available to help our family navigate the emotional and financial aspects of long-term care?

Questions for You

  • • Do I feel that the team is listening to my concerns and explaining things in a way that I clearly understand?
  • • Is the location of the cleft center manageable for our family, given that we will be visiting regularly for several years?
  • • Am I keeping a central folder or digital record of my child's surgical history, speech evaluations, and dental plans to share with the team?
  • • How am I doing emotionally? Have I asked the team about parent support groups or counseling resources?

Want personalized information?

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References

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    [Guideline for cleft lip and palate team approach management].

    Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology 2024; (59(3)):221-229 doi:10.3760/cma.j.cn112144-20240104-00010.

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    Six-year Burden of Care for Nonsyndromic Unilateral Cleft Lip and Palate Patients: A Comparison Between Cleft Centers and Noncleft Centers.

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    Interdisciplinary Team Care for Children with Facial Differences.

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    Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care.

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    Cleft and Craniofacial Team Orthodontic Care in the United States: A Survey of the ACPA.

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    PMID: 30602292
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    Diagnostic Protocols for Alveolar Clefting and Barriers to Acquiring Imaging: A Survey of ACPA-Approved Cleft Teams in the United States.

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    PMID: 35099307
  9. 9

    Effect of Surgeon Volume and Craniofacial Fellowship Training on Cleft Palate Complication Rates.

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    Annals of plastic surgery 2017; (78(5 Suppl 4)):S229-S232 doi:10.1097/SAP.0000000000001046.

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  10. 10

    American Indian and Alaska Native Accessibility to Comprehensive Cleft Lip and Palate Treatment.

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    PMID: 35642251
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    Prenatal to Adulthood: The Responsibility of the Speech-Language Pathologist on the Comprehensive Cleft Palate and Craniofacial Team.

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  12. 12

    Current Ear and Hearing Care Practices for Infants and Toddlers with Cleft Palate in the United States.

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  14. 14

    Factors Influencing Timely Preparation of Alveolar Bone Grafting: A Survey of the ACPA.

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  15. 15

    Dental age, agenesis, and morphological anomalies in individuals with Van der Woude syndrome and isolated cleft palate.

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This page provides educational information about building a cleft palate care team. It is not a substitute for professional medical advice, diagnosis, or treatment for your child.

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