the role of the multidisciplinary cleft team in adult cleft care
Adults presenting with poor outcomes or complications of previous cleft care are usually far more challenging and complex to treat, compared with babies and children. Yet, it may often be the case that adult cleft care, particularly from a multidisciplinary perspective, is less well resourced than paediatric cleft care.
Post-surgical anatomy, often with tissue loss and scarring is much more variable than the anatomy of an unoperated cleft, making adult cleft care less amenable to the establishment of relatively rigid protocols that characterise the care of babies and children with clefts. This makes comparative intercentre data difficult to interpret. Additionally, intercentre studies on treatment outcomes require some standardisation of preoperative severity.
Research studies and international trials have focussed to a greater extent on primary surgery, thus the body of evidence for adult cleft care is less robust than that for paediatric cleft care.
While input from all disciplines in the multidisciplinary team is important, the importance of input from psychology and restorative dentistry cannot be underestimated and allows for patients to explore both surgical and non-surgical treatment options. For many adults, it can be very emotional re-presenting for treatment; and the input of a psychologist to help patients articulate concerns and expectations to the team is important. Often, the most significant concern to a patient, is very different from what clinicians may perceive to be the main problem. Access to genetic services varies but is important.
Many charities and peer support groups tend to focus on parents and children with clefts.Feedback from adult patients indicates that they too, gain a great deal frompeer support and patient involvement activities, which bring an added dimension of support, that clinical teams alone, cannot provide.
This talk will examine some of the above challenges and consider how they may be addressed.