Voice and Resonance Disorders 83the last few weeks, the woman was required to spend most of her time in bed and take medi cation
to delay premature birth. Early one morning the twins were born, but the joy of their birth was
tempered by the sight of their unilateral cleft lips and palates. The obstetrician told the parents
that although the cause of this condition would prob ably never be known, in a certain percentage
of cases, it may have a ge ne tic link. In this case, there was a maternal family history of cleft lip and
palate; an uncle had been born with the defect. However, it was also pos si ble that during gestation,
intrauterine factors may have affected the fetuses and caused the birth defect.
The primary cleft palate team at the children’s rehabilitation hospital consisted of a pediatri-
cian, reconstructive surgeon, orthodontist, dental surgeon, audiologist, medical social worker,
and speech- language pathologist. Other specialists such as dietitians, nutritionists, and psycholo-
gists also participated when necessary. The team met weekly and focused on patients seen in the
hospital. The captain was the medical social worker, who or ga nized and conducted the meetings,
allowing all team members to pres ent their reports and discuss specific issues. This was the initial
meeting with the twins’ parents, who also were to be members of the team. The first professional
to discuss Kyle and Jarod was the pediatrician, who said that she would be the children’s primary
care doctor until their 18th birthday. She told the parents that children with cleft lip and palate
often have special medical needs, and careful monitoring and regular checkups were impor tant.
She said that any medical concerns they might have should be addressed to her. She would also
arrange and coordinate all intervention activities related to their birth defects.
According to the plastic surgeon, the surgeries to repair the twins’ clefts and reconstruct the
facial features would begin before their first birthday. He reported that in more than 80% of cases,
primary repair of the palate results in adequate velopharyngeal closure. Only a few patients need
secondary physical management.
He suspected that because of the nature of their clefts, the twins would likely need secondary
management. In addition, the pharyngeal f lap surgery, in which tissue is connected between the
velum and the posterior pharyngeal wall to aid velar movement and closure, would have to be
supplemented by speech therapy.
The orthodontist predicted that both children would re quire extensive orthodontic and dental
reconstruction. He and a dental surgeon would do preliminary work on the children’s temporary
teeth, but the major reconstruction and alignment would be done on the permanent teeth. The
orthodontic work would not begin for several years.
The audiologist explained that children with cleft lip and palate have more frequent hearing
prob lems. These prob lems are primarily middle ear dysfunctions prob ably caused by eustachian
tube abnormalities. The eustachian tube equalizes pressure between the external environment and
the middle ear. When this pressure cannot be equalized, earaches and conductive hearing loss can
occur. The audiologist also said that tubes could be placed in the ear drums to help equalize the
pressure. He concluded that frequent hearing testing was necessary in managing individuals with
orofacial anomalies.
The speech- language pathologist indicated that children with cleft lip and palate can have
articulation, voice and resonance, and language disorders. Kyle and Jarod might have articula-
tion disorders due to the malformation of their lips, dental pro cesses, and palates. Even after the