 
| Please
click on the speciality below for more
information
|
- Annie Cole
- Jayne Tomlinson
- Pat Lynch
- Michelle Jones
The Cleft Nurse Specialists are a team of experienced nurses, who have all held Sisters posts before joining the Cleft Team. Between them, they have a wide knowledge of many specialities, as well as many years experience of working with children born with cleft lip and/or palate.
The Cleft Nurse Specialists will provide advice and support in your baby's first year. They will visit you in hospital when your baby is born and continue to see you at home to offer practical feeding guidance. Your nurse will be in close contact with you before, at the time of and after your baby's surgery. The nurses will liase with your Health Visitor and any other relevant health professional, including the wider Cleft Team. They will also see you at any out-patient appointments you may have with us at Birmingham Childrens Hospital.
| Back to Top |
Audiologists
- Lead Cleft Audiologist - Clarissa Ryder The team comprises of 10 Audiologists, from a variety of backgrounds and training routes and with varying levels of experience, a Senior Assistant Audiologist and 3 secretarial staff.
The Audiologists have all chosen to specialise in Paediatric Audiology, and are dedicated to ensuring that any hearing loss is diagnosed as quickly and efficiently as possible and managed appropriately.
In addition to providing support to the Cleft Lip and Palate Service, we also provide support to the Ear Nose and Throat department and receive referrals directly into Audiology for assessment from a variety of sources. We also have an habilitation service for permanent hearing loss and routinely fit digital, bone conduction and bone anchored hearing aids.
Paediatric Audiology is a specialism within the field of Audiology, and deals with assessing and managing children's hearing problems.
We use a variety of different test techniques depending upon the developmental age of the child. Some of these are described briefly below:
Click Here for a link to the Audiology page
Brain Stem Evoked Response Audiometry
This test is usually used for very young babies. Sounds are produced through headphones and the electrical activity in the brain is recorded using electrodes. Normal electrical activity in the brain is averaged out to leave the response to sound alone. The test is generally very accurate, however the baby must be asleep to get clear responses.
Visual Reinforcement Audiometry
We use this test on children from about 6 months to 2½ years old. Sounds are presented through a speaker to one side of the child, and they are conditioned to turn to the sound when they hear the noise. When they turn they are rewarded by seeing a toy light up and move. We can also test individual ears using insert phones.
Pure Tone Audiometry
From about 2½ years old this is the test most commonly used. The child is conditioned to respond whenever they hear a noise by, for example, putting a man in the boat. The child wears headphones for the test.
Tympanometry
This test is very simple to perform but very complicated to explain! Basically a probe is put against the child's ear canal, it pushes some air into the ear canal and then pulls the air out again, and throughout this process, the movement of the eardrum is recorded. The test takes a matter of seconds to complete and is not painful for the child. The results can show us if the child has any fluid in the middle ear, which is very common in babies and toddlers, and particularly those with cleft palate.
| Back to Top |
Speech and Language Therapy
(Paediatric and Adult Service) |
Speech & Language Therapists
- Imogen Underwood
-
Alison Jeremy
-
Louise Edwards
-
Jane Russell
- Prue Yarwood
Many children with cleft lip and palate or cleft palate develop normal speech with few or no problems but others need help. They may have difficulty learning how to use their tongue; lips and palate correctly for speech. Also, air may escape down their nose when they are speaking.
The Birmingham Children's Hospital (BCH) Speech and Language Therapists monitor the development of all children who have had clefts of the palate to identify those who may have problems and to make sure that they get the right help when they need it.
Speech problems are rare in children with clefts of the lip only, but assessment can be arranged if parents are concerned.
Links with Local Speech and Language Therapy
In each district of the West Midlands there is an identified Link Speech and Language Therapist (SLT) who co-ordinates local care for cleft palate children. The BCH team liases closely with Link Therapists and provides training for them as part of the wider team.
The BCH SLTs notify the Link Therapists when a new baby with a cleft palate or a cleft lip and palate has been seen in the outpatient clinic. The Link Therapists may contact families by phone or letter at this stage or they may take no action until they receive a formal referral from the BCH therapist following the palate operation.
Specific Times When The BCH Speech and Language Therapists
See the Children
All the children who have had cleft palate operations are seen for assessment
• Between 18 months and 2 years
• 3 years
• 5 years
At these assessments they check that children are getting any help they need and the results of the assessment help to evaluate the success of surgery and to plan future care.
If there is concern that the child's palate is not working very well, children may be seen in the speech investigation clinic for x-rays and possibly nasendoscopy investigation.
Second Opinion Clinic
Some children who do not have obvious clefts of the palate may develop “cleft type speech”. Their speech may sound nasal (the opposite to how people sound when they have a bad cold and a blocked nose) and some sounds may be difficult for them to make if the palate is allowing air to escape into the nose when it shouldn't. When referrals for children with these types of difficulty are received, the Cleft Palate Team protocol is that they should all be seen for speech and language therapy assessment first. Following speech and language therapy assessment a decision is made regarding whether they then need to be seen in a cleft palate clinic, speech investigation clinic or require a different type of management.
Adult clients
Together with other members of the cleft palate team, the speech and language therapists see adults who have had clefts of the palate for assessment and treatment. Adults are seen for outpatient appointments at the Queen Elizabeth Hospital, but speech investigations and therapy are carried out at BCH.
The Speech and Language Therapy Team
The therapists working in the team all have considerable experience in the field of cleft palate.
| Back to Top |
- Victoria Clark
Having a healthy mouth and teeth is important for all children. The milk teeth play an important function in maintaining space for the permanent teeth to grow into later. In babies and children with cleft this is of added importance as jaw development is best if all milk teeth are present and space for the adult dentition is achieved. Often if the cleft is in the tooth-bearing region of a child's jaw then there may be a later need for orthodontic treatment to straighten the teeth to put them in a more ideal position either to improve function or their appearance.
Ideally children will be registered with a family dentist in your area. This is important to ensure children get the very best dental advice at the appropriate time. In addition Paediatric Dentists work as part of the Cleft Team and there will be an opportunity to meet with them during some of the visits to the Hospital. At home maintaining teeth in a healthy state involves brushing twice daily with fluoride toothpaste appropriate for the child's age and restricting all sugar intakes to mealtimes only. In addition avoiding any juices containing gas/fizz would ensures that the child is given the best chance of retaining their teeth in the best health.
| Back to Top |
| Restorative Dentistry (Adult Service) |
- Anthony Summerwill
The Restorative Dentist will resolve any complex dental problems you may have or might develop in the future. Your treatment will be planned in combination with your family dentist.
| Back to Top |
- Naresh Patel
- Mark Hammond
A cleft may result in a gap in the bone of the gum. This can lead to some of the teeth coming through into the mouth twisted and in the wrong position. Sometimes teeth may be missing or there may be additional teeth. If the palate is affected the upper dental arch of teeth is sometimes narrow. This may lead to some of the teeth meeting incorrectly with the lower teeth a condition called a crossbite. A crossbite can also exist on the front teeth if the upper and lower jaws do not grow forward at the same rate.
The orthodontist will usually obtain records of the teeth before treatment; as record, and to monitor changes in the teeth and jaws. X-rays are also used to monitor the developing teeth and changes in the teeth with treatment and growth.
Orthodontic braces used are the same as those used with all other children. They are either of the removable or fixed type. The removable braces are removable as they can be taken out for cleaning, but they normally should be worn full time.
The main reasons for offering treatment are to improve the appearance of the teeth. Teeth do not have to be perfectly straight to look acceptable or remain healthy. You can discuss treatment with the orthodontist. It is important that the mouth is kept very clean if a brace is used to protect the teeth and gums.
Crossbites and other dental irregularities are noticeable as soon as the teeth come through into the mouth. However, treatment may not be recommended for baby teeth, as braces are not tolerated very well, and the changes are often not reflected in an improvement in the second teeth.
Treatment may be started at around 8-9 years of age when the front teeth are often straightened. This may be done as part of the alveolar bone grafting procedure. Most fixed appliance treatment is carried out in teenage years when all the permanent teeth are present, and this may take several years.
Alveolar Bone Grafting
If the cleft passes through the bone in the gum beneath the upper lip there may be insufficient bone present to allow the teeth to come through. The nose may also benefit by having more bony support.
A graft of bone - usually taken from the hip - is placed in the gum. This is usually done between the ages of 8-10 years, often before the 'eye' teeth come through into the mouth. To gauge the correct time for the operation X-rays are often taken of the teeth. This operation requires sometime in hospital.
Sometimes the upper dental arch is widened and the front teeth straightened by the Orthodontist before the operation. The orthodontic treatment may take 6-12 months. The brace may remain in place for between 3 and 6 months after the operation.
| Back to Top |
| Plastic Surgery (Paediatric Adult Service) |
Consultant Plastic Surgeons:
- Rona Slator
- Bruce Richard
The Plastic Surgeon will repair your child's cleft lip and/or palate. They may also perform other operations to improve function or appearance as your child grows.
At the Queen Elizabeth Hospital, in the Adult Clinic, the Plastic surgeon and the Maxillofacial Surgeon will ask you general questions about your previous treatment for cleft lip and/or palate. They will be able to discuss with you any future surgical treatment that you may or may not require.
| Back to Top |
ENT Surgeons:
- Ken Pearman
- Michael Kuo
The ENT Surgeon will look after your child's hearing and treatment related this.
| Back to Top |
| Maxillofacial Surgery (Paediatric and Adult Service) |
- Ian Sharp
With training in both dentistry and medicine, the maxillofacial surgeon has a highly specialised knowledge and surgical experience of the facialstructures and their function. This is brought to the cleft team through close working relationships with the orthodontists and the other surgeons, particularly in dealing with the jaw bone problems that can occur in cleft patients.
| Back to Top |
| Genetics (Paediatric and Adult Service) |
Consultant Clinical Geneticist:
- Jenny Morton
The Geneticist can discuss with you the possible reasons for cleft lip and/or palate occurring and the chances of it being an inherited condition within your family.
Cleft lip and or cleft palate usually occur as a 'one-off' within a family, and the chances of another baby also having a cleft are usually low.
There are a few families with a hereditary tendency to clefting. If patients would like to discuss in greater detail the possible reasons for cleft lip and/or palate occurring and the chances of it being an inherited condition within your family, please ask to see the Geneticist. Adolescents who have had a cleft may also ask to see the Geneticist to discuss their own future children's risk of having a cleft.
| Back to Top |
- Julie Reed
- Liz Shea
The psychologists can discuss any concerns you or your child may have about the impact of having a cleft lip and palate. If required they can also assist you and your child in making any decision about future treatment.
The psychologists will meet with patients and parents at some of the clinic visits. Their role is to help deal with the emotional side of growing up with a cleft. We often discuss shyness, low self-esteem, friendship difficulties and coping with teasing. We also assist young people and their families in decisions about surgery, changing schools and relationship difficulties. In addition to meeting the psychologists at clinic, parents and patients can contact them directly for advice or an appointment and other members of the Cleft Team may suggest a meeting with us.
Yvonne Searle (Adult Service)
A Clinical Psychologist routinely attends the cleft clinic. She can assist you in making any decision on future treatment if required, or if you have any general concerns about the impact that having a cleft lip and palate has had on your life.
| Back to Top |
Kerry Ali - Jackie Lee - Rona Slator
Tel:
0121 333 8132
Lynn Gough - Ian Sharp - Naresh Patel - Mark Hammond
Tel: 0121 333 8078
Keely Bennett - Bruce Richard
Tel:
0121 333 8755
Alexis Russell - Ken Pearman
Tel:
0121 333 8111
Naomi Parish - Michael Kuo
Tel:
0121 333 8113
Cleft Administrative Team
John Reading
Cleft Inforamtion Manager
Tel:
0121 333 8235
Joy Bond
Cleft Clinic Co-ordinator
Tel: 0121 333 8235
Elly Reeve
Cleft Lip & Palate Support Worker (SLT)
Tel:
0121 333 9382
Barbara Singh
Adult Cleft Secretary
Tel:
0121 627 5720
| Back to Top |
|
