Team approach concept in management of oro-facial clefts: a survey of Nigerian practitioners

Abstract

Background: Cleft palate craniofacial teams have evolved across the globe in the last 20 years in compliance with the interdisciplinary concept of management of oro-facial clefts. An interdisciplinary care allows a coordinated treatment protocol for the patient. The objective of this study was to evaluate oro-facial cleft care in Nigeria with particular emphasis on the compliance of the practitioners to the team approach concept.

Methods: A snapshot survey was conducted among specialists that attended the Pan African Congress on Cleft Lip and Palate, at the International Institute of Tropical Agriculture, Nigeria in February 2007.

Result: Sixty three respondents successfully completed and returned the questionnaire for analysis. Mean age of respondents was 43.5 years and the range was 38-62 years.Male to female ratio was 2.7:1. Oral and Maxillofacial Surgeons and Plastic Surgeons constituted the majority of respondents (38.1% and 22.2%) respectively. Only 47.6% (n = 30) of the specialists belonged to cleft teams. Majority of Oral and Maxillofacial Surgeons and Plastic Surgeons belonged to cleft teams (70% and 63.3% respectively) while speech pathologists and orthodontists were less represented (20% and 36.7% respectively) in teams.

Conclusion: Findings from this study suggests that interdisciplinary care for the cleft patient does not appear to have been fully embraced in Nigeria. This may be a result of several reasons ranging from non availability of the requisite specialists, the relatively young age of cleft care practice in this part of the world to the poor state of infrastructure.

Figure 1

The figure described the representation of various cleft care professionals on cleft teams. Only 30 of the 63 participants belonged to cleft team [46.6%]. Of these, 70% had OMFS as team members while 63.3% of such had plastic surgeons as cleft team members. Others are distributed as follows: Orthodontics 36.7%, Otorhinolaryngology 26.7%, Anaesthesia 16.7%, speech pathologist 20%, paediatrics 40%, nutritionist 23.3% , paedodonticss 16.7%, paediatric surgery 10%. These percentages were represented alongside the frequency of each specialty among the participants. Thus OMFS has a frequency of 24, plastic surgery 14, orthodontics 8, otorhinolaryngology 5, anaesthesia 5, speech pathology 2, paediatrics 3, restorative dentistry 1 and general surgery 1. Nutritionists, paedodontics and paedtriatic surgery do not have representation among the respondents, although some respondents claimed that these specialties were members of their respective cleft teams.