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Cleft Lip and Palate Clinic: A multidisciplinary resource to smile about


Andrew Scott, MD, Co-Director of the Cleft Lip and Palate Clinic at Floating Hospital for Children, believes that taking a multidisciplinary approach to treating this complex condition is the most important thing that any institution can do.

“And that’s exactly what we do here,” says the fellowship-trained pediatric otolaryngologist and facial plastic surgeon who joined Floating’s Pediatric Otolaryngology/ Head and Neck Surgery service last October. “Children are seen by multiple providers including facial plastic surgery, ENT, oral surgery, pediatric dentistry, psychiatry, genetics, speech and language pathology, feeding therapy and audiology.”

“It’s a big team because this condition requires it,” he continues. “Cleft is a significant birth defect that, if untreated, leads to social stigma because the child looks so different. There are functional problems because teeth don’t come in right, which leads to problems with eating and speaking. When there’s a hole in the palate, air escapes through the nose, making speech hard to understand. Infants can’t create suction and eat properly.”

“And even though the vast majority of kids are completely normal neurologically, the lay person often assumes the child is cognitively limited,” he adds. “Fixing the problem allows these children to be shielded from some discriminatory societal and cultural behavior, and can often make the difference between a child being depressed and being able to reach his or her potential.”

Scott shares leadership of the clinic with Arnold Lee, MD, Division Chief for Facial Plastic Surgery at Floating Hospital for Children.

“We see 60 to 100 patients over the course of a year,” Scott says. “As a result, we can spend a lot of focused time with our patients. This not only enables us to give better care, but we also can have closer relationships with referring providers.”

Notably, the Floating Hospital for Children at Tufts Medical Center cleft team is one of the only programs in New England to offer neonatal mandibular distraction osteogenesis for children born with a cleft palate and a small jaw.

“This procedure is performed on select newborns who would otherwise come to require a tracheotomy or a feeding tube for breathing and eating problems related to these deformities,” Scott explains. “The surgery is performed shortly after birth, and allows the jaw to be brought forward a millimeter at a time over the course of the following two weeks. After the procedure, the jaw size is corrected and feeding and breathing are greatly improved; all of this is done before the baby even leaves the hospital.”

Floating Hospital’s affiliation with the Tufts School of Dental Medicine is also an important asset.

“Most of cleft care in early childhood and adolescence revolves around pediatric dentistry and oral surgery to deal with growing teeth and jaws,” Scott notes. “The dental school is a nationally renowned center for oral maxillofacial surgery in dentistry and an important part of our team.”

In fact, the dental school is one of the few facilities in the world to offer Nasal Alveolar Molding (NAM), a cutting-edge orthodontic device worn during early infancy to help reduce the width of cleft and mold the nose and overlying lip, making surgical repair easier and more successful.

“We also are available for prenatal and feeding consultations,” Scott says. “When cleft is identified on ultrasound, we’ll see expectant moms and get them educated and involved to prevent dehydration and starvation, since cleft babies often have a hard time feeding.”

Scott points out that his team is committed to taking care of older children, too.

“Adolescents and teenagers have unique problems and can be extremely self-conscious,” he says. “Dr. Lee is highly experienced in adult rhinoplasty and offers continuity from pediatric to adult care. That’s important because cleft lip and palate is something that’s with you for life.”

Scott’s dedication to pediatric patients is in his blood. His mother was a Boston pediatrician for 35 years, his uncle is a pediatric neurosurgeon and his brother is a pediatric allergist.

“I’ve always gravitated toward taking care of kids,” he says. “They’re so resilient, with an incredible capacity for healing from both an emotional and physical standpoint. It’s quite inspiring.”

“Most kids with cleft have 80 years ahead of them,” he adds. “It’s challenging and rewarding to see what we do stand the test of time.”

To refer a patient to the Cleft Lip and Palate Clinic at Floating Hospital for Children, please call 617-636-2820.