Discussion: Travel Burden to American Cleft Palate and Craniofacial Association-Approved Cleft and Craniofacial Teams: A Geospatial Analysis.

Despite the existence of cleft and craniofacial teams approved by the American Cleft Palate and Craniofacial Association (ACPA), access to multidisciplinary team-based care remains challenging for patients from rural areas, leading to disparities in care. The authors investigated the geospatial relationship between US counties and ACPA-approved centers. The geographic location of all ACPA-approved cleft and craniofacial centers in the United States was identified. Distance between individual US counties ( n = 3142) and their closest ACPA-approved team was determined. Counties were mapped based on distance to nearest cleft or craniofacial team. Distance calculations were combined with US Census data to model the number of children served by each team and economic characteristics of families served. These relationships were analyzed using independent t tests and analysis of variance. Over 40% of US counties did not have access to an ACPA-approved craniofacial team within a 100-mile radius ( n = 1267) versus 29% for cleft teams ( n = 909). Over 90% of counties greater than 100 miles from a craniofacial team had a population less than 7500 ( n = 1150). Of the counties more than 100 miles from a cleft team, 64% had a child poverty rate greater than the national average ( n = 579). Counties with the highest birth rate and more than 100 miles to travel to an ACPA team are in the Mountain West. Given the time-sensitive nature of operative intervention and access to multidisciplinary care, the lack of equitable distribution in certified cleft and craniofacial teams is concerning. Centers may better serve families from distant areas by establishing satellite clinics, conducting telehealth visits, and training local primary care providers in referral practices.

This study is the first comprehensive national survey of the organization, function, and composition of cleft palate and craniofacial teams in the U.S. and Canada. Complete descriptions of cleft and craniofacial teams are not currently provided in the literature, and this study will provide an overview for health services research and policy use. Conducted by a national organization, this study examines teams in detail using a pretested and standardized methodology. All known (n = 296) North American cleft palate and craniofacial teams were contacted for team listing purposes using a self-assessment method developed by an interdisciplinary committee of national stature. Team clinical leaders classified their teams into several possible categories and provided data on team care. The response rate was 83.4% (n = 247). The distribution of listed teams was: 105 (42.5%) cleft palate teams, 102 (41.3%) craniofacial teams (including craniofacial teams that are both cleft palate and craniofacial teams), 12 (4.9%) geographically listed teams, and 28 (11.3%) other teams (including interim cleft palate teams, low-density cleft palate teams, and evaluation and treatment review cleft palate teams). Eighty-five percent of all teams systematically collected and stored clinical data on their team's patient population in the past year. Furthermore, 50% of all teams had a quality assurance program in place to measure treatment outcomes. Other findings presented include the annual number of face-to-face team meetings; new and follow-up patient censuses; and surgical rates for initial repair of cleft lip/palate, orthognathic/osteotomy procedures, and intracranial/craniofacial procedures. Two of five North American teams classify themselves as having the capacity to provide both cleft palate and craniofacial care. An additional two of five teams limit their primary role to cleft palate care. Issues are raised regarding the distribution of teams, the regionalization of craniofacial services, health policy, and resource allocation.

The role of the orthodontist on a cleft palate team was defined when the cleft palate team approach was recognized as the most appropriate method to manage the care of patients with facial clefts. In the past, individuals with clefts and craniofacial anomalies underwent a succession of evaluations and hospitalizations by their independent caregivers. This individualized delivery of care was considered in the best interest of the patients in spite of additional hospital admissions and general anesthetics. However, this led to the fragmentation of care and higher costs and risks. A team approach for providing care has been developed and is the contemporary standard endorsed by the American Cleft Palate Association, which was established in 1943. In 1972, craniofacial teams became established as an extension to the cleft palate team, and the organization was renamed the American Cleft Palate-Craniofacial Association. This was a natural development to the cleft palate team as clinical geneticists and dysmorphologists became increasingly aware that facial clefts were part of a phenotypic spectrum of craniofacial anomalies (Shprintzen et al., 1985). The team approach to comprehensive care requires the orthodontist to work in a collaborative way to determine the timing and sequencing of treatment interventions. This patient-centered care by an interactive and evidence-based team of caregivers provides the basis for a rational approach to diagnosis and treatment planning and delivery. Because there are multiple methods and alternative treatment interventions available, the team approach to management requires that patients and their parents be aware of the choices with a risk/cost/benefit appraisal so that they can make an informed decision, understanding the consequences of the different options available, especially in light of emerging technologies and treatment modalities for which long-term outcomes are not available.

To characterize the presurgical infant orthopedics (PSIO) and gingivoperiosteoplasty (GPP) protocols across the American Cleft Palate-Craniofacial Association (ACPA) approved and international cleft palate (CP) and craniofacial teams. Cross-sectional survey. ACPA approved and international CP and craniofacial teams. Respondents from 115 out of 215 ACPA approved and international CP and craniofacial teams permitted to contact (out of a total of 259 total teams) completed the survey (response rate = 53.5%). There were 89 (77.4%) ACPA approved teams and the remaining international teams were mainly located in Europe (13.0%). Seventy-eight CP and craniofacial teams (67.8%) provided PSIO and 65 (83.3%) of these teams used alveolar molding (AM). Twenty-two CP and craniofacial teams (19.1%) provided GPP. A mean of 9.5 ± 2.6 different specialists were on the cleft team with the most common being orthodontists (97.4%), speech therapists (96.5%), and plastic/craniofacial surgeons (90.4%). Most ACPA approved and ACPA registered international CP and craniofacial teams provided PSIO techniques by orthodontists using lip taping (LT) and AM, while few provide GPP.

Cleft-orthognathic surgery

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

Comprehensive cleft care is an important component when caring for a child with cleft palate with or without cleft lip (CP ± L). Speech-language pathologists (SLPs) serve different capacities on comprehensive cleft palate and craniofacial teams. This tutorial highlights the role of the SLP on the cleft palate and craniofacial team from the prenatal consultation to adulthood. This tutorial emphasizes the importance of collaboration between the cleft team SLP and other professionals on a comprehensive cleft team. Additionally, the tutorial provides education for feeding infants with CP ± L and focuses on assessment and treatment of children with CP ± L before and after the palate repair. Finally, this tutorial underscores the importance of working as part of and collaborating with interdisciplinary team members. SLPs are an essential member of comprehensive cleft teams in addition to other medical providers. SLPs play a critical role on these multidisciplinary teams and are fundamental to the assessment and treatment of feeding, speech, language, and resonance disorders in children with CP ± L. It is critical that SLPs are involved in comprehensive cleft team care from the prenatal consultation through adulthood to monitor resonance, speech, and language development and outcomes.

Aims: The aim of this study was to describe the epidemiological characteristics of patients with orofacial clefts attended at the Craniofacial and Cleft Surgery Unit of the University Hospital of Maracaibo. Settings and Design: This was a retrospective, epidemiological, cross-sectional study. Subjects and Methods: The sample was constituted by clinical histories of patients with orofacial clefts attended in the Craniofacial Surgery and Clefts Unit of the University Hospital of Maracaibo from September 2015 to March 2018. Demographic data of the patient, family history, anatomical structures involved in the cleft and syndromic association. were collected, and analyzed in accordance with the type of research and the objectives set, a descriptive analysis of each variable was performed, represented by absolute and relative frequency. Results: There were 137 patients with cleft lip and/or palate in the unit, with an average age of 5.3 ± 9.8 years, evidencing an almost equitable distribution in relation to gender. Of the facial clefts, the most common was cleft palate (CP), followed by cleft lip and palate. A low incidence of the presence of craniofacial anomalies was observed in the family history and the syndromic association. Conclusions: It was observed that the prevalence of cleft lip and CP has increased in recent years; these epidemiological figures vary by region, age, and gender. However, a greater knowledge on the part of health professionals is necessary to understand the clinical and epidemiological aspects of orofacial cleft and is crucial to improve the understanding of pathogenesis, promote preventive strategies, and guide multidisciplinary clinical care.

The need to establish an on-line cleft palate teaching program for orthodontic residents and practicing orthodontists

The objective of this study is to evaluate online educational resources on cleft lip and palate teams. A Cross-Sectional Study. An International, Multi-Institutional Study. All American Cleft Palate and Craniofacial Association-approved teams with websites. None. Websites were assessed for patient education and support content. Affiliation between presence of materials and U.S. Newsweek Top 100 Hospitals was also assessed. 187 teams were included. Presence of educational videos were available in 29.4% of websites, educational infographics in 18.2%, written materials in 66.8%, perioperative instructions in 19.3%, diagnosis information in 34.8% and treatment information in 63.1%. Information on team members were available on 77.0% of websites, resources in languages other than English in 38.5%, and support group resources in 25.7%. Cleft lip and palate diagnosis information was significantly associated with geographic region, with the largest impact from the West region (P = .03). There was a significant difference between teams affiliated with U.S. Newsweek Top 100 hospitals: Top 100 hospitals had a higher presence of educational infographics, perioperative instructions, definitions, diagnosis, and treatment (P < .01). There was no significant difference between presence of educational videos (P = .37). While many websites had basic educational materials, very few included detailed information on peri-operative planning, as well as additional forms of information including videos, infographics, and non-English languages. Providing comprehensive patient education materials online is an important supplement for patients with cleft lip and palate and should be prioritized by cleft teams.

Part 1 The human evolution and definition of growth, development and anomalies: history of craniofacial surgery evolutionary biology and the study of craniofacial growth, development and dysmorphology recent evolution of craniofacial structure classification of craniofacial anomalies. Part 2 Initial analysis and concerns: radiological analysis and visualization of craniofacial anomalies genetics and craniofacial syndromes patient-parent-surgeon issues concerning craniofacial surgery a philiosophical approach to craniofacial surgery. Part 3 Procedures and management: anaesthetic management in craniofacial surgery surgical techniques for the correction of craniosynostosis and neurocranial asymmetry reconstructive problems in cleft lip and palate and craniofacial malformations hypertelorism correction oculoplastic surgery in craniofacial surgery analysis and principles of surgery for Treacher Collins syndrome analysis and reconstruction of hemifacial microsomia orthognathic considerations of maxillary and mandibular surgery vascular malformations of the head and neck craniofacial trauma and its management management of craniofacial and cranial base tumors microvascular surgical applications to the craniofacial area applications of craniofacial techniques to aesthetic surgery post-operative management following major craniofacial surgery management of complications of craniofacial surgery. Part 4 New techniques and procedures: applications of autogeneous bone grafting for craniofacial problems the use of alloplastic materials for craniofacial anomalies the use of tissue expansion in craniofacial surgery unusual problems and situations new horizons in craniofacial surgery.

A cleft team experience addressing non-syndromic cleft palate and cleft lip and palate is presented. The purpose of the present study is to compare surgical outcomes using 2 different protocols for cleft palate repair provided by a cleft team in Lima, Perú. This is a comparative study between 2 groups of patients with non-syndromic cleft palate who were operated using different surgical protocols from 1999 to 2014. One hundred twenty-four children with non-syndromic isolated cleft palate and cleft lip and palate treated from 2007 to 2014 using a surgical protocol developed by our cleft team in Lima, Perú were compared with 145 children with cleft palate and cleft lip and palate treated by the same team using different protocol from 1999 to 2007. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency (VPI) and postoperative complications. Statistical significant differences were observed between the 2 groups regarding the development of flap necrosis in favor of the Lima protocol. No significant difference in palatal fistula and VPI rate between the 2 protocols was found. The Lima Surgical Protocol for cleft palate repair is an alternative strategy which uses the strengths of different surgical techniques based on the severity of the cleft. We observed better surgical outcomes using the Lima protocol with regards to postoperative complications in patients with non-syndromic cleft palate.

Development of the Palate. Moore K, Persaud T. In: The Developing Human. 5th ed. Philadelphia, Pa: WB Saunders Co; 1993The Oral Cavity: Cleft Lip and Palate. Tinanoff N. In: Behrman R, Kliegman R, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:1532The Multidisciplinary Evaluation and Management of Cleft Lip and Palate. Robin N, Baty H, Franklin J, et al. South Med J. 2006;99:1111–1120Craniofacial, Cleft Palate. Witt PF. eMedicine Specialties, Plastic Surgery, Craniofacial. 2006. Available at: http://www.emedicine.com/plastic/TOPIC519.HTMCleft Lip/Cleft Palate. Healthinfo. Children's Hospital, St. Louis. 2007. Available at: http://www.stlouischildrens.org/tabid/88/itemid/2526/Cleft-Lip–Cleft-Palate.aspxCleft Palate Foundation Website. Available at: http://www.cleftline.org/Feeding Your Baby With a Cleft Palate Video. Moses M, Alexander ME. New Orleans, La: Cleft & Craniofacial Team of New Orleans. Available at: http://www.neworleanscleftteam.org/videos.htmlCleft palate (CP) is a relatively common birth defect throughout the world. However, it is important to distinguish between cleft palate alone (CPA) and cleft lip with or without cleft palate (CLP), two distinct birth defects that have different causes, incidences, and sex and racial predilections. For example, in the Caucasian population, the incidence of CLP is about 1 in 750 births and that of CPA is about 1 in 2,500. CLP is more common in males; CPA is more common in females. The distribution of CPA varies slightly in different ethnic groups, but is significantly different for CLP, which is most common in Native Americans (1 in 230 to 1,000) and Asians (1 in 400 to 850) and least common in African Americans (1 in 1,300 to 5,000).The incidence of concurrent genetic disorders is increased for children who have CLP and even higher in those born having CPA. More than 200 genetic syndromes have CLP as a feature; a larger number of syndromes feature CPA. Any newborn who has CLP or CPA should be evaluated by a geneticist for the presence of additional congenital anomalies; complete pregnancy, birth, and family histories should be obtained; and a physical examination should be performed. Identifying whether a cleft is isolated or part of a syndrome is essential in guiding the evaluation for additional associated anomalies, providing anticipatory guidance for the family, and performing genetic counseling. The recurrence risk for the family of a child who has isolated CLP is about 4% and for the family of a child who has isolated CPA is about 2%. These numbers are increased if more than one child is born with a clefting defect, if a parent also is affected, and as the severity of the clefting defect increases. If the CLP or CPA is part of a genetic syndrome, the recurrence risk depends on the inheritance pattern of the syndrome.Clefting defects occur early in embryologic life, generally between the 6th and 9th weeks of gestation. The primary palate begins to form at about 35 days, complete lip development occurs by the 6th week, and palatal fusion follows. Cleft lip occurs when there is interruption or hypoplasia of the mesenchymal layer, which causes a failure of fusion of the medial nasal process, maxillary process, and lateral nasal process. Clefts of the lip can be unilateral or bilateral and can vary from a small notch in the border of the lip to complete separation at the philtral column and extension to the border of the nose.Cleft palate occurs when the palatal shelves fail to fuse. Clefts of the palate also can be unilateral or bilateral and can vary in severity from a submucous cleft to clefts involving both the primary (anterior to the incisive fossa) and secondary (posterior to the incisive fossa) palates. Although clefting defects generally are multifactorial traits caused by an interplay between genetic and environmental factors, some clefts result from mutations in single genes (TBX22, IRF6, MSX1), some are part of chromosomal aneuploidy or deletion syndromes (trisomy 13, velocardiofacial syndrome), and others result from teratogens (anticonvulsants).An important type of clefting defect to recognize in the neonatal period is Pierre Robin sequence (PRS), which includes micrognathia (small mandible), a retropositioned tongue, and a U-shaped cleft palate. The initial embryologic event is believed to be failure of the mandible to grow properly, leading to positioning of the tongue in the back of the pharynx, which blocks the ability of the palatal shelves to fuse properly. Affected children often experience severe respiratory distress, leading to a mortality rate as high as 30% and requiring interventions ranging from prone positioning to allow the tongue to fall forward out of the airway to intubation and tracheostomy. Children who have PRS require careful monitoring, particularly in the first 1 to 4 weeks after birth. Over time, the lower jaw generally “catches up” in growth, but sometimes surgical intervention is required for jaw expansion. PRS generally occurs as an isolated birth defect, but may be part of syndromes such as trisomy 18 or Stickler syndrome.Regardless of the cause, the child who has a cleft and his or her family face many challenges. Initially, difficulty in feeding and growth may be encountered, followed by recurrent ear infections and sometimes hearing loss, dysfunctional speech and communication, and social struggles because of the child's appearance, not to mention the physical and emotional strain encountered because of the medical and surgical interventions needed to treat these birth defects.Because of the complexity of the sequelae of CP, comprehensive multidisciplinary care for affected children is necessary and generally should be provided by a CP team, consisting of a pediatric geneticist, plastic surgeon, otolaryngologist, dentist, oromaxillofacial surgeon, orthodontist, prosthodontist, audiologist, speech and language pathologist, and social worker. It is vital for this team to work together to balance the many factors important in managing the care of a child who has a cleft.An important initial concern to parents of a newborn who has a cleft is how to feed their baby. Although many new parents find feeding their babies challenging, feeding can be particularly difficult for the baby who has a cleft. Parents have the added concern that the baby must gain weight before the cleft can be repaired.Several techniques can help in feeding a baby who has a cleft. Babies who have a cleft lip but an intact palate generally are able to breast- or bottle-feed. There may be some difficulty in creating a seal from the lip around the breast or bottle, but holding the baby in an upright “football” position or adjusting the breast to help tuck the cleft into the breast tissue usually can help the baby feed successfully.Infants who have a CP have a connection between the mouth and the nose and, therefore, have difficulty creating sufficient suction in the mouth to complete a feeding without tiring. Often they are unable to obtain enough nutrition by breastfeeding alone. Mothers should be encouraged to try breastfeeding, but if weight gain is poor, supplementation with a bottle, ideally using pumped human milk, will be needed. However, bottle-feeding also may present a challenge. Infants who have CP often need small, frequent feedings, particularly in the beginning. Babies should be positioned relatively upright, so a limited amount of milk escapes through the nose, although this occurrence generally is not harmful to the baby.Because babies who have CP often swallow more air than do other babies, they should be burped two to three times during a feeding, with the bottle positioned as upright as possible to avoid air in the nipple, or fed with an angled bottle. However, parents should be cautioned not to stop for too long in the middle of the feeding to burp the baby or the infant may lose interest in completing the feeding.Several special types of nipples and feeders can help babies who have CP. Using a cross-cut nipple and cutting the cross-cut hole at the tip of the nipple larger with a scalpel or small scissor allows the baby to get more milk without having to increase suction. Feedings generally should be limited to about 30 minutes, and if the baby takes longer to feed, the size of the hole should be increased to allow greater milk flow. The hole can be enlarged slightly after each feeding until the baby coughs or chokes during the feeding, indicating that the hole is too large. The parent should dispose of this nipple and use a new one, cross-cutting the hole to the largest size that did not cause coughing.Many parents find it helpful to use soft, squeezable bottles, which allow them to provide the force for giving a mouthful of milk to the baby, rather than having the baby suck to provide the force. Several companies make feeders specifically for infants who have CP, using specially cut nipples and compressible bottles. Pediatricians should consult the CP team for recommendations of specific types and brands of nipples and bottles suited best to the needs of a particular patient.A cleft lip generally is repaired surgically between the ages of 10 and 12 weeks, according to the “rule of tens”–10 pounds, 10 weeks old, and hemoglobin of 10.0 g/dL (100.0 g/L). A cleft palate usually is repaired between 6 and 12 months of age. Such early repair provides the benefit of better speech outcome, but poses the risk of impairing maxillary growth. Several techniques are used in CP repair, depending on the characteristics of the cleft and experience of the surgeon, with the Furlow double-opposing Z-plasty being the most common. As they get older, children may need revisions of a cleft lip or palate repair, along with alveolar grafting or rhinoplasty to repair a nasal deformity associated with the cleft lip.Most children who have CP experience problems with middle ear disease. Probably because of anomalies of the insertion of the tensor and levator veli palatini muscles into the eustachian tube, affected children are unable to open and ventilate the middle ear adequately. If left untreated, chronic serous otitis media can lead to hearing impairment, which might impair speech and learning, so myringotomy tubes often are inserted at the time of palatoplasty. Children who have CP must have frequent hearing evaluations throughout childhood.After CP repair, about 10% to 20% of patients experience velopharyngeal insufficiency, a phenomenon in which the soft palate cannot form a tight closure with the pharynx, causing air to escape through the nose rather than being directed through the mouth during speech. This effect manifests as audible nasal air escape and as hypernasal resonance during speech, particularly when making the s, z, sh, f, p, and b sounds. Affected children may develop maladaptive compensatory articulation errors for these sounds, making their speech more difficult to understand. Children who have CP also may have speech problems caused by dental malocclusion from the cleft or from fistula formation after surgery. Fistulas can develop between the oral and nasal cavities, leading to air escape during speech and to regurgitation of food or liquids through the nose. Surgical correction of velopharyngeal insufficiency, fistula, or other structural anomalies generally is necessary before speech therapy, an integral part of treatment for the child who has CP, can be successful.Many patients have an osseous defect of the maxillary alveolar bone, requiring a bone graft, which generally is performed between 6 and 8 years of age. About 25% of children who have CLP have residual jaw deformities after their cleft repairs and may need a maxillary advancement (LeFort I procedure), orthodontic treatment, or palatal expanders. Children who have CLP may be missing their lateral incisors in the area of the alveolar cleft and often have poorly formed teeth or teeth that lack enamel. Good dental hygiene is important from the time the first tooth erupts because healthy teeth stimulate and retain alveolar bone, which is important for lip support and function.Clefting deformities are relatively common birth defects and have a multifactorial inheritance pattern. Children who have clefts and their families can anticipate difficulties with feeding, speech and hearing, dentition, and cosmesis. With care from a multidisciplinary CP team, however, they can receive appropriate help and compassion to get through the challenging early years.Comment: Centers that provide coordinated team care for children who have clefting and other craniofacial deformities are ideal for meeting the multitude of issues confronting the affected child and family. Not all of us have ready access to such centers for our patients, and our responsibility becomes appreciating the following issues: feeding, hearing and speech, dental and orthodontal problems, the need for genetic counseling, and emotional needs. We must do our best to provide, beyond surgical repair, the full spectrum of services needed.

To establish preliminary data describing the number of patients who visit a multidisciplinary cleft and craniofacial team who use augmentative and alternative communication (AAC) supports. This retrospective study consisted of chart reviews for all patients who visited a single site's multidisciplinary cleft and craniofacial team for 1 calendar year. A single multidisciplinary craniofacial team at a tertiary teaching hospital. Four hundred sixty-four patients met the inclusion criteria for this study. Of these, 59.9% (n = 278) were male and 40.1% (n = 186) were female. Of the sample population, 6.9% (n = 32) were AAC users as they received AAC intervention in a therapeutic context, while 93.1% (n = 432) were not. The AAC group had a mean age of 5.1 years (standard deviation [SD]: 4.2) and was 68.8% (n = 22) male. The non-AAC group had a mean age of 6.3 (SD: 4.9) and was 59.3% (n = 256) male. Within the AAC group, 40.6% (n = 13) were found to have an identified syndromic diagnosis in comparison to 17.6% (n = 76) of the non-AAC group (P = .003). This is the first study to report the prevalence of AAC use among patients in the care of multidisciplinary cleft and craniofacial teams. Our findings suggest that a subset of craniofacial team patients may have complex communication disorders that require AAC supports. Craniofacial teams should be aware of resources available for these patients so that the patients' communication needs are met in the hospital, in school, and in the community.

Background:Craniofacial Trauma and Anomalies affect a substantial proportion of the global society, especially those in the low-and middle-income countries (LMICs). The literature stresses the concept of a team approach for craniofacial surgery and the need for the interaction of many specialists to provide optimal care for the patient. Craniofacial surgery is practiced mainly in the advanced countries of Europe and America. This report describes the establishment of craniofacial care in an African country. It reports on 6-year early outcomes of craniofacial surgery in a low-resourced country, counting the successes, challenges, and prospects. Methods: The establishment of an international collaboration that facilitated the training in craniofacial surgery is described. A 6-year retrospective review of craniofacial surgery cases managed by the Multidisciplinary Cleft and Craniofacial team at the Komfo Anokye Teaching Hospital (KATH) was done from January 2016 to December 2022. Results: Two Ghanaian surgeons were trained in Alabama, USA (a maxillofacial surgeon and a neurosurgeon), then returned to Kumasi to begin a Craniofacial practice with the help of the craniofacial team in Children of Alabama Birmingham Al, USA. A total of 646 procedures were performed (616 cases of orofacial cleft, 20 cases of craniofacial anomalies, and 10 cases of craniofacial trauma involving the cranial vault or base of the skull). Ninety percent of the cases were cleft lip and palate, with the remainder being a mixture of isolated and syndromic craniosynostosis, craniofacial trauma, encephalocele, and craniofacial fibrous dysplasia. Conclusion: The Commonest craniofacial procedure performed was cleft lip and palate repair. Other surgeries were for the repair of velopharyngeal incompetence (VPI) and atypical facial clefts. Complex craniosynostosis and encephaloceles are also now being repaired at KATH. The foundation for a sub-regional center of excellence in cleft and craniofacial surgery is being laid in Ghana at KATH.