The Craniofacial unit at Great Ormond Street Hospital is one of four supraregionally funded craniofacial units in the United Kingdom (UK).
While many craniofacial conditions are rare, relatively large numbers of children with craniofacial disorders are seen across the four UK units.
Children are usually referred in infancy and remain under the care of the units until maturity.
Multidisciplinary assessment and management is essential to meet the complex surgical, medical and developmental requirements of this population.
Disciplines involved include neurosurgery, plastic surgery, audiology, opthalmology, ear, nose and throat (ENT), orthodontics, speech and language therapy, psychology, genetics and social work.
Treatment and management of this population within the supraregional units allows for the development of clinical expertise in children with craniofacial conditions, as well as providing unique opportunities to carry out research and clinical audit, which contributes further to the body of knowledge related to this population.
There is a high incidence of communication difficulties in children in this population. Some profiles of speech and language development are unique to particular craniofacial conditions.
Speech and language problems occur secondary to deviant oral structures, hearing impairment and cognitive impairment.
The psychosocial impact of a craniofacial dysmorphology may also result in impaired social interaction, which can have a significant impact on speech and language acquisition.
Additionally, many children have oro-motor and feeding problems.
Currently, only supraregional craniofacial units in the UK have speech and language therapists (SLTs) with this dedicated caseload.
All new craniofacial cases are seen for speech, language and feeding (when indicated) assessments as part of the initial multidisciplinary craniofacial team assessment.
Thereafter, frequency of follow-up depends on the nature of the primary craniofacial condition and the presenting communication and feeding difficulties.
Providing parents/carers and other professionals with information and advice to facilitate speech, language, oro-motor and feeding skills within this population is an essential component of the service.
Timely information and advice given to craniofacial cases known to be at risk for communication and feeding difficulties, may prevent difficulties from occurring or becoming exacerbated.
Liaison with other specialities within the craniofacial unit, other specialties within the hospital and external agencies including local SLTs, GPs, paediatricians, other medical personnel, schools (teachers, SENCOS, assistants) educational and clinical psychologists, portage workers and teachers for hearing impaired children, is also fundamental to the service.