Closing the Loop on Centralization of Cleft Care in the United Kingdom.

OBJECTIVE

We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes.

SETTING

Audit clinics held in Cleft Centers in the United Kingdom.

PATIENTS,

PARTICIPANTS

Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate.

INTERVENTIONS: Centralization of cleft care.

MAIN OUTCOME MEASURE(S): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey.

RESULTS

We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged.

CONCLUSIONS

Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.