Providing lifelong care and support…


The Spires Cleft Centre is pleased to offer services to teenagers and adults within our service coverage areas drawing from expertise across our specialities. Services available are outlined below by speciality:

Cleft Surgery
As part of the comprehensive service that the centre has developed over many years, we always welcome the opportunity to discuss the whole range of concerns which may develop in young teenagers or adults who happen to have a cleft lip and/or palate. We understand that from time to time, children who have been looked after in our service as well as in their families may develop new concerns as teenagers that they would appreciate discussing in a new light as life unfolds before them. Equally, we also know that many young adults, students and even those later in life may move into the area or develop new concerns which they would value a discussion regarding possible sources of help.

Although our holistic protocol for cleft care is not to focus predominately on surgical solutions to problems, there are often revisions or corrective procedures that can go along way to sort out specific concerns when managed in a timely and thought through fashion. These may include adjustments of the nasal profile, revision of lips which have scars or other functional problems. For speech surgical procedures, closure or refashioning of abnormal openings or defects, and adjustments to the whole facial profile. Whilst the former problems tend to be managed by the Primary Surgeon, the adjustments to facial profile are a more complex correction which form the craft of orthognathic surgery. We have highly specialised orthognathic surgical expertise within our team and this involves detailed preliminary consultation and planning in conjunction with the Orthodontic Consultant and restorative dental experts.

It is not infrequent for those seeking corrections and/or solutions to problems at this stage to want to have a more private or personal consultation with a surgeon. If that is your wish we can easily accommodate this and make specific arrangements within the individual surgeons clinics. However, for new concerns and such like we do encourage a broader view to be taken and would always welcome consultations in the multi-disciplinary clinic which we offer on a regular basis.

The number of revision procedures which are possible is so great and so variable depending on the needs of the patient that it would be impossible to describe them all adequately in a section such as this. We would therefore encourage consultations when and where necessary and believe it one of the strengths of our unit is that we have a fully integrated children's and adult's service on the same site which can offer a "seamless service" between the various other disciplines and age groups.

Maxillofacial Surgery
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The Clinical Psychology Service sees adults of all ages, both those who have had ongoing treatment with the Spires since childhood and adults wishing to return to consider their cleft care at a later stage.

The key to successful treatment is mutually agreed goals and expectations between patients and all the clinicians involved in their care. One of our roles as psychologists is to support patients through the decision-making process about possible treatment, ensuring that they are able to collect all the information they need in a way that’s understandable, in order to make the best possible decision. Deciding whether to proceed with treatment can sometimes be a difficult choice and we offer a neutral, impartial space to help patients reflect on the information and think through the pros and cons of different options. This can also be useful if there are particular fears or worries that are getting in the way of pursing treatment, for example a fear of needles or operations.

We also offer the opportunity to work through psychological concerns at any stage, whether patients are having active cleft treatment or not. For some patients there may be worries or concerns relating to experiences in the past which can cause anxieties about social situations, low self esteem or low self confidence. For other patients returning to treatment can trigger particular memories of previous treatment in the past (when psychological aspects of care were not well looked after). Finally, despite the immense skill of our surgical and dental colleagues, it is not always possible to achieve everything on a patient’s wish list and we work hard to support these patients to minimise the impact and distress of outstanding concerns on their day to day life.

Clinical Psychologists are part of the multi-disciplinary clinic consultation and also offer separate outpatient appointments to discuss specific issues in more detail. The psychology team can be contacted via the website or through other members of the cleft team.

The Orthodontist is able to provide advice and treatment for patients who wish to improve the form and function of their dentition. I often work in collaboration with other team members especially when missing teeth need replacing or when jaw surgery is required.

Restorative Dentistry
Patients with a cleft lip and/or palate often have complex dental needs. As these patients have so many hospital visits throughout their lives, dental health is often neglected. Patients often present when there is a crisis such as pain or multiple missing teeth. Patients are often phobic and general dentists are often uncomfortable to treat this patient group. The Restorative Consultant works very closely with the Psychologists on the team to overcome phobias and establish a realistic, achievable outcome for these patients.

Speech and Language Therapy
If you have concerns about your speech.....

The Spires speech and language therapy service is open to adults of all ages. This includes those who have had ongoing treatment with the Spires centre since childhood as well as people wishing to return to consider their cleft care at a later stage in life. We work as part of the multidisciplinary team alongside surgical, orthodontic, restorative dentistry and psychology colleagues.

The service is able to provide specialist assessment and treatment of speech difficulties related to cleft lip and palate and palate dysfunction. You may or may not have seen a speech therapist in the past but if there are any aspects of your speech that you would like to discuss, you can do so.

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You are welcome to contact us here if you would like further information on any aspect of the care available.