Otolaryngology-Head and Neck Surgery


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Written by Staff

Cleft and Craniofacial Center

Orofacial clefting and congenital craniofacial anomalies are unique and challenging to treat; requiring a specialized multidisciplinary team of providers that includes otolaryngologists. Some of the more common conditions include cleft lip and palate (1:700-1000) and craniosynostosis (1:2000). At the Children’s Hospital of Georgia (CHOG) at Augusta University, the cleft and craniofacial team have made significant strides in recent months. We take this opportunity to review our team approach and discuss the value of multidisciplinary care.

The American Cleft Palate and Craniofacial Association (ACPA) is a 501c3 non-profit organization whose mission is to help create “a world where people with cleft and craniofacial conditions thrive.” The team at CHOG takes this mission to heart sincerely. The CHOG team is one of just two ACPA approved cleft and craniofacial teams in the state of Georgia. To maintain ACPA certification, a team must demonstrate a devotion to multidisciplinary team care, by meeting strict guidelines regarding team composition, team management and responsibilities, patient and family communication, cultural competence, and psychological/social services1. Notably, the CHOG team was recently granted ACPA recertification for another five years, which is a testament to the hard work and devotion of all the team members.

The team at CHOG is equipped with providers from plastic surgery, speech language pathology, otolaryngology, orthodontics, audiology, oral and maxillofacial surgery, social work, and psychology. The glue that holds the team together is the hard work of our team coordinators who work tirelessly behind the scenes to ensure the logistics, maintain communication and keep families informed. Krystal Oestreich is a pediatric otolaryngology nurse practitioner who serves as a joint team coordinator with Elise Hulsebus, a physician assistant with plastic surgery. Together, our two team coordinators keep the ship righted and are an essential part of the team’s organization and delivery of care. Multidisciplinary team care has been shown to be a vital part of the care of orofacial clefts and craniofacial conditions2,3, and the team coordinator’s important role cannot be overstated.

Members of the CHOG cleft and craniofacial team at the ACPA annual meeting in Tucson, Arizona in April 2019. (From left to right: Dr. William Carroll, Dr. Maria Lima, Dr. Amara Abreu, Dr. Daniel Levy-Bercowski, Dr. Jack Yu)

Each monthly team clinic concludes with a lengthy discussion between all specialists regarding the plan of care for each patient. It is here where the “magic happens” and the importance of each specialists perspective is evident. At CHOG, the pediatric otolaryngology division brings a unique perspective to the team. Dr. William Carroll, who started at CHOG in August of 2018, completed a one year pediatric ENT and facial plastic surgery fellowship in Minneapolis, Minnesota. The fellowship was created by the late Jim Sidman with an emphasis specifically in cleft and craniofacial surgery. Krystal Oestreich is a pediatric otolaryngology nurse practitioner whose oldest child was born with a bilateral cleft lip. In addition to her role as a nurse practitioner on the team, she is a joint team coordinator and moreover, brings the invaluable “mother perspective” to many of our patient discussions.

We also take this opportunity to applaud our team leader and director, Dr. Jack Yu with plastic surgery who has worked tirelessly for decades to help treat children in the region with cleft and craniofacial conditions. His expertise and experience have helped put a smile on innumerable children’s faces at CHOG. The interface between general plastic surgery and otolaryngology has strengthened substantially, creating a dynamic academic environment where the team and patient care can flourish. The cleft and craniofacial team at CHOG believes that the team “as a whole is greater than the sum of its parts,” and we strive to put that into action daily.


1. https://acpa-cpf.org/wp-content/uploads/2019/04/Standards-2019-Update.pdf
2. Capone RB, Sykes JM. The cleft and craniofacial team: the whole is greater than the sum of its parts. Facial Plast Surg. 2007 May;23(2):83-6.
3. Chen YR, Chen SH, Wang CY, Noordhoff MS. Combined cleft and craniofacial team – multidisciplinary approach to cleft management. Ann Acad Med Singapore. 1988 Jul;17(3):339-42.