Developing a Cleft Team Coordination Protocol for Multidisciplinary Management in South East Nigeria

Effective cleft lip and palate management requires coordinated care from multiple specialties, and formalising this coordination through a structured protocol improves outcomes in the South East Nigerian cleft treatment landscape. This study developed a cleft team coordination protocol for multidisciplinary management of cleft lip and palate at the University of Nigeria Teaching Hospital and Enugu State University of Science and Technology Teaching Hospital, Enugu State. A professional protocol development methodology was applied, drawing on audit of current cleft management pathways at both institutions, structured consultations with 15 members of the existing cleft teams (maxillofacial surgeons, orthodontists, speech-language therapists, paediatricians, nurses, and social workers), and benchmarking against Eurocleft best practice guidelines and WHO cleft palate team standards. Audit revealed that inter-specialty communication was informal in 68.4 percent of reviewed cases, that orthodontic referral before palate surgery was achieved in only 34.7 percent, and that speech therapy was initiated post-surgically in fewer than 25 percent. The protocol developed specifies a 12-stage cleft team pathway from prenatal counselling through final orthodontic review, with responsible specialty, timing criteria, documentation requirements, and parent counselling checkpoints at each stage. A multidisciplinary case conference schedule is specified. Expert review by ten cleft specialists confirmed the protocol's alignment with international standards. The study recommends formal adoption by both hospital cleft teams, annual cleft team audit using the protocol, and national replication of the model at other Nigerian teaching hospitals.

Keywords: cleft team coordination, multidisciplinary care, cleft lip and palate, South East Nigeria, cleft protocol