The history of cleft services in New Zealand

Background: Approximately 100 children are currently born in New Zealand (NZ) each year with an orofacial cleft (OFC). OFC are a heterogeneous group of embryologic developmental structural defects of the facial processes which can occur as either unilateral or bilateral and involve combinations of the lip, alveolus, hard or soft palate. Children born with an OFC often experience complications with feeding, hearing, appearance, dental anomalies, malocclusions, speech and at times, psychological issues. Many require numerous surgical and non-surgical treatments from infancy to adulthood. This treatment can be complex and in NZ this is provided by various health professionals working in five interdisciplinary cleft services, although the locations and structure of these cleft teams have evolved and changed over time.
Objectives: This article examines the history of cleft services in NZ, the role of the multidisciplinary team (MDT) which contribute to current cleft care and provide some insight into the current pathway of treatment and the dispersed nature of its delivery.
Conclusions: Present-day cleft surgical services in NZ have evolved essentially from the expertise and experiences gained by NZ surgeons based in the UK during and following both World Wars. The development of interdisciplinary cleft teams has become integral to the staging of both surgical and non-surgical treatments which can extend from birth to early adulthood. The burden of care undertaken can be extensive and parent support services have also evolved to aid the families understanding of cleft treatment. The way the cleft centres have evolved and the low population density in NZ has resulted in lower case numbers by surgeons than international best practice recommendations.