Audit

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. We are constantly auditing our clinical outcomes and hold an all-Ireland cleft audit meeting every year. This process is facilitated by collecting data in a secure database. When your baby first attends the cleft service, you will be invited to register them on the cleft database. The database holds information such as the patient’s name and contact details, the type of cleft, details of clinical procedures, assessments and outcomes. The database records are maintained according to the General Data Protection Regulation (GDPR) 2018 by a dedicated data manager. Information from the database is anonymised and used to benchmark outcomes against international standards, to monitor service provision and plan future requirements and for statistical analysis and research. More information about the cleft database can be found here:

Research

We strive to provide the best evidence-based care for our patients. There is a strong culture of teaching and research within the cleft teams and we believe that this keeps our practice current and allows us to deliver the highest standard of care to our patients.

Our ongoing research interests include:

• Psychological wellbeing and educational attainment in children with clefts
• Standardisation of outcomes recording after speech surgery
• Development and integration of an enhanced recovery programme for cleft lip and palate repair
• Incidence, diagnosis and management of airway distress in infants with cleft palate

We are committed to involving patients and parents in the development of our research projects. If you would like to be involved, please do not hesitate to contact your cleft team.

A selection of our publications:

Protocol for the development of a core outcome set for reporting outcomes of management of velopharyngeal dysfunction.
de Blacam C, Baylis AL, Kirschner RE, Smith SM, Sell D, Sie KCY, Harris HE, Orr DJA.
BMJ Open. 2020 Aug 13;10(8):e036824. doi: 10.1136/bmjopen-2020-036824.PMID: 32792441 

Descent of the human larynx: An unrecognized factor in airway distress in babies with cleft palate?
de Blacam C, Duggan L, Rea D, Beddy P, Orr DJA.
Int J Pediatr Otorhinolaryngol. 2018 Oct;113:208-212. doi: 10.1016/j.ijporl.2018.07.052. Epub 2018 Jul 31.PMID: 30173987 

Glossoptosis in Pierre Robin sequence.
Cahill KC, Orr DJA.
Arch Dis Child. 2019 Jul;104(7):693. doi: 10.1136/archdischild-2018-314964. Epub 2018 May 4.PMID: 29728421 

Surgery for Velopharyngeal Dysfunction: A Systematic Review of Interventions and Outcomes.
de Blacam C, Smith S, Orr D.
Cleft Palate Craniofac J. 2018 Mar;55(3):405-422. doi: 10.1177/1055665617735102. Epub 2017 Dec 14.PMID: 29437504

How reliable is the vomer flap in early hard palate repair?
Martin-Smith JD, Fitzgerald L, Orr DJA.
J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):828-832. doi: 10.1016/j.bjps.2017.02.026. Epub 2017 Mar 10.PMID: 28343783

Patterns of orofacial clefting in the facial morphology of bats: a possible naturally occurring model of cleft palate.
Orr DJ, Teeling EC, Puechmaille SJ, Finarelli JA.
J Anat. 2016 Nov;229(5):657-672. doi: 10.1111/joa.12510. Epub 2016 Jun 27.PMID: 27346883

Evaluation of nasal tip definition in closed rhinoplasty.
Buckley CE, McArdle A, McInerney N, O'Broin E.
Plast Reconstr Surg Glob Open. 2016 Feb 5;4(1):e603. doi: 10.1097/GOX.0000000000000588.

Validating the Clinical Use of the Modified Huddart and Bodenham scoring system for outcome in cleft lip and/or palate.
Dobbyn L, Gillgrass T, McIntyre G, Mossey P.
Cleft Palate Craniofac J. 2015 Nov;52(6):671-5. doi: 10.1597/12-170.

Epidemiology of orofacial clefts in the East of ireland in the 25-year period 1984-2008.
McDonnell R, Owens M, Delany C, Earley M, McGillivary A, Orr DJ, Duggan L.
Cleft Palate Craniofac J. 2014 Jul;51(4):e63-9. doi: 10.1597/11-299. Epub 2013 Oct 17.PMID: 24134478

Perceptions and satisfaction of aesthetic outcome following secondary cleft rhinoplasty: evaluation by patient versus health professionals
Byrne M, Chan JCY, O'Broin E.
J Craniomaxillofac Surg 2014 Oct;42(7):1062-70. doi: 10.1016/j.jcms.2014.01.031.

Repair of anterior cleft palate fistulae with cancellous bone graft: a simple technique that facilitates dental reconstruction.
Martin-Smith JD, O'Sullivan JB, Duggan L, O'Mahony A, Orr DJ.
Plast Reconstr Surg. 2013 Mar;131(3):380e-7e. doi: 10.1097/PRS.0b013e31827c7027.PMID: 23446588

Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in cleft patients
Dobbyn L, Gillgrass T, Devlin M.  
Br J Oral Maxillofac Surg. 2012 Oct;50(7):617-20. doi: 10.1016/j.bjoms.2011.10.007.

Calibration of the Modified Huddart and Bodenham (MHB) scoring system against the GOSLON/5-Year index for unilateral cleft lip & palate
Dobbyn L, Weir J, Macfarlane T, Mossey P.
Eur J Orthod. 2012 Dec;34(6):762-7. doi: 10.1093/ejo/cjr092. 

Recent advances in treatment methods for cleft lip and palate
Dobbyn L, Gillgrass T.
Dental Nursing. 2010 Aug: 6(8):437-441

 
Folate-related gene polymorphisms as risk factors for cleft lip and cleft palate.
Mills JL, Molloy AM, Parle-McDermott A, Troendle JF, Brody LC, Conley MR, Cox C, Pangilinan F, Orr DJ, Earley M, McKiernan E, Lynn EC, Doyle A, Scott JM, Kirke PN.
Birth Defects Res A Clin Mol Teratol. 2008 Sep;82(9):636-43. doi: 10.1002/bdra.20491.PMID: 18661527