Craniomaxillofacial - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Category 1 - appointment clinically indicated within 30 days

• craniofacial trauma
• visual or feeding compromise, neurological symptoms, or potential airway involvement

Category 2 — appointment clinically indicated within 90 days

• craniomaxillofacial deformity
• delayed presentation facial fractures
• dentofacial deformity
• growth disturbances
• other maxillary and mandibular growth disorders where there is an established craniomaxillofacial diagnosis
• syndromic craniosynostosis
• Treacher Collins syndrome (TCS) and related conditions

Category 3 — appointment clinically indicated within 365 days

• nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• past medical history
  
• current medications and dosages
• allergies and sensitivities
• presenting symptoms, evolution and duration
• craniofacial disorder symptoms including:
  • difficulty with chewing or swallowing. symptoms must be documented by the referring doctor and must have persisted for more than 12 months.
  • documented significant weight loss, malnutrition, or failure to thrive secondary to facial skeletal deformity
• dentofacial deformity symptoms including:
  • severe class ii malocclusion with an overjet of greater than 9 mm
  • severe class iii malocclusion with a negative overjet of greater than 3.5 mm
  • anterior open bite greater than 4 mm
  • documented speech impairment that is the result of a poor bite or jaw positioning following assessment and confirmation by speech pathologist
• obstructive sleep apnoea (OSA) diagnosis confirmed by respiratory/sleep physician who have failed the following:
  • trial of continuous positive airway pressure (CPAP) device
  • less invasive surgical procedures
• OSA diagnosis confirmed by respiratory/sleep physician, with skeletal anomalies associated with narrowed upper airways

Previously diagnosed patients

• previous surgical/medical management and treatment summary - including outcome of the treatment

Additional information to assist triage categorisation

• photograph, including disposable measurement tool – with patient’s consent, where secure image transfer, identification and storage is possible
• relevant reports and summaries from clinician involvement in medical management

Clinical management advice

Craniosynostoses have a wide range of urgency and early referral is helpful.

If the patient requires urgent attention and/or fulfils category 1 triage criteria, please contact the on-call registrar to discuss and ensure your referral has been received.

Orthognathic surgery (OGS), or corrective jaw surgery is available to patients treated by Cleft & Craniofacial SA at both the Women’s and Children’s Hospital (WCH) and the Royal Adelaide Hospital (RAH).

This is a guideline for outpatient referral only. If you have clinical concerns, please contact the WCH Cleft & Craniofacial SA service via switchboard on (08) 8161 7000

Clinical resources

• WCH – Cleft and Craniofacial SA
• Therapeutic Guidelines - Initial Assessment and Management of Maxillofacial Trauma

Consumer resources

• Children’s Craniofacial Association

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.