The Smile House Network in Italy: A Hub-And-Spoke Multidisciplinary Cleft Care Model

BACKGROUND: Cleft lip and palate are among the most common congenital craniofacial conditions and require prolonged, coordinated care across surgical, orthodontic, speech, audiologic, and psychosocial domains. National pathway documents emphasize early access, centralization of complex care, and structured multidisciplinary follow-up. The Smile House Network was developed in Italy to operationalize a hub-and-spoke model for cleft care. METHODS: We performed a descriptive analysis of the Smile House Network's publicly reported 2023 activity volumes, extracting center-level counts of primary and secondary cleft-related surgical procedures and associated multidisciplinary outpatient care (orthodontic therapy, speech therapy, and psychological counseling). These results were contextualized and compared against national pathway evidence from AGENAS, including Italian population-based indicators (2017-2019) on the timing of primary cleft repair and case volumes. RESULTS: In 2023, the Smile House Network reported 342 primary surgical procedures and 180 secondary procedures (total 522). Secondary surgery included 41 alveolar bone grafts, 26 orthognathic procedures, 28 revisions, 17 labioplasties, and 38 rhinoplasties. Across the network, multidisciplinary care volumes included 2459 orthodontic therapy encounters/patients, 1372 speech therapy encounters/patients, and 409 psychological counseling encounters/patients. Activity was concentrated in hubs for surgery and in selected sites for high outpatient volumes, reflecting differentiated hub-and-spoke functions. Compared with national indicators, the network's primary surgical volume approximated the expected annual volume of primary repairs derived from Italian birth cohorts, supporting the feasibility of a coordinated national model. CONCLUSIONS: The Smile House Network's 2023 volumes demonstrate a mature, system-level implementation of multidisciplinary cleft care, combining substantial surgical throughput with high-volume allied-health services. When interpreted alongside AGENAS pathway evidence, these data support the scientific and organizational rationale for a structured hub-and-spoke network to deliver timely primary repair, manage long-term sequelae, and standardize longitudinal follow-up.