Cleft lip and palate
Cleft lip and palate occurs 1 in 1000 Indian births. Management of cleft lip and palate involves a team approach involving paediatrician, pedodontist, plastic surgeon, oral surgeon, orthodontist, prosthodontist, speech therapist, Psychiatrist, Otolaryngologist etc.
At Smiles N Faces we offer complete Orthodontic care for a cleft lip and palate child.
General guideline for the CL & P patients is as under
Palatal obturator and naso alveolar moulding ( cleft orthodontist) - Birth to 1 year
Allows feeding and moulds shape of nostrils and alveolar pads
Lip repair ( plastic surgeon) – 3 months
Repair of soft and hard palate ( plastic surgeon) – 9 months – 1 year
Speech therapy ( speech therapist) – 3 years to 6 years
Due to the communication of oral and nasal cavity, the speech of the patients with cleft palate is compromised. It is recommended to start the speech therapy of the child as soon as it learns to speak. The speech therapy is continued till the child is able to speak clearly and may continue till the teens.
Orthodontics ( orthodontist ) – 6 yrs to 18 years.
Orthodontics is usually started with the eruption of the first few permanent teeth by the age of 7 years. The cleft palate patients have constricted maxillary arch due to pull of scar tissue of palatal repair. Early Orthodontics is aimed at expanding the collapsed arched with quad helix or screw based expansion appliances to reestablish the dental arch width and correct arch collapse.
Reverse pull headgear ( orthodontist) – Along with lateral expansion a reverse pull headgear appliance is used to effect downward and forward maxillary growth to correct maxillary deficiency in all 3 planes
Alveolar bone grafting ( plastic surgeon) – 9 to 11 years. The teeth in the cleft region do not have enough bone through which they can erupt into the mouth. Alveolar bone grafting is undertaken in the cleft region to fill the bony defect and the unerupted tooth is guided through the new bone.
Comprehensive Orthodontic treatment with fixed braces ( orthodontist) – Comprehensive treatment can begin as early as 9 years of age and may continue till all the permanent teeth are erupted. Sometimes it is advisable to continue the braces till the facial growth of the child is complete.
Orthognathic surgeries and other plastic surgeries ( oral surgeon) – 15 to 21 years Patients with cleft lip and palate generally have deficient maxilla in all 3 dimensions and excessively grown mandible or the lower jaw. If the face mask therapy is not able to reestablish the jaw proportions, after the child’s growth is complete, the jaw proportions are corrected by Orthognathic surgery. During this, the maxilla may be surgically repositioned anteriorly or mandible posteriorly or combination of both.
Plastic surgical procedures ( plastic surgeon)
Plastic surgical procedures such as nose and lip revision are also done after the facial growth is completed.