The main aims of treating patients with cleft lip and palate:

-          To allow patient to achieve normal appearance and to attain normal function of the upper lips

-          To provide the least possible damage to the future growth and development

Treatment timeline for cleft lip and palate patients

After birth (Initial consultation with the pediatric dentist)

The pediatric dentist will evaluate and determine the type of cleft your baby has(whether he/she has a cleft lip/palate or both).An interview with the parents is required to understand the underlying etiology and whether there is any associated medical condition. Proper feeding advice will be given to the parents to prevent nasal regurgitation.   Infants with wide cleft may require a custom made feeding plate to ensure efficient feeding. Efficient feeding is important for infants with cleft palate/lip to obtain adequate nutrition before the corrective surgery.

2-5 months (Lip repair surgery)

Lip repair surgery is also known as cheilorrhaphy.  The aim of performing lip repair surgery is to achieve a normal appearance and continuity of the lips. During the surgery, incisions will be made bring the pieces of lip together to form a full lip.

Rule of 10s by surgeons Wihelmmesen and Musgrav states that the child should be at least 10 weeks of age,  has at least 10g hemoglobin and weigh at least 10 pounds to undergo the corrective surgery.

8- 12months (palate repair/ palatorrhaphy)

Cleft palates are usually repaired between 8 to 12 months of age.   Surgery is done to correct the abnormally inserted muscles of the soft palate and to prevent future speech problems. The entire surgery may take around 2 to 3 hours and your child might need to stay in the hospital for 2 to 3 days.

2-6 years old (Routine dental visit)

Routine dental care is required to monitor your child’s growth and dental development.  As we have mentioned earlier, children with orofacial clefting have more dental problems (such as having an extra tooth/missing tooth) than the other children.  Hence, it is important to monitor his/her dental condition and to deliver preventive dental care (dental practitioner should provide dietary advice, place fissure sealants to protect the first molars and etc)

8 to 10 years old (Alveolar grafting)

Bone grafting is required for patients with alveolar cleft (which means there is an opening in your gum area).  The bone graft which will be used to fill in the space in the alveolar ridge will be taken from the hip bone. The procedure is normally performed when the permanent canine is three quarters formed. Your child might need to put on fixed orthodontic appliance/braces prior bone grafting to expand or widen the upper jaw.

12-15 years old (Fixed orthodontic appliance)

Full orthodontic treatment is required later on to correct the developing malocclusion.  Cleft patients often develop Class III malocclusion and some amount of cross bite (abnormal relation of the upper tooth and the opposing lower tooth) due to the retruded upper jaw.

16-17 years old ( Orthognathic surgery)

Orthognathic surgery which means surgery to correct the conditions of jaw and face may be required  in severe skeletal deformities.  Le fort I Osteotomy is an example of orthognathic surgery. It is performed to correct severe class III relationships. (For your information, patients with class III jaw relationship have protruded lower jaws) Besides jaw surgery, scar revision surgery can be performed to improve the appearance of the cleft patient.

Other treatments :

1)      Speech therapy: As we have mentioned earlier, speech problems can occur especially in cleft palate patients due to velopharyngeal dysfunction. Velopharyngeal dysfunction refers to a condition where by there is improper closing of the soft palate of the mouth during speech. This will allow air to escape through the nose instead of the mouth, producing a nasal tone in the voice. Patients with velopharyngeal dysfunction will not be able to pronounce consonants sounds such as “p” ,”d”,”t”,”d”.  Thus, speech therapy is sometimes required in cleft patients.

2)      Pharyngoplasty to separate the mouth from the nasal cavity

3)      Cosmetic surgery if necessary.

WHAT THE PARENTS SHOULD DO:

1)      Take good care of your child’s oral hygiene: Supervise your children when they are brushing their teeth.

2)      Diet control: Reduce sugar in your child’s diet.

3)      Bring your children for dental appointments to monitor their dental condition.