Step-By-Step Management Of Cleft Lip And Palate

Step-By-Step Management Of Cleft Lip And Palate

• Stage 1: It comprises of the treatment done from birth to 18 months of age.
• Stage 2: It is from 18th month to 5th year of life. This corresponds to primary dentition stage.
• Stage 3: It includes treatment which is carried out during mixed dentition stage. It spans usually from 6th to 11th year of life.
• Stage 4: It includes the treatment done at permanent dentition stage i.e. 12 to 18 years of age.

• Fabrication of passive maxillary obturator
• Presurgical orthopedics
• Surgical management of clef lip
• Surgical management of clef palate

• This is an intraoral prosthetic device fabricated using cold cure acrylic.
• Clasp may aid in retention. If there is insuffient retention, wings made of thick wire can be embedded in acrylic and can be stabilized against cheeks using micropore adhesive tape.
• This fils palatal clef and provides false roofig against which the child can suckle.
• This decreases incidence of feeding diffilties such as insufficient suction, excessive air intake and choking.
• This also provides maxillary cross arch stability, thus preventing arch from collapsing.

• Aim of pre-surgical orthopedics is to achieve upper arch form that conforms to the lower arch.
• Absence of variable amount of the lip tissue and division in alveolus and palate leads to outward displacement of premaxilla.
• An orthodontist should always try to correct the displacement such as outward displacement of premaxilla (in bilateral cleft and displacement of greatest segment (in unilateral cleft) by extra-oral strapping across the premaxilla which is attched directly to face or some form of the head cap.
• A micropore adhesive tape can also be strapped across the premaxilla.
• If there is narrow, collapsed maxillary arch, expansion can be achieved by a suitable appliance incorporating screws or springs.

• Early school thought: According to them surgery should be performed under 45 days of the birth. Early surgery improves the facial appearance and so improves the child acceptance and decreases the parent apprehension.
• Late school thought: According to them surgery should be postponed at the time of completion of dentition. Here the reason suggested is that the tissue would be able to grow and mature, giving the surgeon more muscle mass to work over.
• Millard suggested rule of 10: Surgery should not be carried out less than 10 weeks of age, body weight not less than 10 pounds and blood hemoglobin not less than l0 g%.

• Palatal repair should be attempted between l2 and 24 months of age which facilitates normal speech, hearing and improves swallowing.
• Palatal repair is carried out using bone transplants which are taken from rib, iliac bone, mandibular symphysis, tibial bone or outer table of parietal bone.

• This stage of treatment is carried out during deciduous dentition period.
• The procedures done during this stage are:
  • Adjustments in the intraoral obturator to accommodate the erupting deciduous teeth
  • To maintain a check on eruption pattrn and timing
  • Oral hygiene instructions
  • Restoration of decayed teeth
• Orthodontic treatment should not be initiated during this phase until it damages the underlying permanent dentition follicles.
• In patients with moderately underdeveloped maxilla and no Class 3 hereditary defect, reverse headgear treatment is given at the age of 4 to 7 years.

• Correction of anterior crossbite with the removable or fixed appliances. E.g. Removable appliance with Z spring for treatment of anterior crossbite.
• Buccal segment crossbites are treated using quad helix or expansion screws.
• Secondary alveolar bone grafting is done commonly during mixed dentition period. Successful grafting produces osseous environment to permit the spontaneous eruption of canine tooth inside the graftd area. Iliac crest is the preferred donor site

• It consists of treatment during permanent dentition along with fied orthodontic appliance.
• All of the local irregularities such as crowding, spacing, crossbites and overjet lover bite problems are corrected.
• Patients having hypoplastic maxilla should be given face mask to advance the maxilla.
• Patients with missing teeth should be given prosthesis aftr completion of orthodontic treatment.
• Following completion of orthodontic treatment long retention phase is required in these patients.