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You are in - Home >> Plastic, Hand and Reconstructive Microsurgery and Burns >> Cleft Lip and Cleft Palate>> Cleft Orthodontics

Cleft Orthodontics

The orthodontist plays an integral part in the treatment for cleft patients from infancy to adulthood.This includes presurgical orthopaedics, alignment of teeth and expansion of the constricted maxillary arch; analyzing maxillomandibular growth;attempting to modulate the growth disharmony and providing good occlusion.Cleft patients mostly present with more dental and skeletal anomalies than do individuals without clefts.

Pre-Surgical Orthopaedics

Cleft lip and palate can arise with considerable variation in severity and form .Generally more extensive clefts are associated with more significant nasolabial deformity. These clefts are deficient in hard and soft tissue elements and they present a significant surgical challenge to achieve a functional and cosmetic outcome. Most surgeons would agree that their chance of achieving a finer surgical scar, good nasal tip projection, and more symmetrical and precisely defined nasolabial complex would be better in an infant who presents with a minor cleft deformity. A finer scar forms when a surgical incision heals under less rather than more tension.

In order to achieve this, we have started pre-surgical orthopaedic procedure called nasoalveolar molding which must be started immediately after birth,(within 2 months of age). The principal objective of presurgical nasoalveolar molding (NAM) is to reduce the severity of the initial cleft deformity. By reducing the severity of cleft by naso-alveolar moulding (NAM) the surgeon and the patient can enjoy a positive outcome from the cleft surgery.

The NAM goals include lip segments that are almost in contact at rest, reduction in the width of the alveolar cleft segments symmetrical lower lateral alar cartilages, and adequate nasal mucosal lining, which permits postsurgical retention of the projected nasal tip . This technique takes advantage of the malleability of immature nasal cartilage and its ability to maintain a permanent correction of its form. Utilization of the NAM technique has reduced the surgical scars associated with traditional columella reconstruction and has also reduced the number and cost of revision surgical procedures, and has become the standard of care in many Cleft Palate Centers.

Orthodontics After Infancy

Orthodontic treatment after infancy starts in the mixed dentition period.The objectives at this stage include expansion of posterior and anterior maxilla and to develop a favorable arch form . The cross bite can also be eliminated at this stage.Alveolar bone grafting is now aimed to be performed between 8 to 10 years of age (when one third to one half of canine root has developed). The canine is able to erupt through the graft, bring additional bone support and inducing favourable bone remodelling.The use of a protraction facemask has also been advocated if maxillary jaw deficiency is present.

During the Permanent dentition stage a thorough evaluation aided with cephalometric analysis is undertaken. According to the evaluation a comprehensive orthodontic treatment alone or a combined orthodontic and surgical treatment for the jaws may be indicated. If only orthodontic treatment is indicated, it may be continued with the fixed appliance in place; or it can be deferred until teeth have gained adequate eruption. Some times in exagerrated conditions where surgery is indicated a combined orthodontic and surgical treatment is initiated.

Optimally timed procedures in close coordination with other members of multidisciplinary cleft team can yield best treatment outcome for the patient.