Cleft Lip and Palate Orthodontics

The orthodontists help guide the growth and development of the face as well as treat the dentition of the child with a cleft or craniofacial deformity to improve esthetics and function. As a result of the long-term treatment required for the majority of these patients, different phases of active treatment are interspersed with periods of retention or no treatment will be necessary.

The orthodontic treatment in a patient with cleft lip and palate can be divided into four distinct dental developmental periods: the neonatal or pre-surgical orthopedics period (infants), primary dentition (5-6 year olds), mixed dentition (7-11 year olds), and permanent dentition (12-18 years old).

In the neonatal period the goals of the presurgical orthopedics treatment are to decrease the size of the cleft of both the palate and the lip to resemble the normal infant lip and nose shape. An example of presurgical orthopedics that we use currently in MCG is the NASOALVEOLAR MOLDING (NAM) technique for unilateral and bilateral cleft lip and palate patients. This treatment modality includes as its objectives the active molding and repositioning of the deformed nasal cartilages and alveolar processes (the nose and the palate), as well as lengthening the deficient columella (the tissue that separates the two nasal nostrils). The NAM technique starts ideally during the second week of life and the treatment duration is approximately 16-20 weeks. After NAM treatment the patient is ready for the primary surgery of the lip. NAM improves long-term nasal esthetics and reduces the number of nasal surgical procedures. Savings in cost to the patient and society is achieved through the reduction in number of surgical hospital admissions.