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Children's Hospital

Cleft Lip and Palate: A Team Approach to Care

Approximately one in 700 babies is born with a cleft lip and/or palate. Clefts occur in all races and in both sexes. These children usually have a variety of healthcare needs that are best managed by an interdisciplinary team. Children's Hospital has a dedicated Craniofacial Team to help oversee treatment for children born with oral-facial clefts and other craniofacial anomalies.

Children's Craniofacial Team include plastic surgeons, otolaryngologists, dentists/orthodontists, oral and maxillofacial surgeons, speech therapists, a geneticist, a nurse practitioner, a nurse and a team coordinator. Other specialists that may be consulted include neurosurgeons, audiologists, social workers, dieticians, ophthalmologists, psychologists, and pediatricians.

The team's function is to develop a comprehensive plan of care and assure that all services and treatments are implemented in a coordinated manner. Children are evaluated on an annual basis in the Cleft Palate/Craniofacial Clinic. The plan of care is reviewed and updated based on a child's growth and development.

• Why is it important for the child to be seen by a dentist/orthodontist?

Children born with a cleft lip and/or palate most likely will require extensive dental and orthodontic treatment throughout their childhood. Teeth may grow in abnormal positions such as in the roof of the mouth, be oddly shaped, or be missing entirely. A bone graft is performed to close the gap in their gums. This procedure is done, depending on dental development, between the ages of six to nine years. Dental implants are done to replace missing teeth. The dental and orthodontic process is very lengthy, therefore, it is essential that children are followed regularly so the treatment plan in not interrupted.

• Presurgical Orthodontic/Orthopedic Treatment of Children with Cleft Lip and Palate

Throughout the history of cleft lip and palate treatment, there have been constant concerns about the timing of surgical procedures as well as the use of orthopedic appliances and their effect on growth and development. Those concerns include:

  • If the lip is closed without the use of an appliance to protect the width of the palate shelf, collapse of the palatal shelves occurs. The palatal shelves are two processes that meet in the midline and join with the premaxillary process anteriorly to form the palate.
  • If an appliance is used to protect the palatal shelves from collapsing, a problem with compliance by the patient and/or the parent arises.
  • The premaxillary dental alveolar process is the bone in which the teeth will be anchored. If the pre-maxillary dental alveolar process is protrusive in relation to the palatal shelves, increased tension and stretching of the soft tissue to cover the premaxilla may cause undesirable scarring. In addition, the aesthetic alignment of the lip and nasal anatomy will be more difficult to obtain.

History

During the past 34 years, the Craniofacial clinic at Columbus Children's Clinic has attempted to sort through these concerns in search of finding a method with the following goals:

  • Reduce surgical scarring with the least amount of interference to growth and development
  • Reduce the number of visits to the dental and surgical clinics
  • Reduce the costs of medical treatment
  • Enhance the parents' understanding of the treatment objectives and outcomes
  • Reduce the number of times that the child requires sedation
  • Determine the optimal timing to develop alveolar arch form.