Children's Hospital
Cleft Lip and Palate: A Team Approach to Care
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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.
