Cleft Lip and Palate Sequential Treatment
Cleft lip and palate is a congenital developmental malformation involving several tissues and organs of the jaw and face. Patients with cleft lip and palate, especially cleft palate, have not only soft tissue deformities but also hard tissue deformities. Patients with cleft palate may have many problems, such as: sucking dysfunction, as the child is unable to suck breast milk or milk overflows from the nostrils due to the mouth-nose connection, which increases feeding difficulties and affects the healthy growth of the affected child to a certain extent; excessive nasal voice, slurred spitting, and hearing loss; maxillary dysplasia leading to sunken middle face, and The upper jaw dysplasia leads to sunken middle face and misaligned bite, which seriously affects the chewing function and facial appearance of the patient, and is more likely to cause psychological disorders in the child.
In the past, the treatment of cleft lip and palate was mainly surgical treatment, which was not ideal. With the development of medicine, it has become a consensus that patients with cleft lip and palate need a multidisciplinary and collaborative comprehensive treatment, including oral and maxillofacial surgery, plastic surgery, orthodontics, stomatology, otorhinolaryngology, pediatrics, psychology, speech pathology and other related disciplines to form a treatment team to consult and jointly develop a sequential treatment plan to treat patients with cleft lip and palate at the appropriate age and in accordance with certain procedures. The treatment is comprehensive. The treatment includes preoperative orthodontic treatment, cleft lip repair, cleft palate repair, postoperative orthodontic treatment, alveolar cleft bone grafting, hearing monitoring, speech training, psychological treatment, etc., so as to achieve a satisfactory treatment effect combining function, morphology and psychological status.
The Cleft Lip and Palate Treatment Group of the Department of Dentistry at Children’s Hospital is able to provide a comprehensive cleft lip and palate sequence treatment service for children with cleft lip and palate.
Procedures and basic elements of cleft lip and palate sequential treatment
1) Pre-surgical treatment
A. Counseling and guidance on feeding for parents of children with cleft lip and palate
B. Pre-operative orthodontic treatment for children with complete cleft lip and palate: inducing normal jaw development and creating conditions for cleft lip and palate surgery. Pre-operative orthodontics is performed by orthodontists, (2 weeks after birth)
2) Timing of surgical treatment of cleft lip and palate
Unilateral cleft lip 3-6 months.
Bilateral cleft lip 6-12 months
Timing of surgical treatment for cleft palate (10 months-2 years) (performed by oral and maxillofacial surgeons and plastic surgeons)
3) Speech evaluation and speech therapy after cleft palate surgery
Structural voice disorder: surgical repair.
Functional voice disorder: voice training treatment (jointly implemented by oral and maxillofacial surgeons and voice therapists) (4-6 years old)
(4) Second-stage surgical treatment of secondary deformities of cleft lip and palate
Repair treatment of lip deformity after cleft lip surgery
Surgical treatment of incomplete palatopharyngeal closure after cleft palate surgery (performed by oral and maxillofacial surgeons and plastic surgeons)
(5) Cleft alveolar ridge implantation for cleft lip and palate patients (9-11 years old)
To repair the alveolar ridge cleft and restore the integrity and morphology of the dental arch based on the observation of tooth eruption on radiographs. (Performed by an oral and maxillofacial surgeon)
6）Orthodontic treatment of cleft lip and palate
Orthodontic treatment in the milk teeth period
Orthodontic treatment in the period of teeth replacement and before and after alveolar crevice bone grafting
Orthodontic treatment in permanent dentition
Orthodontic treatment in orthognathic surgery (performed by an orthodontist)
7) Otolaryngological problems in patients with cleft lip and palate
The prevalence of hearing loss in patients with cleft palate is 40-60%
Cause: exudative otitis media – conductive hearing impairment
Treatment: tympanotomy with tube drainage, etc. (performed by ENT physicians)
(8) Psychological problems and psychotherapy of cleft lip and palate patients (implemented with the assistance of psychologists)