Cleft lip and palate are the most common congenital developmental malformations of the oral and maxillofacial region. They often have very complex dental and maxillofacial malformations such as abnormal development of the cranial base, fracture of the lip and palate tissues, misalignment and abnormal development of various maxillary bone segments, abnormal tooth morphology, tooth number, tooth position, arch morphology and sympathetic relationship. Orthodontic treatment of these deformities is carried out throughout the entire cleft lip and palate sequence of treatment.
Starting from the preoperative orthodontic treatment for newborns, to the subsequent orthodontic treatment for infants, milk teeth, mixed teeth, permanent teeth and adults before and after orthognathic surgery, each period has its own unique growth and development characteristics and different orthodontic manifestations. There are also different treatment goals and methods in orthodontic treatment.
The preoperative orthodontic treatment for newborns with cleft lip and palate should focus on correcting the misalignment of the maxillary segments and establishing a normal or near-normal anatomical structure to provide a good anatomical basis for cleft lip and cleft palate revision surgery, thus greatly improving the aesthetic effect of the surgery. In infants, a palatal tray should be made to close the cleft palate in order to facilitate the child’s feeding, establish the normal position of the tongue and normal respiratory function. In addition to speech training, a palatopharyngeal obstruction device can be given to stimulate the growth and development of the palatopharyngeal tissues, enhance the closure of the palatopharynx and help the child establish normal articulatory function if necessary. During the period of the mastoid dentition, the focus is on correcting the anterior mammary teeth retrusion and preventing the occurrence of narrowing of the dental arch and maxillary collapse after cleft palate surgery, thus promoting the growth of the maxilla. The mixed dentition period is the period of breast and permanent tooth replacement, which often has obvious manifestations such as early or late loss of milk teeth, early or late eruption of permanent teeth, tooth misalignment, abnormal arch relationship, anterior and posterior teeth recoil, insufficient maxillary growth, and obvious deformity of the jaw and face. Therefore, timely orthodontic treatment should be provided to induce the replacement of permanent teeth, correct anterior teeth retrusion, unilateral or bilateral posterior teeth retrusion, and stimulate the growth and development of the upper jaw. At the early stage of permanent dentition, when the child is at the peak of growth and development, the coordination of teeth, dental arches, jaws and face should be adjusted at the right time to maintain the good oral function and appearance of the child. For those with very serious deformities, orthognathic surgery can be combined with preoperative and postoperative orthodontics when they reach adulthood (18 years old) to achieve both good dental relationships and satisfactory facial morphology.
The final outcome of the treatment of the child is dependent on the doctor’s treatment, the cooperation of the child and, most importantly, the persistence of the parents. The treatment of cleft lip and palate requires a coordinated team of specialists from different disciplines, such as oral and maxillofacial surgery, orthodontics, oral implantology, otorhinolaryngology and psychology, and the treatment cycle can last from birth to 18 years of age. The most important thing is the persistence of the parents. It is important to have confidence that through joint efforts, most children can achieve good results.
The following is a case I completed, the orthodontic (correction) cycle from 2011.01.17-2015.05.03, in the middle experienced the maxillary anterior traction, maxillary slow expansion of the arch and mandibular extraction after the full fixed orthodontic treatment, the patient is usually 4-6 weeks to review, even after the end of the orthodontic treatment, the child still need to review at least every six months to observe the development of the upper and lower jaws, the presence of orthodontic relapse and oral hygiene.