Cleft Lip & Palate
The following is a sequence of treatments starting at birth.
1. At birth: An impression of the upper jaw is taken, and orthognatic suction and drinking plate is manufactured. Due to the ill aligned arches of the upper jaw, proper alignment needs to be achieved before the age of 3 months. This plate is adjusted every 2 weeks up to the age when closure of the lip and palate can be performed. The plate is adjusted to comply for bilateral clefts as well. The other function of the plate, is to enable the baby to create vacuum for sucking.
2. At age 3 – 6 months: Depending on the alignment of the dental arches, the growth and development of the baby, the lip, the anterior nasal floor, and the hard palate is closed under general anesthetic. The baby is hospitalized for 7 – 10 days, and fed via a naso-gastric tube. A crucial aspect of lip closure now days, is to adhere the 2 separate muscles in the parted lip. Previously only soft tissue closure was performed with no muscle attachment.
3. At the age of 12 – 14 months: The soft palate is closed. Any residual oro – nasal fistulae in the palate is closed as well. This process is crucial prior to speech development.
4. At age 2 – 3 years: Velo-pharyngeal flaps in the naso-pharynx, to enhance speech.
5. At the age of 6 years: Primary orthodontic treatment . This is to align the newly erupted permanent teeth already.
6. At age 10 -12 years: Secondary osteo- plasty in the area of the eruption of the permanent canine tooth. The canine tooth erupts at the age of 12 years, and due to the cleft in the alveolus, there is no bone available for this tooth to erupt. Bone is harvested in the iliac crest ( hip bone), and grafted. The anterior nasal floor is also revised. At this age the patient also starts with the secondary phase of orthodontics. The maxillary growth is usually retarded due to all the scarring in the palate. The teeth are aligned, and the patient is prepared for an osteotomy of the upper jaw (maxilla), called a Le Fort I osteotomy.The osteotomy is performed at the age of 15 years of age and older.
7. At the age of 15 – 16 years of age: A Le Fort I osteotomy of the upper jaw is performed to advance the maxilla into a Class I position. This is done in combination with the orthodontist, and the patient is in orthodontic braces. This is a 3 in 1 procedure where the maxilla is advanced, the bony defect in the palate is reconstructed with bone grafting, and all residual oro – nasal fistulae are repaired.
8. At age 18 – 20 years of age: The nose is reconstructed, and all cosmetic repairs to the nose, the lip etc. is performed. No scar revisions are performed prior to this age