Cleft Lip and Cleft Palate

Cleft lip/cleft palate occurs in approximately 1 in 700 births in the U.S. Although treatment varies regionally, typically the cleft patient will have lip closure surgery at 3-6 months of age and palatal repair between 12-24 months. Although many cleft patients will be followed by cleft palate teams throughout their development, some will also be treated by the wider dental community. A cleft that involves the maxillary alveolar bone will frequently have missing teeth (often the lateral incisor), supernumerary teeth and rotated, malformed or hypoplastic incisors adjacent to the cleft site.

For most cleft patients, it is very important to have orthodontic maxillary expansion and a secondary bone graft in the cleft site before the eruption of the permanent canine into the cleft. Ideally, the permanent canine root should be half to two-thirds formed at the time of the graft. This allows the canine to erupt through bone which will ultimately give good periodontal support to the canine and adjacent teeth. If teeth have already erupted into the cleft site, a later bone graft will not be successful so timely referral and treatment is imperative. The ideal time is based on dental age determined by radiographs, but is typically between 8-11 years.

Just like any other patient, a cleft patient will exhibit his or her own skeletal developmental pattern (which may be Class I, II or III), but due to the unavoidable growth restriction caused by the early repair procedures as well as the tissue defects of the cleft itself, most cleft patients will exhibit maxillary sagittal deficiency resulting in anterior and/or posterior crossbites. The typical cleft patient will appear more maxillary deficient and mandibular prognathic with growth. Typically, in late adolescence the cleft patient will have orthodontic treatment in preparation for orthognathic surgery. Sometimes surgery is done before growth is completed in order to provide the patient with a balanced facial profile during psychologically formative years, even though it is realized that late growth may require an additional surgical correction.

Dr. Garai had extensive experience in treating cleft patients during his orthodontic residency at Eastman Dental Center in Rochester, NY and for over 10 years has been on the faculty of Children’s Hospital/Washington Hospital Orthodontic Residency program, which is a regional referral center for cleft treatment.