fbpx Orthodontic Cleft Lip and Palate Treatment Houston

This Article Is About Cleft Lip And Palate Orthodontic Treatment In Houston, Tx.

cleft lip surgical correction before and after

 

What is Cleft Lip and Palate?

Cleft lip and palate CLP is a correctible birth defect where one or two parts of the upper lip failed to fuse together during pregnancy. This might affect the lip only or the lip and bone together in more complex cases. 

The THREE DOs:

  • Do understand the consequence of CLP on a baby’s feeding, speech, and teeth
  • Do seek support from family members and friends to help you with CLP
  • Do establish a clear vision of the treatment options to correct CLP

The THREE do NOTs:

  • Do NOT think it is the baby’s mistake.
  • Do NOT waste your time searching for what was the cause.
  • Do NOT blame God, yourself, or your partner for the situation

 

Cleft lip and Palate CLP before and After Houston

When is Cleft Lip and Palate discovered? 

Before medicine advancement, CLP was discovered during the delivery day creating an upsetting situation for the parents and family. 
However, with the advancement in Medicine, CLP may be detected as early as 13 weeks of pregnancy with a traditional ultrasound exam. Even better, now the 3D ultrasound can provide a better view for early detection.

Early surgical correction of the lip is very important.
Early surgical correction of the lip is very important.

 


Why is early diagnosis of CLP important? 
The early diagnosis is very important for both parents and the medical team. 

  • The parents need to educate themselves about CLP and what their new child needs.
  • The medical doctor and team to be prepared for any possible complications during the delivery process.  
crooked teeth with cleft palate Houston Texas

 


Who will treat cleft lip and palate? 
Treating CLP requires a team effort

  • Plastic Surgeon: Close the lip and hard palate, 3-4 surgeries,  first one to close the lip 6-8 weeks, Bone graft place 4-6 months, closing the hard palate at 1 Year, and surgical revision for the lip at 6 year
  • Orthodontist / Dentist: 2 weeks for appliance fabrication, 6-7 Years for phase I orthodontic treatment,  11-12 Year for phase II orthodontic treatment 
  • Speech Therapists: speech therapy is required when the patient is having a hard time pronouncing labial letters such as “T, Th, V,  F, …etc”.  
Early orhtodontic treatment for Cleft lip patient Houston Texas
Patients with CLP will require an early orthodontic treatment to correct the front teeth. This phase will last between 12-18 months

Is it important to get the plate for my newborn baby? 
YES, The plate will help your child in two ways: 

  • It will create a seal between the mouth and the nose preventing the milk from coming out of the nose, and
  • Will help to mold the two bone areas in a better way after closing the lip. After the first surgery, the lip will create pressure on the bone causing them to collapse. The Plate will help to prevent this side effect. Your child might need more than one plate during the early growing stages. 

Lip closure without dental arch stabilization:

•    Arch COLLAPSE = Orthodontic nightmare

•    Teeth cannot erupt through thin air
•    Continuous sinusitis via the fistula
•    Nasal airway constriction

Plate importnat effect in CLP patient
Plate effect in CLP patient 
cleft lip plate effect

 


Why do I need to see an orthodontist for my child?
With CLP, the foundation “Bone” is crooked causing the teeth at the CLP area to be displaced or even missing. 

  • Moving teeth will help also to realign the bone in a better way. 
  • The surgeon might request to alter the CLP area size to allow better access for bone grafting. 
  • Prepare the CLP area for future replacement such as an implant
CT scan for the cleft area
Notice the deformed upper arch form on the CT Scan. 

 

At iSmile Specialists, we will take a FREE CT Scan for your child as a part of our comprehensive consult. 


What is the best time to treat cleft lip and palate?
Having a baby born with a cleft can be, but the cleft lip and cleft palate can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring. 

removable expander for early treatment CLP
At age 7-8, a removable expander is needed to help to expand the upper jaw while permanent teeth are developing

What are the possibilities of having missing teeth with CLP?

 

Missing

Present

Useful

Unilateral  CLP

42%

58%

30%

Bilateral CLP

50%

50%

29%

 

Patients with CLP usually have a delayed growth of the upper jaw compared to the lower jaw causing an underbite. This might be corrected with surgery of the upper jaw or orthodontically by using a special expander with a face mask. The orthodontic correction could start as early as 11 years.

In recent years, Trans-sutural distraction osteogenesis (TSDO) was introduced as an alternative method for the early treatment of midfacial hypoplasia in growing patients with cleft lip and palate. 

Midfacial defeciency in cleft lip palate patients
Notice the midfacial defeciency "Red area" in this girl with CLP

Use of folic acid and multivitamins

Folic acid deficiency has been linked to some birth deformities such as spinal Bifida and CLP. Studies have shown that if vitamin supplements namely folic acid and cobalamins were not taken during early pregnancy the risk for CLP could be tripled. The recommended dose to reduce the risk of CLP is 10 mg/ day.

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Timeline for Cleft Lip and Palate repair

2 weeks

Plate Delivery

Dentist/Orthodontist. This helps the baby to feed better

2 MonthS

First Lip Surgery

Plastic Surgeon. Primary lip repair to close the defect.

6 MonthS

First Bone Graft

Plastic Surgeon. Fill the bone defect with the bone for stabilization

12 MonthS

Palate Repair

Plastic Surgeon. Close the posterior cleft inside the mouth

6 Years

First Orthodontics

Orthodontist. Start phase I to correct the front teeth

12 Years

Second Orthodontics

Orthodontist. Start phase II to correct the bite

18 Years

Surgical revision

Plastic Surgeon. Enhance any areas that affect patient's appearance

Cleft Lip and Palate References

  • Rosenstein, et al. The case for early bone grafting in cleft lip and palate. Plast. Reconstr. Surg. 70:297, 1982
  • Rosenstein, et al. The case for early bone grafting in cleft lip and palate:  A second report.  Plast. Reconstr. Surg. 87; 644,835, 1991
  • Rosenstein, et al.  Orthognathic surgery in cleft patients treated by early bone grafting.  Plast. Reconstr. Surg. 87:835, 1991
  • Dado, et al. Long-term assessment of early alveolar bone grafts using three-dimensional computer-assisted tomography: A pilot study.  Plast.  Reconstr. Surg. 99:1840, 1997.
  • Maxillary distraction osteogenesis in cleft lip and palate cases with midface hypoplasia using rigid external distractor: an alternative technique. J Craniofac Surg 2014 May;25(3):746-51.
  • Management of the severe cleft and syndromic midface hypoplasia.Orthod Craniofac Res. 2007 Aug;10(3):167-79. doi: 10.1111
  • Stability of orthodontic treatment in the patients with cleft lip and palate. Zhonghua Kou Qiang Yi Xue Za Zhi. 2018 Sep 9;53(9):585-589