Cleft Lip and Palate Treatments
If your child has a cleft lip or palate, you will be glad to know that Children’s Health provides the region’s most comprehensive care for this condition.
We are home to an interdisciplinary team of the most qualified doctors and medical professionals in dentistry, orthodontics, pediatric plastic surgery and craniofacial surgery. Plus, our dentists are specially trained to provide the exact dental treatments required by children with cleft lip or palate.
A cleft lip occurs when there is a split or opening in the lip. This opening can be small or large enough to connect the upper lip and nose, and can affect one or both sides of the face.
A cleft palate occurs when the roof of the mouth does not close properly during a baby’s early development inside the womb. This cleft does not usually affect the appearance of the face. Sometimes, the cleft in the palate occurs in the muscles of the soft palate at the back of the mouth. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of this type of cleft palate may include:
- Difficulty swallowing
- Nasal speaking voice
- Recurring ear infections
Children with cleft lip and/or palate face a variety of challenges depending on the type and severity of the cleft, including ear infections, speech difficulties and difficulty feeding. If the cleft extends through the upper gum, tooth development will likely be affected. It is important that the cleft be repaired and that oral health and tooth development is monitored from an early age.
Tests and Diagnosis
Cleft lip or palate is usually easy to diagnose during the exam of the infant’s mouth, nose and palate after birth. Sometimes the condition is diagnosed before a baby is born because the clefts can be visible during a routine ultrasound.
Your dentist may do X-rays of your child’s mouth. Diagnostic testing may be conducted to determine or rule out the presence of other abnormalities.
Correction of a cleft palate or lip is ideally performed in your child’s first year. Additional treatments are often required well into your child’s teenage years.
It’s recommended that you get your baby’s cleft lip repaired when he or she is between 3 and 4 months. At Children’s Health, presurgical infant orthopedics includes nasoalveolar molding (NAM) to improve anatomy of the lip, nose and gum for better surgical outcome. During surgery, your child will be put under anesthesia and a surgeon will use tissue and skin from both sides of the cleft lip to make the lip wider and close the gap.
Doctors usually perform surgery to repair a cleft palate when a child is between 6 and 18 months old. During surgery, the muscles and tissue on the two sides of the palate are connected together to close the cleft.
Your orthodontist is an important part of your child’s care team in treatment of a cleft lip or palate, and will provide treatment, which can include:
Initial evaluation. This first orthodontic evaluation may be scheduled even before your child has any teeth, in order to assess facial and jaw growth. As teeth begin to erupt, the orthodontist will make plans for your child’s short- and long-term dental needs, including jaw and teeth alignment.
Nasoalveolar molding (NAM). If your child has a cleft lip and/or palate, your doctor or dentist may recommend nasoalveolar molding (NAM) prior to surgery. Orthodontists perform the NAM technique as early in the life of the child as possible, using wire and acrylic nasal stents attached to a retainer-like appliance. This appliance will mold your child’s nasal cartilage, premaxilla (small bones in the upper jaw), and alveolar ridges (ridge-like border of jaw) into normal form and position before surgery is accomplished.
- If your child is a good candidate for the NAM device, your child’s orthodontist will make a mold of your child’s mouth in order to create the best fit for the device, which is similar to an orthodontic retainer.
- Your baby will wear the device 24 hours a day (except for a short time when you clean the NAM) for three to six months.
- You will be shown how to properly remove and clean the device, and replace the tape and bands. In addition, you will need to bring your baby in for adjustments to the NAM every week.
Once the cleft has closed to approximately 5 millimeters, a wire with an acrylic tip that fits into the nose will be added to the device. The acrylic tip gently lifts your child’s nose, while at the same time tape connected to the appliance pulls down on the nose. The stretching raises the flattened, cleft side of the nostril. Once the best possible results are achieved with the NAM device, the first corrective surgery can be scheduled.
Phase I orthodontic treatment
Children born with cleft lip and palate are often missing gum tissue where they have cleft lip and palate. They are likely to develop malocclusion such as an underbite or crossbite. These malocclusions should be repaired before alveolar bone grafting surgery. The most common treatments are:
Palate expansion. If your child’s palate (upper jaw) needs to be expanded, the orthodontist will install an expander appliance.
Reverse pull head gear (face mask). If your child has an anterior crossbite or underbite, it may be treated using a special head gear that will help the growth of the upper jaw.
Phase II/III orthodontic treatment
Braces. For children with craniofacial conditions like cleft lip and palate, the orthodontist will provide braces and retainers to align teeth and aid in correct jaw development. Typically, these children benefit from multiple phases of orthodontic treatment.
Growth monitoring If your child has any craniofacial condition, or has undergone craniofacial surgery, the orthodontist will provide comprehensive routine care and monitor dental progress in your child. Your child’s orthodontist will regularly evaluate the growth and position of your child’s teeth and collaborate with other specialists as needed.
What causes a cleft lip or palate?
Cleft lip and cleft palate occur when tissues in the baby's face and mouth don't form properly. Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. The condition is more likely to occur if the mother smokes, drinks alcohol and or takes certain medications during pregnancy. Cleft lip and palate are most common in American Indian and Asian children.
Why is orthodontic care so important for a child with cleft lip/palate?
Keeping the teeth and gums healthy prevents loss of teeth which can cause further issues with tooth spacing, bite, and speech. Furthermore, good oral health is important for all children. Orthodontic treatment for children with dentofacial conditions is an important part of a coordinated approach to treatment.
Why should a dentist be a part of my child’s cleft treatment plan?
Your child’s dentist will see him or her on a regular basis and can monitor the growth and position of your child’s teeth as well as identify potential problems.