Craniofacial Orthodontics

Our office has been involved with the Cleft Lip/Cleft Palate Clinic of Eastern Maine Medical Center for over 30 years. One day a month, Dr. Jamie goes to the Pediatric Specialty clinic for the patient's yearly evaluations. He meets with all the other members of the team allowing them to provide the most comprehensive care for these patients.

Craniofacial Orthodontics – Cleft Lip and Palate

What is Craniofacial Orthodontics?

Craniofacial orthodontics is a sub-specialty of orthodontics that focuses on the treatment of patients with birth defects such as cleft lip and palate. The orthodontist will work with a team comprised of speech pathologists, oral surgeons, pediatricians, peditric dentists, and craniofacial plastic surgeons in planning treatment to correct cleft lip and palate, as well as other jaw and face abnormalities. As a member of a craniofacial team, a craniofacial orthodontist evaluates tooth and jaw development and growth. He or she takes care of the non-surgical treatment of the position of the jaws, and is also responsible for the pre- and post-operative treatment of jaw surgery, monitoring growth by means of X-rays and models.

What is a Cleft Lip and Palate?

Cleft lip and cleft palate are orofacial malformations that occur early in pregnancy, before the baby is born, in which the parts of the face that form the upper lip and mouth do not join together properly. A cleft lip, which can be unilateral or bilateral, occurs as a result of a failed fusion of the two sides of the upper lip. A cleft palate is the result of a failed fusion of the primary of secondary palate.  It can involve both the hard bony palate or the soft palate in the back of the mouth. While the defect occurs in early fetal development, in most cases, the cause is unknown. However, there appears to be a link with genetics and maternal environmental exposures during pregnancy.

While there are certainly aesthetic considerations associated with cleft lip and palate, having this birth defect can affect people in many more serious ways.

  • Difficulty Eating – When there is a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. While waiting for surgery, patients can use specially designed prosthetics to help keep fluids flowing downward towards the stomach, ensuring that they receive adequate nutrition.
  • Speech Difficulties – Because the upper lip and palate are not properly formed, it may be difficult for children to speak clearly, and when they do, it may produce a nasal sound. As speech may be hard to understand, a speech pathologist may be used to resolve these issues.
  • Ear Infections – Cleft lip and palate can lead to a buildup of fluid in the middle ear, leaving children at a higher risk for ear infections, and if not properly treated, even deafness. To prevent infections, small tubes may be placed in the eardrums to facilitate fluid drainage.
  • Dental Problems – Children who suffer from cleft lip and palate also often have missing, malformed, or displaced teeth, leading to a higher number of cavities and other dental and orthodontic issues.

Treatment

Services and treatment for children with orofacial clefts can vary depending on the severity of the cleft; the child’s age and needs; and the presence of associated syndromes. Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life or earlier if possible. Many children will need additional surgical procedures as they get older. Surgical repair can improve the look and appearance of a child’s face and might also improve breathing, hearing, and speech and language development. Children born with orofacial clefts might need other types of treatments and services, such as special dental or orthodontic care or speech therapy. Because children with orofacial clefts often require a variety of services that need to be provided in a coordinated manner throughout childhood and into adolescence and sometimes adulthood, the American Cleft Palate - Craniofacial Association recommends services and treatment by cleft and craniofacial teams. Cleft and craniofacial teams provide a coordinated approach to care for children with orofacial clefts. These teams usually consist of experienced and qualified physicians and health care providers from different specialties.1

References

1. http://www.cdc.gov/ncbddd/birthdefects/cleftlip.html