Orthodontic management of sequelae of facial clefts
Georges Herzog, orthodontist spéc. SSO.
Orthodontics is one of the specialties of the multi-disciplinary team dealing with the sequelae of palatal, labial, labio-maxillary and labio-maxillo-palatal clefts. All children and adolescents affected by the malformation are followed, assessed regularly on the dental and orthodontic planes and the majority, if not all, will require orthodontic treatment at some point in time during their growth and development.
It should be stated in the preamble that there are as many treatment concepts as active teams. This has been highlighted by numerous studies and surveys, such as the community project known as Eurocleft (2001).
Unfortunately, on many points, there is little or no consensus: technique and timing of primary surgical procedures, need and usefulness of a palatal plate (feeding plate) need and timing of alveolar bone graft, indication for early orthopaedic (orthodontic) treatment, need and indications for orthognathic surgical management.
This page does not pretend to be representative or to constitute a sort of method, a system worthy of being recommended and generalized. It simply reflects the vision and treatment concepts of a multi-disciplinary team, based on the experience of the specialists on this team.
The problems encountered vary with the severity of the initial cleft. An isolated cleft of the palate will have less severe consequences than a complete uni- or bi-lateral cleft involving the primary palate and the secondary palate. We will therefore consider first and foremost the orthodontic treatment of complete clefts.
Sequelae of the facial clefts affect the craniofacial complex as a whole. The inter-maxillary relationships are affected by the growth disorders induced by the malformation itself and subsequent deformities, which are largely caused by the scar tissue-related inhibitions that inevitably primary surgery has produced (Fig. 1). This scar tissue intervenes in areas of sensitive growth: the alveolar bone and the supporting tissues of the teeth, the palate, the base of the nose, the soft tissues, etc.
Fig 1 Scar tissue : left, cleft of the lip and palate ; right, isoéated cleft of the palate