CLEFT LIP AND PALATE

                The formation of the face and oral cavity is of complex nature and involves development of multiple tissue processes  that must merge and fuse in a highly orchestrated fashion.Defective fusion of the medial nasal process with the maxillary process  causes cleft lip ; failure of the palatal shelves to fuse results in cleft palate.                                                                                                                                           The problems afflicted on a cleft lip   and palate patient are numerous.....

• The dental problem  like missing teeth,presence of supernumerary teeth,anomalies of tooth morphology,smaller sized tooth,spacing or crowding of the teeth  .
• esthetic problems - facial disfigurement can  vary from mild to severe.
• hearing and speech difficulties.
• psychological stress faced by the patient.

MANAGEMENT OF CLEFT LIP AND PALATE

            The cleft lip treatment is usually multi -professional.  It can be divided into the following stages:

STAGE 1     :  treatment done from birth to 18 months of age.   
        the treatment moalities carried out during this stage are

• fabrication of a passive obturator  :it is an intra oral prosthetic device that provides a false roofing in the child`s mouth which facilitates in feeding and helps the baby to suckle. 
• Presurgical orthopaedics : the aim is to achieve an upper arch form that conforms to the lower arch form.
• surgical management of cleft lip: surgical lip closure is done
• surgical management of cleft palate :   this has to be done between 12 to 24 months of age.this facilitates normal speech, hearing and  improves swallowing

STAGE 2 : this phase  is from 18th month to 5 th year of life .the procedure carried out during this phase are

• adjustments  in the intra oral obturator to accommodate the erupting primary teeth
• to maintain a check on the eruption pattern and timing 
• restoration of the decayed tooth

STAGE 3 : it spans from 6 years to the 11 th year of life . Orthodontic corrections are done during this phase                                            

• anterior crossbites and buccal crossbites are managed by using removable or fixed appliances

STAGE 4 : this phase is carried out during the 12th to 18the year of life.

• fixed orthodontic appliances are provided during this phase to correct irregularities like crowding,spacing,overjet etc.

The key to the successful rehabilitation of a cleft lip and palate includes flexibility and a multidiscilinary approach.