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, pediatric dentist, ENT surgeons, oral surgeons, and craniofacial plastic surgeons in planning treatment to correct cleft lip and palate, as well as other jaw and face abnormalities. Dr. Foley has worked on the Thames Valley Cleft team for 20 years serving London and Southwestern Ontario. As a member of a TVCC cleft and craniofacial team, a craniofacial orthodontist evaluates tooth and jaw development and growth. He takes care of the non-surgical treatment of the position of the jaws. As well, he is also responsible for the pre- and post-operative treatment of jaw surgery, monitoring growth by means of X-rays and models. These records are to be stored at Thames Valley Children’s Centre for long term evaluation of these patients.
What is a Cleft Lip and Palate?
Cleft lip and cleft palate are facial malformations in which the parts of the face that form the upper lip and mouth remain split, instead of sealing together before birth. Similar splits can occur in the roof of the mouth, or palate. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly. 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 esthetic 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 - The Process
The treatment for cleft lip and palate is most likely surgery, and this is where your craniofacial orthodontist and team of specialists in London, Ontario come in. Dr. Foley’s orthodontic role in cleft care starts at birth, where he fabricates infant orthopedic appliance for cleft lip and plate infants.
The aim of orthodontic treatment is, where possible, to align all the teeth and close all residual spaces without the use of bridges or dentures.
At age 8, Dr. Foley and the team will review children with alveolar bone concerns for orthodontic treatment to prepare for alveolar bone graft. In most cases, however, expansion of the maxilla and bone grafting of the alveolus (tooth bearing portion of the upper jaw) is necessary, with the expansion beginning at about 8 to 9 years of age. The purpose of the expansion is to bring the child’s teeth into correct relationship to each other. When this has been deemed successful, the maxillo-facial surgeon then places a bone graft (from the top of the hip bone) to replace the missing bony tissue. The expanded position of the dental arch is maintained for 6 to 12 months by which time the graft should have taken successfully. Depending on the severity of the case, more than one surgery may be necessary. In children, surgery usually takes place between three and six months of age. The procedure should be completed by the age of 10.
Full orthodontic alignment can start with the use of fixed braces when all the permanent teeth have erupted (usually by the age of 12- 13 years).
In a significant number of cases an osteotomy to correct a misalignment of the dental arches is necessary and this surgery is carried out at about 18 years of age. In the majority of cases this surgery gives very good results.