According to the Journal of Medical Sciences, cleft lip and palate (CLP) occurs in about 1 in 700 live births, making it the most common orofacial congenital malformation. Patients born with CLP not only experience aesthetic, speech, eating, hearing and psychological problems, but also a higher incidence of certain dental anomalies compared to the general population. Some of the dental anomalies experienced by these patients include missing teeth (most commonly the maxillary lateral incisors and lower incisors), supernumerary teeth, malocclusion, ectopic tooth eruption, delayed tooth development and morphological anomalies in both deciduous and permanent dentition.
Because CLP patients experience a multitude of complications, it is challenging to alleviate the consequences of the defect, which also have a significant and long-term impact on patients’ facial anatomy and self-esteem. For this reason, young CLP patients require the care, love, education, fortitude, and teamwork of many players.
CLP team: Being a bilateral CLP patient myself, my team included a plastic surgeon, oral and maxillofacial surgeon, general and pediatric dentists, orthodontist, nurses, ENT physician, pediatrician, and speech therapist, all whom I saw before age eight. It is crucial to have a strong interdisciplinary team of specialists to work with the patient’s family to develop and follow a treatment plan from the time the child is born to young adulthood. Being in the patient chair was certainly a long and arduous journey for me, but I was blessed to have such great members of my team to assist me along the way to improve not only the aesthetics of my smile, but also the function!
CLP treatment: The general timeline for CLP treatment involves key interventions at certain age ranges. At 1-4 months, the child’s cleft lip is often repaired, while at 5-15 months, the child’s cleft palate is repaired. At 2-5 years, rhinoplasty is often performed, while at 6-11 years, orthodontic treatment and alveolar bone grafting are needed. Additional rhinoplasty, orthodontic treatment, and bone grafting may continue up to 21 years of age.
The future of CLP repair through new research and treatments: In utero surgery is an exciting intervention that may become possible as fetal surgery becomes safer for the mother and the fetus. It has the potential to minimize the ripple effect of scarring and to decrease the number of post-natal reconstructive surgeries in CLP children. Current studies are being conducted to determine the impact of reduced scarring on craniofacial growth after in utero palatal repair.
Nasoalveolar molding (NAM) is a recent advancement designed as a nonsurgical way of reshaping the gums, lips, and nostrils with a plastic plate before a child’s CLP surgery. NAM may decrease the number of surgeries the child needs as it makes the cleft smaller. This in turn provides less tension and less reshaping that is needed when the surgeon closes the cleft.
In essence, the CLP patient is indeed an anomaly with a multifaceted defect that makes treatment complex. However, this is also what makes them different and unique, a treasure who may just be one of the best patients you ever come across (not biased of course!). These patients may be more shy and calm during procedures like myself, primarily due to experiencing so many CLP surgeries that we have learned to build up any pain tolerance with a smile. But one thing for sure is that being part of a child’s CLP transformation team will likely be one of the most rewarding things you experience as a dental professional, as you watch the child grow up and overcome self-esteem challenges with confidence: confidence to change the world, one smile at a time!
~Katherine Ong, predental, incoming Maryland ’20