**Cleft Lip and Palate Patients: Diagnosis and Treatment Cleft Lip and Palate Patients: Diagnosis and Treatment**

Letizia Perillo, Fabrizia d'Apuzzo, Sara Eslami and Abdolreza Jamilian and Abdolreza Jamilian Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Letizia Perillo, Fabrizia d'Apuzzo, Sara Eslami

http://dx.doi.org/10.5772/67328

#### **Abstract**

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22 Designing Strategies for Cleft Lip and Palate Care

2009;140:80–4.

7907.2010.483510

55. doi:10.1093/aje/kwi132

Cleft lip or palate is one of the most common types of craniomaxillofacial birth anomalies. Midface deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure. Cleft lip and palate patients should be carefully evaluated by the craniofacial team in order to detect potentially serious deformities. Craniofacial team is involved with diagnosis of facial morphology, feeding problems, guidance of the growth and development of the face, occlusion, dentition, hearing and speech problems, and psychosocial issues and jaw discrepancy of the patients with cleft lip and palate or craniofacial syndromes. Treatment for cleft children requires a multidisciplinary approach including facial surgery in the first months of life, preventive and interceptive treatment in primary dentition, speech therapy, orthodontics in the mixed dentition phase, oromaxillofacial surgery, and implant and prosthetics in adults. Treatment plan from orthodontic perspective can be divided into the following stages based on the dentition stages: (1) presurgical orthopedics, (2) primary dentition, (3) mixed dentition, and (4) permanent dentition. The aim of this chapter is to assess a rational team work approach in the management of the patient with cleft lip and/or palate from birth to adulthood.

**Keywords:** cleft lip, cleft palate, diagnosis, treatment, maxillary deficiency

#### **1. Introduction**

Cleft lip or palate is one of the most common types of cranio-maxillofacial birth anomalies. It accounts for 65% of all head and neck deformities [1]. Maxillary deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure. For treatment of maxillary deficiency, various devices, such as facemask [2], protraction headgear [3], orthopedic mask [4], reverse chin cup [5], tongue appliance [6], tongue plate [7], surgically assisted orthopedic protraction, and distraction osteogenesis have been introduced [8]. Treatment of

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

cleft lip and palate in patients should be started after birth and continues to adulthood. Lip closure and palatal closure are performed at 3 months and around 12 months of age, respectively, as well as secondary alveolar bone graft is done between 9 and 12 years of age [9]. However, orthodontic intervention usually begins during the mixed dentition. Orthodontic treatment in patients with cleft lip and palate are focused on maxillary arch expansion, correction of upper incisor misalignments, gross rotations of incisors, and crossbites and correction of Class III skeletal growth pattern. Patients with cleft lip and/or palate should be treated by teamwork. The team conception allows a systematic treatment plan to be developed and allows the team members to work together properly to identify problems. Orthodontic treatment plan can be divided into the following stages based on the dentition stages: (1) presurgical orthopedics, (2) primary dentition, (3) mixed dentition, and (4) permanent dentition.

In the following sections about diagnosis, classification, and treatment options in different period of time are discussed. Therefore, the aim of this chapter is to assess a rational teamwork approach to the management of the patient with cleft lip and/or palate from birth to adulthood.

## **2. Diagnostic considerations**

Ultrasonography serves as a noninvasive diagnostic tool, now regularly recommended as a routine component of prenatal consideration. This noninvasive diagnostic tool helps to determine gestational age, confirm fetal viability, check placental location, establish the growth and their number of fetuses, and examine fetal anatomy to detect any deformities [10].
