**1.3 Medical/behavioral presentation**

Cleft lip and palate patients may present with numerous behavioral/ medical conditions that can influence orthodontic management. Unfavorable behavioral characteristics can lead to poor oral hygiene and co-operation with orthodontic treatment. Medically, patients may also exhibit neuromuscular anomalies, mental retardation, frequent upper respiratory infections and enlarged adenoids/tonsils. Cleft lip and palate patients may also present with associating syndromes. Associating syndromes with autosomal dominant inheritance include Van der Woude syndrome, Apert syndrome, Treacher Collins syndrome, Cleidocranial syndrome, Ectodermal dysplasia, Pierre Robin sequence and Stickler's syndrome. Roberts syndrome, Christian syndrome and Meckel syndrome are also examples of syndromes with autosomal recessive inheritance patterns.

As a consequence of the above, cleft patients are seen multiple times by an orthodontist from a young age to monitor their dental development and jaw growth. The majority of patients will require orthodontic intervention at various stages extending from presurgical nasoalveolar molding as a baby to orthodontic preparation before alveolar bone grafting in the mixed dentition to alignment of the upper arch once the permanent dentition is established. Patients may undergo a second course of orthodontic treatment on cessation of jaw growth to either camouflage an underlying skeletal discrepancy or in preparation for orthognathic surgery.

**21**

**Figure 1.**

*patients.*

*Orthodontic Management of Cleft Lip and Palate Patients*

Management of the cleft lip and or palate patient is a multi-disciplinary approach involving a number of health care professionals illustrated in **Figure 1**. All members of the multi-disciplinary team are deemed to be equally important and it is prudent that they all work in tandem with each other to ultimately improve a

The orthodontist is involved in the management pathway at a number of differ-

Occasionally, an orthodontist is involved prior to the birth of a baby if a cleft lip and or palate is diagnosed on a 20 week scan. Ultrasonography is a noninvasive diagnostic tool which is widely used. The unexpected finding is a considerable psychological blow to parents and counseling is often necessary. In a district general hospital an orthodontist may be called to counsel the parents on the process and subsequently pass on the details to a hub cleft lip and palate

Postnatally the orthodontist may be required to continue to provide support and counseling to the parents. Additionally, the orthodontist may be involved in the identification of syndrome related conditions and congenital disorders. Cleft patients may also be born with mobile natal teeth which require assessment and

*Illustrative diagram of members involved in the multi-disciplinary management of cleft lip and palate* 

*DOI: http://dx.doi.org/10.5772/intechopen.90076*

patient's appearance, speech and function.

**2. Integrated care pathway**

**2.1 Ante/post-natal stage**

ent stages:

Centre.

possible extraction.
