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I am an orthodontist and we also deal with children having cleft lip and plate. These children require multidisciplinary treatment with the involvement of different healthcare provider team. The timing of orthodontic treatment, orthopedic treatment involving jaws and surgical treatment of lip, palate, and jaws needs special emphasis. Ask me anything!

Dr. Aisha
Jun 18, 2017

Cleft lip and palate patients require treatment from multiple healthcare providers amongst which Orthodontist also play a major role. These children often have multiple missing teeth due to the cleft alveolus. In addition, their midface growth remains deficient due to earlier palatal surgery leading to scar formation. This patient may require early orthopedic treatment or can be later treated orthodontically and surgically. Ask me anything! 

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Are you a specialist only for children or do you treat adults too?

Jun 17, 3:16AM EDT0

I am an Orthodontist and I dealt with both children and adult patients. As for cleft lip and palate patients, we treat them in coordination with other healthcare team members to give these children the best possible outcome. 

Last edited @ Jun 17, 9:26AM EDT.
Jun 17, 9:25AM EDT0

Are children with cleft palate required to wear braces post surgery and treatment?

Jun 16, 8:36PM EDT0

Yes, patients with cleft palate are often with cleft alveolus which also affects the dentition. In addition, they have tipped, rotated, supernumerary and missing teeth. Hence they usually require braces

Jun 17, 9:24AM EDT0

What exactly happens during the palate repair surgery?

Jun 16, 10:20AM EDT0

Cleft palate is a hole or fistula in the roof of the mouth and occurs when the palatine shelves do not fuse during the early developmental years. This cleft results in a number of problems related to feeding, speech, growth etc. So we treat this cleft or hole by surgical repair during 9-18 months of child's age. The goal of this surgery is to achieve proper seal so that food and drink do not regurgitate and to allow articulating and achieve normal speech.

The surgery is undertaken under general anesthesia and is usually performed in a single day. The surgeon gives you special instructions for pre-operative and post-operative care that you must have to follow. 

Hope this answers your question

Jun 18, 11:22AM EDT0

Does tooth correction through braces improve the overall look of a person?

Jun 16, 1:14AM EDT0

Yes, it definitely improves the overall aesthetics and appearance. If the braces treatment is done in concordance with orthognathic surgery then it can completely change the overall look by changing the orientation of malaligned jaws and teeth.

Jun 17, 9:27AM EDT0

Is it always necessary to treat buck teeth or an underbite?

Jun 16, 12:17AM EDT0

As an orthodontist, we usually advise treatment for buck teeth as they can deteriorate your child's physical appearance, decrease his confidence and can cause stress related to bullying. Furthermore, there is an increased chance of trauma to the forwardly placed teeth. 

Underbite or Class III malocclusion must have to be treated as it causes difficulty in chewing, mastication as well as it may lead to a temporomandibular joint problems in future. 

Jun 18, 11:29AM EDT0

How many hours does the palate repair surgery take and what kind of repairs are done during the surgery?

Jun 15, 6:38PM EDT0

Depending on the type of surgery, it usually takes 2-6 hours to repair a cleft or hole.The child has to stay overnight for post-surgical recovery.  The surgeon connects the muscles of the soft palate and rearranges the tissues to close the hole. 

There are different kinds of repair depending upon the cleft type i.e. if it is isolated cleft palate or it's in association with unilateral or bilateral cleft palate. This may include simple palatal closure, palatal closure with lengthening and closure with palatal muscle reapproximation

Please feel free to ask if you have any further questions

Jun 18, 11:39AM EDT0

What is the right age for a child to begin orthodontic treatment?

Jun 15, 6:29PM EDT0

What help is available for children with unclear speech or nasal-sounding speech?

Jun 15, 7:30AM EDT0

I am not a speech therapist to tell you in detail about speech related problems but I can provide a little info on it. 

1. Speech therapists help in articulation of sounds by making your child to correctly position the tongue and lips

2. Certain devices such as obturators and speech bulb can be used

3. In the case of velopharyngeal problem/fistula, surgery like the pharyngeal flap is required.

It is important to discuss the treatment of speech problems with the speech-language pathologist (SLP) who has special knowledge and skills to accurately diagnose and treat or monitor treatment of your child's speech problems

Jun 18, 11:40AM EDT0

Do children feel pain or are they provided enough medications to numb them till recovery?

Jun 15, 2:05AM EDT0

The children after surgery are provided with analgesic medications for pain relief

Jun 18, 11:47AM EDT0

What are the chances of children with a cleft palate developing glue ear?

Jun 14, 3:18PM EDT0

Glue ear is very common in these patients especially before the age of one and can remain for a longer period of time due to the abnormalities of the eustachian tube. It may or may not occur along with hearing issues.

Jun 14, 4:53PM EDT0

What kind of monitoring or help is provided during speech and language therapy?

Jun 14, 1:24PM EDT0

I am not a speech therapist to tell you in detail about speech related problems but I can provide a little info on it. 

1. Speech therapists help in articulation of sounds by making your child to correctly position the tongue and lips

2. Certain devices such as obturators and speech bulb can be used

3. In the case of velopharyngeal problem/fistula, surgery like the pharyngeal flap is required.

It is important to discuss the treatment of speech problems with the speech-language pathologist (SLP) who has special knowledge and skills to accurately diagnose and treat or monitor treatment of your child's speech problems. 

Jun 14, 4:54PM EDT0

Which is the correct age for the bone graft surgery to correct the cleft in the gum area?

Jun 14, 4:18AM EDT0

The ideal timing for alveolar bone grafting is 10-11 years when the canine is erupting. In case of missing lateral incisor, alveolar bone grafting is done a little earlier. The goal is to erupt the tooth into the bone so that the erupting tooth also brings its bone into the newly grafted area. This increases the chances of survival of graft. 

Jun 14, 4:56PM EDT0

In which cases additional surgery is required to repair the gum?

Jun 14, 2:57AM EDT0

What kind of multidisciplinary treatment is required for children having a cleft palate?

Jun 13, 10:01PM EDT0

These children require:

1. ENT specialist - for their glue ear and hearing problems

2. Speech therapist - for speech and language therapy

3. Orthodontist- for teeth alignment and guidance of eruption

4. Plastic Surgeon- for alveolar bone grafting, lip and nose revision

5. Orthognathic surgeon - for correcting their jaws

6. Restorative dentist- for prosthesis placement

7. Geneticist- to evaluate the genetic etiology

8. Psychologist- for counseling and psychological evaluation

9. Nursing care - for feeding and nursing training

Jun 14, 5:13PM EDT0

Which additional problems are babies with a cleft palate susceptible to?

Jun 13, 5:27PM EDT0

These children have many other problems that have to be dealt by a different team member. The problems may include glue ear or hearing issues, speech and language problems, teeth and gums problems, a deficient growth of maxilla leading to jaw imbalances, alveolar bone deficiency needing a graft, problems with feeding and nursing, psychosocial issues and others.

Jun 15, 6:42AM EDT0

What is the best time for a nose correction surgery in children with cleft palate?

Jun 13, 5:27PM EDT0

How many years does a cleft palate treatment usually last?

Jun 13, 5:10PM EDT0

Is it possible to treat overcrowded teeth without tooth extraction?

Jun 13, 3:52PM EDT0

If there are already existing spaces available to accommodate the blocked out teeth, then it can be treated simply by slicing or trimming of teeth or by expansion places which expand the arches but if the teeth are overcrowded then usually extraction is mandatory

Jun 15, 5:28PM EDT0

What is the right time for brace treatment in babies having had cleft palate surgery?

Jun 13, 3:43PM EDT0

Do children face any speech handicaps or require additional assistance or therapy post surgery?

Jun 13, 2:36PM EDT0

What kind of treatment plan is available for babies with a cleft palate?

Jun 13, 1:40PM EDT0

Which is the best time for surgery to repair a cleft palate in babies?

Jun 13, 11:54AM EDT0

Cleft palate surgery is usually repaired at the age of 12-18 months of age.

Jun 13, 12:44PM EDT0

Until what age is orthodontic monitoring required for children undergoing cleft palate surgery?

Jun 13, 11:36AM EDT0

Presurgical orthopedics which consists of naso-alveolar molding with adhesive tapes and stents can be started as early as 6 months of age. But the proper alignment of teeth and arches is usually undertaken in mixed dentition (after 8 years). The ortho follow-up continues along with the alveolar bone grafting (as we bring the tooth into the newly formed bone to promote better outcome). The final orthodontic-orthognathic plan is taken in adulthood where there is no further growth remaining. In short, these individuals require long-term monitoring.

Jun 13, 12:51PM EDT0

What age is considered the best time to treat cleft lip in babies?

Jun 13, 9:08AM EDT0

Cleft lip is usually repaired at 3 months of age.

Jun 13, 12:52PM EDT0

How can a person know whether they require orthodontic treatment?

Jun 13, 8:27AM EDT0

What causes cleft lip and plate in babies and children?

Jun 13, 7:05AM EDT0

Do children get to live a normal life post surgery for a cleft lip or palate?

Jun 13, 5:42AM EDT0

What kind of help is available for feeding babies who have a cleft palate and cannot breastfeed easily?

Jun 13, 4:37AM EDT0

To minimize the risk of aspiration of milk or fluid in these children, special feeding equipments are available. There are also support groups who provide education and counseling to the parent of these children.  use of obturator appliance, feed slowly, let the child burp frequently, always feed in an upright position, place your child on the side after feeding, and keep suction equipment to prevent aspiration and regurgitation.

Use of the special type of teets or an obturator appliance is advisable. Also, we advise parents to feed slowly, let the child burp frequently, always feed in an upright position, place your child on the side after feeding, and keep suction equipment to prevent aspiration and regurgitation.

Jun 14, 4:05AM EDT0

What kind of treatment is available for children suffering from glue ear?

Jun 13, 12:33AM EDT0

Glue ear which is called otitis media with effusion is common in cleft lip and palate patients. It can get better without treatment or sometimes require surgical treatment by inserting grommets or by using certain hearing aids. The details of each procedure can be given by ENT specialist (otolaryngologist). 

Thanks

Jun 13, 1:44PM EDT0

What kind of treatments do you provide as an orthodontist apart from cleft lip and palate?

Jun 12, 10:32PM EDT0

We straighten teeth with braces, Invisalign, and lingual braces. We modify the growth of the jaws in preadolescents with functional appliances, we give certain preventive or interceptive treatment to prevent occurrence of malocclusion or getting it severe, we work in coordination with maxillofacial surgeons in orthognathic surgical treatment planning which treat faces, jaws, and teeth and make it beautiful, we treat impacted canines and other teeth and bring them into the arch and a lot more to write in a short paragraph :)

Jun 12, 11:19PM EDT0

How do the speech and language therapist help children post cleft surgery?

Jun 12, 10:15PM EDT0

Dear Linda, 

I am not a speech therapist to tell you in detail about speech related problems but I can provide a little info on it. 

1. Speech therapists help in articulation of sounds by making your child to correctly position the tongue and lips

2. Certain devices such as obturators and speech bulb can be used

3. In the case of velopharyngeal problem/fistula, surgery like pharyngeal flap is required.

It is important to discuss the treatment of speech problems with the speech-language pathologist (SLP) who has special knowledge and skills to accurately diagnose and treat or monitor treatment of your child's speech problems. 

Jun 13, 1:57PM EDT0

Is rhinoplasty really necessary for children with a cleft lip or palate?

Jun 12, 6:21PM EDT0

The development of human face occurs by the fusion of two maxillary,  two mandibular, and frontonasal process. The Cleft lip and nasal deformities occur due to the failure of fusion of maxillary process with the frontonasal process which gives rise to upper lip, philtrum, and part of the nose. 

So, rhinoplasty is necessary for giving proper nasal structure. This is carried out early and later revised in adulthood.

Please feel free to ask if you have any other questions

Jun 12, 10:40PM EDT0

What kind of precautions and care suggested for children with a cleft palate?

Jun 12, 6:14PM EDT0

Children with the cleft palate require special care and precautions preoperatively. These include

1. Minimize the risk of aspiration of milk or fluid: This can be done by using special feeding equipment, use of obturator appliance, feed slowly, let the child burp frequently, always feed in an upright position, place your child on the side after feeding, and keep suction equipment to prevent aspiration and regurgitation.

2. The parents also need education and counseling on feeding, nursing, the surgical procedures necessary for their child, their outcome and post-operative care. Encourage parents to attend support groups. Also emphasize the importance the other related problems with cleft lip and palate such as middle ear infections, dental problems, psychosocial problems, speech problems and others

3. These children also have other anomalies such as middle ear infections, dental problems, psychosocial problems, speech problems and others and hence require multidisciplinary treatment

Cleft lip and palate children need special attention and care and with your support and effort, these children can live a healthy and normal happy life. Let all these kids smile and live happily

Cheers :)

Jun 12, 10:31PM EDT0

How long do kids have to stay in the hospital after a palate repair surgery?

Jun 12, 5:46PM EDT0

Cleft palate surgery takes around 2-6 hours and is done under general anesthesia. It is usually advised to stay overnight or for a day post surgery.

Regards.

Jun 12, 10:11PM EDT0

Does the palate repair surgery leave any visible scars on the face?

Jun 12, 4:37PM EDT0

The cleft palate is usually repaired inside the oral cavity and does not leave any scar on face, however, due to palatal repair and surgical scarring inside, the growth of maxilla is retarded. It is the cleft lip extending to the nose that leaves the visible scar on face.

Cheers :)

Jun 12, 9:02PM EDT0

Is a crossbite harmful and is it really necessary for a person to get treated for the same?

Jun 12, 12:58PM EDT0

Crossbites can be harmful to your temporomandibular joint (TMJ) if persists for a longer duration of time. Moreover, they can also cause difficulty in chewing and masticating food. It is therefore advised to get the proper treatment of crossbite.

Regards

Jun 12, 7:32PM EDT0

Does the lip repair surgery cause visible scarring which remains during their lifetime?

Jun 12, 12:21PM EDT0

It depends on the surgical cut and technique. There are different techniques including Millard Z-plasty and Tennison technique. Many new advanced techniques cause less prominent scarring. The initial lip surgery is usually done at the time of birth or during at three months of age. Later lip revision is again performed during adult life. However, there remain some scar visible throughout life

Hope this answer is helpful. Regards

Last edited @ Jun 12, 10:08PM EDT.
Jun 12, 7:29PM EDT0