Principles of the treatment

Rehabilitation in multidisciplinary centers as the most optimal way for successful cleft treatment is accepted in whole world; this and close cooperation between patient, cleft team, and family, are very important for reaching the best results.
To ensure planning and commencing of treatment in appropriate time, the first consultation is recommended as soon as possible (at 7th – 14th day after birth).


Surgical Treatment

The most appropriate methods and maturities for surgery are developed, based on analysis of the treatment results and long-term experience. Nevertheless, results of surgical operations depends on growth and overall health conditions of a child. A superior care, regular health controls, and close cooperation with family doctor are recommended.
Primary surgical operations:

• Primary lip plastic and nose correction – at the age of 3 – 5 months
• Soft palate plastic – at the age of 8 – 12 months
• Hard palate plastic – at the 3-4 years of age
• Soft and hard palate plastic in one stage – at the 3 – 4 years of age
• Alveolar bone grafting – at the 7-10 years of age.
  

Primary operations have be performed at due time.

Several secondary surgical operations are performed, too:

• Secondary nose plastic
• Secondary lip plastic
• Pharyngeal flap surgery for palatal rehabilitation and support of better speech development, etc.
  

Closure of Cleft Lip

Recommended after stabilization of infant`s weight and adaptation to environment – at the 3 – 5 months of age.


Complete cleft lip and palate before primary lip plastic and scheme of cleft lip closure


Complete cleft lip and palate 3 years after primary lip plastic


Closure of Cleft Palate

Optimal age of palatal cleft closure depends on form of the cleft.
In case of cleft soft palate only, closure is recommended during the first year of life (at the age of 8 – 12 months), for better speech development.
If cleft affects hard palate also, surgery is recommended later (appropriate time is denoted individually, often at the age of 3 – 4 years), as there could be a risk of wrong jaw development.
In cases of complete cleft of lip, alveolus and palate, surgery is recommended in two stages - soft palate closure, as the first stage, at the age of 8-12 months; and hard palate closure, as the second stage, at the age of 3-4 years).


Soft and hard palate cleft before the soft palate plastics


Soft palate plastic scheme


Hard palate plastic scheme


Alveolar bone grafting

In majority, cleft lip or complete cleft lip and palate are combined with cleft alveolar ridge region.  Such malformation deters eruption of maxillary lateral incisors. For aesthetic and functional dental arch, replacement of this malformation with bone graft is necessary. This is recommended before eruption of nearest teeth, at the age of 7-10 years.




Dental arch after orthodontic treatment before alveolar bone grafting, operation scheme, and dental arch after canine eruption scheme


Orthodontic treatment

Early orthodontic treatment is necessary in cases of complete cleft lip and palate. It means wearing of orthodontic appliances starting from the first days of infants` life until the primary lip plastic. These appliances:

• establishes aesthetics for the infant and psychological comfort for parents
• prevents food entering in nose
• facilitates normal breathing
• prevents  tongue entering in the cleft
• keep fragments of the jaw together and promotes better development of maxillar arch

In the cases of isolated lip or palate clefts and early orthodontic is not necessary.