Cleft palate is a congenital malformation suffered by a large number of newborns. Among the various types are cleft lip isolated or associated with cleft palate, more frequent in males, and cleft palate isolated, more frequent in females.
Causes of cleft palate or cleft palate
Less than a quarter of the cases of this disease have a syndromic character, and of the remaining part, half are associated with systemic malformations. It can also be associated with different syndromes such as Goldenhar syndrome (congenital disease that affects cheekbones, maxilla and mandible, mouth, ears, eyes and bones of the spine), and Larsen syndrome (multiple congenital dislocations with skeletal dysplasia and deformities in bones, joints and tendons), among others.
Consequences of cleft palate or cleft palate
The lack of fusion of the mamelons that give rise to a correct development of that part of the facial mass can be classified into different types:
Types of cleft lip
- Scar lip: slight depression of the mucosal border.
- Simple cleft lip: with continuity of the alveolar arch.
- Total cleft lip: affects the entire lip and primary palate.
- Central palatal lip
Types of cleft palate
- Alveolar cleft palate
- Simple cleft palate
- Total unilateral cleft palate (includes primary palate)
- Bilateral total cleft palate (includes primary palate)
- Central cleft palate (plus central cleft lip).
All this obviously leads to the affectation of the functions of phonation, chewing, swallowing and aesthetic deficits, which will be the objective of the different phases of treatment.
Cleft palate or cleft palate treatment
The treatment in dentistry is very complex and lasts for years. As a possible protocol to follow to treat cleft palate or cleft palate of a newborn are the following points to consider:
- Up to the first week after birth a first consultation with a medical team and an orthodontist should be performed.
- During the first month, a basic blood test, a chest X-ray, a genetic analysis, an abdominal ultrasound, an echocardiography, a consultation with a pediatrician, a geneticist and a radiologist should be performed.
- From the first to the third month it is advisable to perform a cheiloplasty and a primary rhinoplasty with a maxillofacial surgeon.
- From the sixth to the ninth month the parents should be more actively involved with speech therapy and a speech therapist.
- During the ninth month it is important to perform an audiometry, a middle ear evaluation with an otolaryngologist.
- Between 12 and 18 months a palatoplasty should be performed.
- From 3 to 5 years of age, a mixed dentition control, a maxillary expansion with a dentist. – During the first year up to 6 years of age, speech controls should be performed every six months by a speech therapist.
- At 5 years of age, an evaluation of velopharyngeal insufficiency, a nasofibroscopy with a maxillofacial surgeon and a speech therapist.
- Between 5 and 6 years of age, a pharyngoscopy, secondary rhinoplasty, adenoids and tonsils with a maxillofacial surgeon and an otolaryngologist.
- Between the ages of 7 and 9, an alveoplasty, orthodontics and periodontics with a maxillofacial surgeon and a dentist.
- Between the ages of 9 and 14 years an orthodontics and an evaluation for possible implants by a dentist.
- Between 16 and 18 years of age, orthognathic surgery to correct possible sequelae in the lip and nose. Performed by a maxillofacial surgeon and a dentist.