Craniofacial Orthodontics

Craniofacial Orthodontics

Craniofacial orthodontics is a subspecialty of the field of orthodontics. It focuses on the treatment of birth defects, most commonly cleft lip and cleft palate. To treat craniofacial issues, a coordinated effort from many disciplines is needed, including medical, surgical, and dental/orthodontics. Patients may be treated from birth into their late teens.

What is cleft lip and palate, and how does it occur?

A cleft lip, or orofacial cleft, occurs when a baby is born with an opening in the lip or roof of the mouth (the palate). This happens when, during the beginning of pregnancy (usually in the first six to 10 weeks) when the bones and tissues of the upper jaw, nose, and mouth are fusing together to form the mouth, palate, and upper lip, these pieces do not fuse properly, leaving an opening.

A cleft lip can look like a small opening at the corner of the lip. It can also extend into the nose and into the gums. Cleft palates can vary in size, affecting either only the soft palate near the back of the throat or could create an opening in the hard palate near the front of the mouth.

The exact cause of cleft lip and palate may not always be clear, but some common factors include genetics (from either the mother or father), medications taken during pregnancy, vitamin deficiencies, or smoking, doing drugs, or drinking during pregnancy.

How are clefts treated?

Cleft lip surgery takes place in a hospital under general anesthesia. A team of doctors is usually needed to treat a cleft lip or palate, including a pediatrician, plastic surgeon, oral surgeon, ear, nose, and throat specialist, orthodontist or craniofacial orthopedic specialist, dentist, and other specialties as needed.

Surgery for cleft lip can be performed on a child when they are three to six months old; it should be performed initially before they turn one. The goal of the surgery is both function and appearance. A surgeon will close the separation in the lip by making incisions on both sides of the cleft. These incisions create flaps of tissue that can then be stitched together to create a more “normal”-looking lip. It will also be able to function properly.

Surgery for cleft palate can occur a little later, typically between nine and 12 months, but definitely before 18 months of age. Different procedures may be used, depending on what type of cleft palate the child has. As with cleft lip surgery, incisions will be made on both sides of the cleft. The tissue and muscles will then be repositioned before the incision is stitched closed.

Follow-up surgeries may be necessary to help improve facial appearance or the child’s speech. These surgeries take place later on, as the child grows and his or her facial structure changes.

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