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Dr. Fawzi Alqatami
Diplomate of the American Board of Orthodontics
Ministry of Health, Kuwait
Cleft lip and cleft palate are a complex subject, especially when the family is informed about having a baby with cleft. Having a good understanding of your child’s need will simplify the process for sure. So let’s start explaining the process.
First, we consider all the patients that we had a privilege of treating as our own kids. We always inform the families that their child – according to his / her case – will take part in a program or a journey. This program will last for the first 18 years of his/her life, so we will get to know your child and you will get to know us really well over the years. There will be several doctors and specialists involved in taking care of your child; as they will work towards a single goal, which is providing the best available care; in order to achieve the best result. To achieve this goal, we will need your help and support. You are part of our team now.
The journey begins by receiving the news that your child has a cleft, this could be during your pregnancy or right after childbirth. This news is usually very stressful and upsetting, we understand that. Some parents would even feel guilty, but don’t worry, we are here to provide you with help and support. The best way for you and your spouse to overcome all the emotions before welcoming your child, if diagnosed prenatally, is to obtain all the necessary information on your child’s needs and know where to go and who to see. Depending on the cleft’s type (complete or incomplete, one or both sides) and after being discharged from the maternity hospital, you will need to see the team; in order to assess your child’s need regarding the presurgical infant orthopedics (Nasoalveolar Molding “NAM” Technique) and the cleft closure surgery. The Orthodontist, in coordination with the Plastic Surgeon, will decide on the treatment phases and the estimated time for the first and second surgeries during the first 12 months. The role of the NAM Technique is to improve the shape of your child’s nose and the cleft segments in order for the Plastic Surgeon to perform the closure surgery for the lip and nose with the best clinical outcome. The NAM phase can last between 3-6 months depending on cleft’s type and severity. You can find more about NAM by clicking here.
At the same time, you will need to resume your regular checkup visits with your child’s pediatrician to make sure that the weight gain is as expected. There are some modified bottles with certain techniques; in order to facilitate the feeding process for you and your baby. During the first 3 months of your child’s life, a consultation with an E.N.T. (Ear, Nose and Throat) Specialist is needed to ensure that the child’s hearing is fine and no ear infection is present. If needed, your child’s E.N.T. Specialist will determine when and if tubes are needed.
After completion of the NAM Technique, i.e. the primary closure of the lip and nose, the lip closure surgery will take place. The next 4-6 months will be a period where you and your child will have a break. At the age of 10-14 months and if your child has a cleft palate, a palatal closure surgery will be needed. This is an important step for the Plastic Surgeon to close the opening and connect the palate’s muscles.
Once the palatal surgery is completed, the next 3-6 years will be a period where your child will need to work closely with his/her pediatric dentist, speech therapist and pediatrician. The Pediatric Dentist’s role will be to explain and supervise the correct oral hygiene practices; in order to prevent cavities. Furthermore, they will perform the necessary cleanings and the fluoride application that are required. Once your child’s teeth start erupting, we will need to take care of every single one of them. They will be extremely important for the next phase in the later years to come. The visits to the Pediatric Dentist will need to be every 3-6 months. The Speech Specialist’s role will be to make sure that all the muscles that were repaired are working properly when your child speaks. Sometimes children with cleft lip and cleft palate learn incorrect pronunciation of some sounds, such as the letters B M and K. When that happens, your child will need to be taught how to produce these sounds in the correct manner. If intervention is needed, the Speech-Language Pathology (SLP) Therapist and the E.N.T. Specialist may need to do a nasal endoscopy (camera in the nose). Obviously, your visits with your child’s pediatrician must continue; in order to ensure his/her well-being.
When your child’s adult teeth start erupting at the age of 7 years old onwards, the Orthodontist will need to be involved again to ensure that the teeth emerge in the right place and order. Sometimes, there will be a need to make the upper jaw wider due to the scar tissue that occurred after the palatal surgery that was performed. At this phase, the Orthodontist will also need to evaluate the amount of bone available in the area where the cleft was. A detailed plan will be designed for when and if the bone graft surgery is available. There will be many factors that will play into this decision. Between the ages of 7-9 years old, some children with cleft lip and palate will have delayed growth in the upper jaw or excessive growth in the lower jaw. An interceptive orthodontic treatment may be beneficial for your child. Your Orthodontist will be the best specialist to assess the need and advise you on what to do.
At the phase where all the permanent teeth have erupted, usually around the age of 12 years old, a detailed evaluation of the growth levels of the upper and lower jaw will need to be completed by your Orthodontist. This will be the time to check if your child will need a corrective jaw surgery, which is usually a common need for children with cleft lip and cleft palate. A detailed orthodontic treatment plan will be designed according to your child’s need. If a corrective jaw surgery is indicated, the orthodontic treatment will be delayed until the end of the growth of lower jaw; in order to achieve the best and most stable results; this is usually carried out after the age of 18 years old. An Oral and Maxillofacial Surgeon will need to be consulted in coordination with your Orthodontist; in order to design the best treatment plan and check the growth cessation.
At the end of the 18 years of the journey of treating your child, any corrective revision surgery of the lip or nose can be assessed by the Plastic Surgeon.
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