The care for a cleft lip/palate child requires a number of interventions and treatments to bring the parts of the face an mouth back to ideal. These treatment start at birth and are initiated at specific, critical times during growth of the face and teeth.
NAM treatment: Nasal Alveolar Molding started at birth, to re-position and align the gum sections of the upper jaw, reshape the nose and reduce the tension on the cleft lip. The cartilage of the nose can be reshaped for the first 3 months of life. After this early period, they can not be reshaped. The shape of the nose at four months of age will be the shape for the rest of the life. It will grow but not change shape. This treatment can be done with a retainer like device and/or a nasal conformer with various lip tapes. The initial lip and nose surgery is usually done at 3 to 4 months of age.
Alveolar Bone Graft Treatment: The initial lip an nose surgery does not close the gap in the gum. The gum surgery is usually done at age 9 to 11 and is based on the growth of adult teeth in the cleft area, not the child’s age. At age 7 the child will be evaluated with an x-ray to see how close teeth are to the gap in the gums. The gap will be closed just in time so the teeth will grow all the way to the other upper teeth. At this time, the upper jaw usually needs to be reshaped with palate expansion to match the shape of the lower jaw. Also, the upper front tooth usually grows turned 90 degrees from ideal. This alignment issue is also addressed. The lower front teeth, often in front of the upper front teeth are straightened, and a retainer places to keep them from over-growing. The upper jaw may be a little behind the lower jaw creating an underbite.
Adolescent Treatment: At age 13 to 14 when all the remaining adult teeth have grown into the mouth, the teeth are aligned. This step is often combined with the mixed dentition treatment.
Adult Treatment: When the face has completed growth, the upper jaw has often not kept up with the other bones and there is an underbite. At this age braces are placed on all teeth, the dental alignment refined and the upper jaw is moved forward with surgery (LeForte) to catch up with the rest of the face. Final lip an nose surgery is usually done six months after the upper jaw surgery.