DEPARTMENT OF PAEDIATRICDEPARTMENT OF PAEDIATRIC
SEMINAR OF CLEFTSEMINAR OF CLEFT
Prenatal Diagnosis.Prenatal Diagnosis.
Protocol For Dental Care.Protocol For Dental Care.
A Multi- Disciplinary Team.A Multi- Disciplinary Team.
Dentofacial OrthopedicsDentofacial Orthopedics
Management of cleft Lip & Nasal Deformity.Management of cleft Lip & Nasal Deformity.
Cleft Palate Repair.Cleft Palate Repair.
Orthodontic Treatment.Orthodontic Treatment.
Role of E.N.T. Specialist, Speech Pathologist.Role of E.N.T. Specialist, Speech Pathologist.
Correction of Maxillary HypoplasiaCorrection of Maxillary Hypoplasia
Correction of Enamel Hypoplasia.Correction of Enamel Hypoplasia.
Role of ProsthodonticsRole of Prosthodontics
Role of PsychologistRole of Psychologist
• Intrauterine diagnosis of orofacial clefts is
possible by ultrasonography.
• Complete clefts are seen easily at 16
• Incomplete clefts are seen more readily at
• Palatal clefts are difficult to visualize by
prenatal ultra sonography.
• The family or obstetrician may request
prenatal consultation with a surgeon.
Protocol For Dental Care of Cleft
Lip and Palate in Children
At BirthAt Birth
• Predental treatment is provided which comprises feedingPredental treatment is provided which comprises feeding
plate, pre surgical orthopedics and helps surgeon in repairplate, pre surgical orthopedics and helps surgeon in repair
by stimulating palatal bone growth and preventing collapseby stimulating palatal bone growth and preventing collapse
of dental arches.of dental arches.
3-5 Month.3-5 Month.
• Alignment of the primary teeth and palatal expansion to beAlignment of the primary teeth and palatal expansion to be
started using a simple fixed appliance like warch & Arnoldstarted using a simple fixed appliance like warch & Arnold
expander plastic surgeon to repair the lip.expander plastic surgeon to repair the lip.
• Suction myringotomy for “Glue ear”Suction myringotomy for “Glue ear”
12 Months.12 Months.
• Pedodontic review palatal pro sthetic speech.Pedodontic review palatal pro sthetic speech.
Appliance may by required to correct veloAppliance may by required to correct velo
pharygeal incompetence.pharygeal incompetence.
• Plastic surgeon to repair the cleft palate.Plastic surgeon to repair the cleft palate.
2-6 Years.2-6 Years.
• Pedodontic showed review facial growth and development withPedodontic showed review facial growth and development with
regular monitoring one year interval.regular monitoring one year interval.
• Preventive measures for caries like fissure, sealing, fluoride.Preventive measures for caries like fissure, sealing, fluoride.
6-7 years.6-7 years.
• Removal of super numerary teeth, correction of cross bite.Removal of super numerary teeth, correction of cross bite.
• Orthodontic consultation.Orthodontic consultation.
8-9 years.8-9 years.
• Suitability about bone grafting.Suitability about bone grafting.
• Dental bone assessment (OPG, wrist, lateral cephalogram,.Dental bone assessment (OPG, wrist, lateral cephalogram,.
• Review by the plastic surgeon, speech pathologist & ENTReview by the plastic surgeon, speech pathologist & ENT
• If needed to relieve crowding and retroclination of the anteriorIf needed to relieve crowding and retroclination of the anterior
9 years.9 years.
• Combined orthodontist and pedodontistCombined orthodontist and pedodontist
• Bone graft alveolar cleft at half to 1/3 rootBone graft alveolar cleft at half to 1/3 root
development of permanent cuspid.development of permanent cuspid.
10-12 years.10-12 years.
• Orthodontic consultationOrthodontic consultation
• Monitoring changing dentition and growth.Monitoring changing dentition and growth.
12-15 years.12-15 years.
• Orthodontic treatment.Orthodontic treatment.
• Speech pathologist to review changing ofSpeech pathologist to review changing of
the pitch of voice in boys.the pitch of voice in boys.
A Multi-Disciplinary Team for CleftA Multi-Disciplinary Team for Cleft
Lip and Palate Patients.Lip and Palate Patients.
ObstetricianObstetrician == Refers the child to plastic surgeonRefers the child to plastic surgeon
and pediatrician for expert opinion counseling theand pediatrician for expert opinion counseling the
Pediatrician or Neonatology'sPediatrician or Neonatology's==Provide medicalProvide medical
care refers the case to the plastic surgeon.care refers the case to the plastic surgeon.
Plastic Surgeon:-Plastic Surgeon:-Carries out initial lip repairCarries out initial lip repair
and palate surgery – performs pharyngoplasty orand palate surgery – performs pharyngoplasty or
reversionary lip & nose surgery.reversionary lip & nose surgery.
Oromaxillofacial SurgeonOromaxillofacial Surgeon== Usually comes in theUsually comes in the
picture of bone grafting – if any final orthopedicpicture of bone grafting – if any final orthopedic
surgery is performed at later stage.surgery is performed at later stage.
NeurosurgeonNeurosurgeon== any craniofacial syndrome isany craniofacial syndrome is
A key member who sees the baby and the parent atA key member who sees the baby and the parent at
the time of repair of the lip.the time of repair of the lip.
Provides pre surgical orthopedic treatment for theProvides pre surgical orthopedic treatment for the
Pedodontist monitor the growth and development.Pedodontist monitor the growth and development.
To maintain perfect oral health.To maintain perfect oral health.
To guide the occlusion and facial growth.To guide the occlusion and facial growth.
Motivates the parent & the child to cooperate withMotivates the parent & the child to cooperate with
the treatment.the treatment.
Orthodontist:Orthodontist: Carries out definitive orthodonticCarries out definitive orthodontic
treatment once the full permanent dentition istreatment once the full permanent dentition is
Speech pathologist: =Speech pathologist: =
• Monitors the speech development to normal.Monitors the speech development to normal.
• Test for an adequate palato pharyngeal closure and guidingTest for an adequate palato pharyngeal closure and guiding
the surgeon as to whether a pharyngeal flap may bethe surgeon as to whether a pharyngeal flap may be
Audiologist:-Audiologist:- To test hearing in the babyTo test hearing in the baby
infants & the young child providing essentialinfants & the young child providing essential
information in hearing loss for both speechinformation in hearing loss for both speech
patholigist and otolarynologist.patholigist and otolarynologist.
OtolarynologistOtolarynologist:: Concerns with the health ofConcerns with the health of
nasopharyngeal tissues including tonsils, adenoidsnasopharyngeal tissues including tonsils, adenoids
and middle ear structures.and middle ear structures.
Blockage of the auditory canal and gluteneousBlockage of the auditory canal and gluteneous
secretion (glue ear) is very common in these disease.secretion (glue ear) is very common in these disease.
Psychologist:Psychologist: Plays on important role when thePlays on important role when the
child’s family is under stress.child’s family is under stress.
General ConsiderationGeneral Consideration:-:- Patients with C.L.P. requires,Patients with C.L.P. requires,
interdisciplinary care from a team of provides including ainterdisciplinary care from a team of provides including a
geneticist, plastic surgeon, oral and maxillofacialgeneticist, plastic surgeon, oral and maxillofacial
surgeon, otolaryngologist, dentist, orthodontist, speechsurgeon, otolaryngologist, dentist, orthodontist, speech
therapic audiologist, psychologist, social worker & nurse.therapic audiologist, psychologist, social worker & nurse.
The role of each specialist depends on the age of theThe role of each specialist depends on the age of the
During the first days of the infant’s life:-During the first days of the infant’s life:-
The infants with a cleft palate cannot generate the negativeThe infants with a cleft palate cannot generate the negative
intraoral pressure needed to suck from a bottle.intraoral pressure needed to suck from a bottle.
The Nurse on the team or another feeding specialist mustThe Nurse on the team or another feeding specialist must
instruct the parents in the use of special feeding device for theinstruct the parents in the use of special feeding device for the
infant eg:- Haberman nipple, catheter & syringe, spoon feeding.infant eg:- Haberman nipple, catheter & syringe, spoon feeding.
Infants with cleft palate have difficulty ventilating theInfants with cleft palate have difficulty ventilating the
eustachian tube. This result in the accumulation of fluid in theeustachian tube. This result in the accumulation of fluid in the
must be treated promptly with antibiotics.must be treated promptly with antibiotics.
DENTOFACIAL ORTHOPEDICSDENTOFACIAL ORTHOPEDICS
In unilateral complete cleft lip and palate (UCCLP) orIn unilateral complete cleft lip and palate (UCCLP) or
bilateral complete cleft lip and palate (BCCLP) with abilateral complete cleft lip and palate (BCCLP) with a
protruding premaxilla, labial repair is oftenprotruding premaxilla, labial repair is often
completed with tension on the closure.completed with tension on the closure.
Orthopedic appliances bring the dentoalveloarOrthopedic appliances bring the dentoalveloar
segments together facilitating a tension free labialsegments together facilitating a tension free labial
repair that requires undermining of tissues.repair that requires undermining of tissues.
In addition, alveolar approximate forms the skeletalIn addition, alveolar approximate forms the skeletal
plateform for correction of the nasal deformity andplateform for correction of the nasal deformity and
permits gingivoperiosteoplasty. Alveolar closurepermits gingivoperiosteoplasty. Alveolar closure
eliminates an around fistula.eliminates an around fistula.
The appliance is removed at the time of labial repairThe appliance is removed at the time of labial repair
and replaced with a passive appliance to maintainand replaced with a passive appliance to maintain
the alveolar position.the alveolar position.
Management of Cleft Lip And NasalManagement of Cleft Lip And Nasal
Single stage:Single stage: repair the unilateral complete cleft liprepair the unilateral complete cleft lip
and nasal deformity in a single stage.and nasal deformity in a single stage.
Two stage repairTwo stage repair: First repair unilateral cleft lip &: First repair unilateral cleft lip &
than lip nasal adhesion.than lip nasal adhesion.
Reasons For Two Stage RepairReasons For Two Stage Repair
Minimize tension.Minimize tension.
Increase the bulk of the orbicularis oris muscle toIncrease the bulk of the orbicularis oris muscle to
construct the filtral ridge.construct the filtral ridge.
Increase the vertical dimension of labial elements.Increase the vertical dimension of labial elements.
Particularly on the medical side andParticularly on the medical side and
Gives the surgeon two chances to correct the positionGives the surgeon two chances to correct the position
of the lower lateral cartilage.of the lower lateral cartilage.
TIMING OF NASOLABIAL REPAIRTIMING OF NASOLABIAL REPAIR
Labial repair is traditionally carried out when the child isLabial repair is traditionally carried out when the child is
approximately 10 weeks of age, weight 10 pounds, and has aapproximately 10 weeks of age, weight 10 pounds, and has a
serum hemoglobin value of 10mg 1 ml & total leukocyte countserum hemoglobin value of 10mg 1 ml & total leukocyte count
less than 10,000/C.C. it is important to wait until the period ofless than 10,000/C.C. it is important to wait until the period of
postnatal anemia is corrected. The child should be gainingpostnatal anemia is corrected. The child should be gaining
weight and growing before under going nasolabila repair.weight and growing before under going nasolabila repair.
TECHNIQUES OF NAGOLABIAL REPAIR.TECHNIQUES OF NAGOLABIAL REPAIR.
• Type of cleft lip surgery:-Type of cleft lip surgery:-
• Millard’s rotation advancement flap and tennison randallMillard’s rotation advancement flap and tennison randall
triangular flap methods.triangular flap methods.
• Rose Thompson straight line repair, the skoog’s procedure are lessRose Thompson straight line repair, the skoog’s procedure are less
frequently used.frequently used.
• Rectangular flap method of triangular hagedorn le mesurier areRectangular flap method of triangular hagedorn le mesurier are
rarely used.rarely used.
• For bilateral cleft lip can be repaired in two stage by in a singleFor bilateral cleft lip can be repaired in two stage by in a single
stage by veau -III procedure, millards single stage procedure orstage by veau -III procedure, millards single stage procedure or
black procedure.black procedure.
• Basic steps in cleft lip repair.Basic steps in cleft lip repair.
• The lip is closed in three layers – mucosa, muscle, skin.The lip is closed in three layers – mucosa, muscle, skin.
AIM OF REPAIRAIM OF REPAIR
To achieve equal length of filtral ridges an eitherTo achieve equal length of filtral ridges an either
Horizontal cupid’s bow.Horizontal cupid’s bow.
Accurate repair of muscle, skin, mucosa withoutAccurate repair of muscle, skin, mucosa without
vermilion deformity.vermilion deformity.
Proper alignment of white line.Proper alignment of white line.
Symmetrical nostril floor, and finally an estheticallySymmetrical nostril floor, and finally an esthetically
acceptable scar.acceptable scar.
1.1.Straight Line Lip Repair.Straight Line Lip Repair.
IndicationIndication:- of incomplete and narrow clefts.:- of incomplete and narrow clefts.
AdvantageAdvantage :- Easy repair:- Easy repair
DisadvantageDisadvantage:- Limited Indications.:- Limited Indications.
Tennison Randall RepairTennison Randall Repair
A triangular flap is created on the lateral sideA triangular flap is created on the lateral side
of the cleft to fit into the triangular.of the cleft to fit into the triangular.
This procedure can be planned exactly afterThis procedure can be planned exactly after
initial measurements the results can not beinitial measurements the results can not be
modified once the lip is cut.modified once the lip is cut.
The scar is more prominent than in otherThe scar is more prominent than in other
• AdvantageAdvantage:-:- Measured techniquesMeasured techniques
More easily taught.More easily taught.
Can be used for wide dept.Can be used for wide dept.
• DisadvantageDisadvantage: Scar: Scar interrupts the philtruminterrupts the philtrum
line difficult to modify duringline difficult to modify during
VEAU REPAIRVEAU REPAIR
There is only a displacement, deformation and underThere is only a displacement, deformation and under
development of the muscles and the skeletal tissue.development of the muscles and the skeletal tissue.
The surgical procedure should thus aim at returningThe surgical procedure should thus aim at returning
there structures to their correct positions.there structures to their correct positions.
The naso labial muscles are reconstructed accuratelyThe naso labial muscles are reconstructed accurately
and within a few weeks, without any form of flapand within a few weeks, without any form of flap
This method gives satisfactory results in bilateralThis method gives satisfactory results in bilateral
cleft lip.cleft lip.
MILLARD’S Techniques (Rotation advancementMILLARD’S Techniques (Rotation advancement
technique) principles of closing bilateral cleft lip.technique) principles of closing bilateral cleft lip.
• Maintain symmetryMaintain symmetry
• design the prolabium of proper size & shape.design the prolabium of proper size & shape.
• Ensure primary muscular continuity.Ensure primary muscular continuity.
• Construct the median tubercle from lateral labialConstruct the median tubercle from lateral labial
• Peeform primary construction of the columella &Peeform primary construction of the columella &
nasal tip.nasal tip.
Procedure :-Procedure :-rotation flap and columella flap arerotation flap and columella flap are
planned on the medial side of the cleft. after fullplanned on the medial side of the cleft. after full
thickness of the lip is cut along the marking rotationthickness of the lip is cut along the marking rotation
gap is produced on the medial side which is filled bygap is produced on the medial side which is filled by
an advancement flap planned on the lateral side ofan advancement flap planned on the lateral side of
AdvantageAdvantage:-:- Minimal tissue is discardedMinimal tissue is discarded
Allows modification during repairAllows modification during repair
DisadvantageDisadvantage:: Difficult for use in wide cleft.Difficult for use in wide cleft.
May narrow the nostrial.May narrow the nostrial.
Basic goals of palate repairBasic goals of palate repair
Separation of oral and nasal cavities.Separation of oral and nasal cavities.
Construction of watertight and airtight velopharyngealConstruction of watertight and airtight velopharyngeal valve.valve.
Preservation of facial growth.Preservation of facial growth.
Development of esthetic dentition.Development of esthetic dentition.
Development of functional occlusion.Development of functional occlusion.
TIMING OF SURGERYTIMING OF SURGERY
Early repair leads to a better speech development but severeEarly repair leads to a better speech development but severe
mid facial growth retardation and dental malocclussion.mid facial growth retardation and dental malocclussion.
Palate repair after full growth of maxilla midfacial growthPalate repair after full growth of maxilla midfacial growth
retardation & dental malocclusion problem is less but speechretardation & dental malocclusion problem is less but speech
problem become more severe.problem become more severe.
Palate repair should be done 1-1½ years age give the bestPalate repair should be done 1-1½ years age give the best
balanced result.balanced result.
Only soft palate are closed by 6-18 months.Only soft palate are closed by 6-18 months.
CLEFT PALATE REPAIRCLEFT PALATE REPAIR
TECHNIQUES OF PALATE REPAIRTECHNIQUES OF PALATE REPAIR
Single stare technique.Single stare technique.
eg:- von langenbeck repaireg:- von langenbeck repair
Ven wardill kilner v-y push back palatoplasty at areVen wardill kilner v-y push back palatoplasty at are
1½ years.1½ years.
Two stare technique:-Two stare technique:-
• First stage : soft palate repair before 18 month.First stage : soft palate repair before 18 month.
• Second stage hard palate repair at 4-5 years.Second stage hard palate repair at 4-5 years.
eg. Schweckendiek technique.eg. Schweckendiek technique.
1)1) Primary Veloplasty By SchweekendiekPrimary Veloplasty By Schweekendiek..
• First soft palate is closed at an early age 16-12 months)First soft palate is closed at an early age 16-12 months)
• Hard palate closed after few years.Hard palate closed after few years.
• Principle of this techniques is that the soft palate aids in thePrinciple of this techniques is that the soft palate aids in the
speech and is essential to be closed early for velopharyngealspeech and is essential to be closed early for velopharyngeal
DisadvantageDisadvantage::- Speech problem (Severe)- Speech problem (Severe)
Additional surgical procedure.Additional surgical procedure.
2) VON LANGENBECK’S PALATO PLASTY.2) VON LANGENBECK’S PALATO PLASTY.
• Use bipedicled mucoperiosteal flaps of theUse bipedicled mucoperiosteal flaps of the
hard and soft palate for repair of the defect.hard and soft palate for repair of the defect.
• There interiorly and posteriorly based flapsThere interiorly and posteriorly based flaps
are advanced medially closed the palatalare advanced medially closed the palatal
AdvantageAdvantage:-:- Easy to perform, requiresEasy to perform, requires
less dissection. results inless dissection. results in
decreased denuded palate.decreased denuded palate.
DisadvantageDisadvantage:-:- Failure to provideFailure to provide additionaladditional
palatal length.palatal length.
- Poor results in large clefts.- Poor results in large clefts.
- Currently not commonly used.- Currently not commonly used.
Veau-Wardill-Kilnar-v-y- PushbackVeau-Wardill-Kilnar-v-y- Pushback
Two mucoperiosteal flaps are raised from a hardTwo mucoperiosteal flaps are raised from a hard
palate and nasal layers are mobilized abnormalpalate and nasal layers are mobilized abnormal
attachment of palatal muscles are divided from theattachment of palatal muscles are divided from the
posterior border of the hard palate to be sutured inposterior border of the hard palate to be sutured in
midline to the opposite side the palatal muscle.midline to the opposite side the palatal muscle.
Suturing done anterior of the nasal layer andSuturing done anterior of the nasal layer and
progressed toward Uvula.progressed toward Uvula.
ORTHODONTICS AND MAXILLARYORTHODONTICS AND MAXILLARY
Different stages of dentition methods.Different stages of dentition methods.
A)A) predental treatment.predental treatment.
B)B) Deciduous dentition ( 3 to 6 years)Deciduous dentition ( 3 to 6 years)
C)C) Early mixed dentition ( 7 to 9 years)Early mixed dentition ( 7 to 9 years)
D)D) Late mixed and early permanent dentition.Late mixed and early permanent dentition.
E)E) Permanent dentition.Permanent dentition.
A) PRE DENTAL TREATMENTA) PRE DENTAL TREATMENT
II Feeding palate proper feeding advise pre-surgicalFeeding palate proper feeding advise pre-surgical
feeding plate.feeding plate.
II.To help the surgeon in the repair of the cleft byII.To help the surgeon in the repair of the cleft by
III. To stimulate palatal bone growth and to restoreIII. To stimulate palatal bone growth and to restore
orofacial functional matrix.orofacial functional matrix.
IV. To expand or prevent the collapse of maxillaryIV. To expand or prevent the collapse of maxillary
B) PRIMARY DENTITION TREATMENTB) PRIMARY DENTITION TREATMENT
- Simple form of fixed maxillary lingual appliance (i.eSimple form of fixed maxillary lingual appliance (i.e
warch or an Arnold expander) are preferred over thewarch or an Arnold expander) are preferred over the
removable palatal expansion for improving speech.removable palatal expansion for improving speech.
C) MIXED DENTITION TREATMENTC) MIXED DENTITION TREATMENT
I.I. Minor crossbites may be neglected but severeMinor crossbites may be neglected but severe
crossbites one corrected by expansion by usualcrossbites one corrected by expansion by usual
II.II. Retroclination of permanent incision and anteriorRetroclination of permanent incision and anterior
cross bite to correct this usually partial bandedcross bite to correct this usually partial banded
approach is needed .approach is needed .
III.III. Crowded dentition: This may require serialCrowded dentition: This may require serial
extraction primary cupids are removed to treatextraction primary cupids are removed to treat
incisior crowding & the primary molars.incisior crowding & the primary molars.
IV.IV. After alveolor bone grafting.After alveolor bone grafting.
To movement carriage enough space is createdTo movement carriage enough space is created
in the arch to allow the cuspids to erupt.in the arch to allow the cuspids to erupt.
PERMANENT DENTITION TREATMENTPERMANENT DENTITION TREATMENT
The problem at this stage are posterior cross biteThe problem at this stage are posterior cross bite
and malposed permanent incisors.and malposed permanent incisors.
If orthognathic surgery is done to correct theIf orthognathic surgery is done to correct the
underlying skeletal imbalance pre operative and postunderlying skeletal imbalance pre operative and post
operative orthodontic treatment is needed tooperative orthodontic treatment is needed to
achieve proper alignment, position and indication ofachieve proper alignment, position and indication of
the teeth on their respective arches.the teeth on their respective arches.
ROLEOFENTSPECIALIST, SPEECHPATHOLOGISTSROLEOFENTSPECIALIST, SPEECHPATHOLOGISTS
ENT specialist, Audiologist and speech specialistENT specialist, Audiologist and speech specialist
work together to note the middle ear problems andwork together to note the middle ear problems and
progress in speech.progress in speech.
Detect abnormalities in articulation and resonanceDetect abnormalities in articulation and resonance
which is develops due to velopharyngeal inwhich is develops due to velopharyngeal in
competence after palatoplasty.competence after palatoplasty.
The abnormalities detected by video fluoroscopy orThe abnormalities detected by video fluoroscopy or
PROCEDURE FOR CORRECTION OFPROCEDURE FOR CORRECTION OF
VELOPHARYNGEAL INSUFFICIENCYVELOPHARYNGEAL INSUFFICIENCY
Pharyngeal flap 2) Sphincter pharyngoplasty.Pharyngeal flap 2) Sphincter pharyngoplasty.
-- Pharyngeal flap designed on the basis of location and extent ofPharyngeal flap designed on the basis of location and extent of
lateral pharyngeal wall motion. The raw under surface of thelateral pharyngeal wall motion. The raw under surface of the
flap is lined with tissue from the nasal side of the soft tissueflap is lined with tissue from the nasal side of the soft tissue
palate to prevent contracture and narrowing of the flap thepalate to prevent contracture and narrowing of the flap the
donor site on the posterior pharyngeal is closed.donor site on the posterior pharyngeal is closed.
• ALVEOLAR BONE GRAFTING TIME 8-11 years.ALVEOLAR BONE GRAFTING TIME 8-11 years.
- Cancellous bone is used for alveolar grafting.Cancellous bone is used for alveolar grafting.
- It promotes more rapid vascularization due to presence ofIt promotes more rapid vascularization due to presence of
living osteoblasts.living osteoblasts.
- DONAR SITE OF BONEDONAR SITE OF BONE
- Ilium, calvaria, tibia mandible or ribs.Ilium, calvaria, tibia mandible or ribs.
- The bone should be placed within the cleft from the piriformThe bone should be placed within the cleft from the piriform
aperture to the level of the alveolar crest.aperture to the level of the alveolar crest.
- Gingival mucoperiosteal flaps are used for oral closure over anGingival mucoperiosteal flaps are used for oral closure over an
alveolar bone graft because they are well vascularized.alveolar bone graft because they are well vascularized.
Bony support to teeth.Bony support to teeth.
Helps stabilize the maxillary segments.Helps stabilize the maxillary segments.
Aesthetic appearance of the alveolus.Aesthetic appearance of the alveolus.
Closure of oro nasal fistula.Closure of oro nasal fistula.
Gives supports to the alar bone of the nose.Gives supports to the alar bone of the nose.
Provides bone for a titanium implants.Provides bone for a titanium implants.
OPERATIVE CORRECTION OF MAXILLARYOPERATIVE CORRECTION OF MAXILLARY
Maxillary hypoplasia is three dimensionalMaxillary hypoplasia is three dimensional
Class III malocclusion ( Sagittal plane)Class III malocclusion ( Sagittal plane)
Narrowed arch (horizontal plane)Narrowed arch (horizontal plane)
Over closure the mandible (vertical plane)Over closure the mandible (vertical plane)
Destruction osteogenesis.Destruction osteogenesis.
Pre surgical orthodontics & Lefort – I osteotomy.Pre surgical orthodontics & Lefort – I osteotomy.
Fabrication of an over lay denture may be necessaryFabrication of an over lay denture may be necessary
for improved occlusion and appearance.for improved occlusion and appearance.
DENTAL ENAMEL HYPOPLASIA:DENTAL ENAMEL HYPOPLASIA:
Defect occurs in central & lateral incisors.Defect occurs in central & lateral incisors.
Placement of stainless steel crown.Placement of stainless steel crown.
Fluoride application.Fluoride application.
Dietary advice.Dietary advice.
Preventive oral health carePreventive oral health care
ROLE OF PROSTHODONTISTROLE OF PROSTHODONTIST
Replacement of absent maxillary lateral incisor.Replacement of absent maxillary lateral incisor.
Replacement by fixed partial denture andReplacement by fixed partial denture and
implantation method.implantation method.
ROLE OF PSYCHOLOGISTROLE OF PSYCHOLOGIST
The psychiatrist and psychologist evaluate theThe psychiatrist and psychologist evaluate the
patient for strength and weakness in cognitivepatient for strength and weakness in cognitive
interpersonal, emotional, behavioural and socialinterpersonal, emotional, behavioural and social
development: emphasis is placed on the patient’sdevelopment: emphasis is placed on the patient’s
ability to cope with the emotional and psychealability to cope with the emotional and psycheal
stress created by the cleft defect. Consultation withstress created by the cleft defect. Consultation with
the parents and schools regarding educational orthe parents and schools regarding educational or
behavioural management if carried out whenbehavioural management if carried out when
The management of cleft lip & palate isThe management of cleft lip & palate is
necessary at correct time. If delayed innecessary at correct time. If delayed in
the treatment there may be possibility tothe treatment there may be possibility to
developed abnormalities.developed abnormalities.
So to prevent some problems like speechSo to prevent some problems like speech
problem facial asymmetry, feedingproblem facial asymmetry, feeding
problem & infection to nasal cavity &problem & infection to nasal cavity &
unasthetic appearance. The treatment isunasthetic appearance. The treatment is
Pediatric Oral & Maxillofacial Surgery byPediatric Oral & Maxillofacial Surgery by
Leonard B. Kaban , Maria T. Troulis.Leonard B. Kaban , Maria T. Troulis.
Facial cleft and cranio synostosis ByFacial cleft and cranio synostosis By
Timothy A. Turvey, Kathorine W L VIG ,Timothy A. Turvey, Kathorine W L VIG ,
Raymond J. Fansecu.Raymond J. Fansecu.
Clinical Pedodontics By Sidney B. Finn.Clinical Pedodontics By Sidney B. Finn.
Oral & Maxillofacial Surgery by ChitraOral & Maxillofacial Surgery by Chitra
Clinical Pedodontics By Shobha Tandon.Clinical Pedodontics By Shobha Tandon.