This document provides a comprehensive overview of the management of cleft lip and palate patients by a pediatric dentist. It discusses the causes of clefts, diagnosis, parental counseling, feeding techniques, nasoalveolar molding, surgical repair techniques, speech and hearing considerations, dental care, orthodontic treatment, and various expansion appliances used to correct transverse maxillary deficiency.

1. COMPREHENSIVE MANAGEMENT OF CLEFT LIP AND PALATE PATIENT BY A PEDODONTIST

4. EXPERTS INVOLVED BASIC CONFUSION

7. Heredity- defect seems to run in families Environmental factors- teratogens like rubella virus, thalidomide

11. Diagnosis

12. Parental Counseling At Birth

13. The photos of the treated patients can be used for parents counseling

14. Feeding Advise

16. Feeding by nasogastric tube

17. Feeding of cleft lip and palate patients Pigeon feeder Haberman feeder Squeeze bottle

18. Feeding Spoon Feeding teats

19. Cleft Babies Should Be Kept In Upright Position For Feeding To Make Gravity Aid In Milk Feeding Fruit drinks, baby fruit juices and squashes have an erosive potential .

28. The Pre Maxillary orthopedics Naso Alveolar Molding

29. It is a modern presurgical orthopedic device that allows for a positive growth of alveolar ridges into a improved arch form NAM is non surgical method of reshaping alveolus, lip and nostrils before cleft lip and palate surgery, lessening the severity of cleft. It is the passive method of bringing the gum and lip together by redirecting the forces of natural growth

40. The nasal stent is delayed until the cleft of the alveolus is reduced to about 5-6 mm in width. Incorporation of the nasal stent

49. LATHAM S APPLIANCE FOR PRESURGICAL REPOSITIONING OF THE PROTRUDED PREMAXILLA IN BILATERAL CLEFT LIP AND PALATE The appliance is designed so that it could be secured to the palatal segments with stainless steel pins(pinning principle as described by Georgiade in 1970

53. SURGICAL REPAIR OF CLEFT LIP & PALATE

54. Palatoplasty

56. Timing of cleft palate repair

58. DENUDED BONE The filling in of the denuded area produces scar tissue, which exerts an initial contracting force on adjacent tissues resulting in midfacial growth retardation and skeletal malocclusion hemorrhage, and hematoma formation, or contraction during healing, tends to pull the flaps away from the vault. The lowered, irregular vault impinges on the space available for the tongue and interferes with tongue posture and function. Effect of palate reconstruction on maxillary complex

64. A lateral cephalogram showing A: a low-draped soft palate and a wide opening in the velopharyngeal port, and B: elevation of the soft palate by the palatal lift prosthesis.

73. Expansion Screws Bonded Type Banded Type An acrylic splint with full occlusal coverage bonded to expand (0.2mm/day) for one month has shown approximately 4.2mm expansion.

75. The children should be instructed to wear the facemask a minimum of 12-14 hrs/day. Though the skeletal changes are limited, they produce marked improvements in the soft tissue profile Orthopedic expansion and protraction of maxilla in cleft palate patients-a new treatment rationale. Protraction using a Petit’s face mask orthopedically Moving the maxillary segments after expansion of the maxilla with an expander appliance, 450 grams per side attached to the canines for 1.2 years.

76. 3 months of maxillary expansion increased arch width between first deciduous molars by 8 mm and was followed by protraction using the facial mask for 6 months. Post treatment retention period was for 1 year. Changes in 3months of expansion 8 months of protraction Changes in 1 yr retention

86. For class III occlusion mandibular osteotomy is done after skeletal maturity(16 -18 yrs) Preoperative and post operative orthodontic treatment is needed to achieve proper alignment, position and inclination of tooth

87. Psychological factors in cleft surgery Education and communication problems Facial appearance and teacher perception. Behavioral inhibition and lower school achievement. Speech defectiveness and self esteem. Communication disorders are more the result of psychological problems than phonological which influences the entire development of an affected child. Anxiety and depression in adults with cleft lip and palate have been reported to be twice than normal controls. Odd one out

88. Psychological aspects Existing multispeciality care is primarily aimed at physical rehabilitation, psychological issues often being neglected. Parents of children with clefts are more likely to spoil their child by being over protective.

89. Children of the lesser god?

90. This is our domain