Cleft Palate

Cleft Palate & Lip The cleft is a separation of parts of the lip and/or palate that takes place when they fail to join during the early weeks of prenatal development. It is a congenital defect whose exact cause is not known.

It is genetically linked as evidenced by the higher percentage in certain races and ethnic groups. It is also greatly influenced by the environment. A genetic predisposition coupled with lack of certain nutrients, especially folic acid during the first trimester, can lead to a cleft lip and/or palate. Soft tissue closure of the cleft should be performed in early infancy to eliminate the oral–nasal communication. This allows the infant to nurse and to respirate normally.

However, this surgery frequently results in the loss of one or more permanent tooth buds. If this occurs space should be maintained for the missing dental units. The cleft will cause an underdevelopment of the maxilla. The child must be treated with an orthopedic appliance to correct, and to maintain the normal size of the maxilla as the patient matures.

The hard tissue closure of the cleft palate should be delayed until the patient completes the final pubertal growth. This allows for additional orthopedic appliance therapy as may be required to maintain a balanced maxilla. If the cleft palate occurs unilaterally, and is not properly treated with an orthopedic appliance, it creates a true unilateral posterior skeletal cross bite.

When this occurs the most effective orthopedic appliance to correct the unilateral skeletal cross bite is a modified Schwarz appliance designed by Dr. Charles Nord.

Unilateral Cleft Palate

Early soft tissue closure
Osseous surgery following puberty

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Before

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Nord Appliance

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After

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After