Cleft Lip and Palate Orthodontics Vancouver Surrey BC

Cleft and Lip Palate

Presurgical Orthopaedics for Neonates with Cleft Lip and Palate

This technical sounding title will lead to a description of a technique that our team provides to new born babies with cleft lip and palate. This technique allows us to move several of the facial structures into a more normal position prior to your baby's surgeries thereby simplifying the surgical procedures and improving the overall result and facial aesthetics.

As you will have already seen the clefting process lead to obvious problems with the soft tissues of your babies face and palate, less obvious is the effect on the bones that house your baby's teeth, form the palate, as well as the effect on the cartilages that shape and support your baby's nose.

During the first 3 months of your babies life the levels of estrogen (a hormone) is relatively high in your baby's blood stream. High levels of estrogen allow cartilage in the nose which is usually resistant to being reshaped, will be quite mouldable. Once your baby is past this stage the cartilage becomes "set" in shape. Therefore if these cartilages are allowed to "set" in a deformed shape it will be difficult to reshape them surgically when older. However if this mouldable period is used to reshape the cartilage, the nose will "set" in a more normal shape.

During this first three months it is also possible reposition the tooth bearing parts of the jaws this helps with the shape of the face in the upper lip area and means the lip is under less strain when the surgeon closes the lip. The appliances used for these procedures also help with feeding, your baby will still not be able to "suck" but they will be able to squeeze the teat between the gum pads and the appliance allowing baby to feed herself without you having to squeeze the bottle, this all helps to put on weight which is vitally important any way, but also allows surgery to proceed on time.

What do the appliances look like?
How is all of this treatment going to be carried out, by whom, and where?
What do we the parents have to do?
What is the time line?
Will this hurt my baby?
How is my baby going to look when the procedures are complete?

What do the appliances look like?

This is a picture of the appliance, it is called a Nasal Stint and the design can vary depending on whether the cleft is single (Unilateral) or double (Bilateral). This is a Bilateral Nasal Stint.

This is a picture of a baby with a bilateral cleft lip and palate with all of the tapping in place, it looks really complicated but don't worry we will lead you through the process step by step

These diagrams show in general the way in which appliances work in a bilateral case followed by a unilateral patient.

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How is all of this treatment going to be carried out, by whom, and where?

The measuring of your baby and the manufacture and fitting of the appliance will be performed by your Orthodontist a dental specialist trained in this area, but you may be more familiar with them as the type of Doctor that fit Braces to people.

An impression or mould will need to be taken, this is usually done when the baby is 7-14 days old and this procedure is most frequently performed by your orthodontist in the OR with an anaesthetist "standing by" Your baby will not be anaesthetised, the anaesthetist is just there to monitor your baby and help with breathing if there is a concern, this however if very unlikely, we just want to be as careful as possible. Our nurse practitioner or the anaesthetist will advise you as to when your baby's last feed before the procedure is to occur.

Once the baby is returned to you after about 15 - 30 minutes you may feed him. At this stage you will be given an appointment at your orthodontist's office for the fitting of the appliance usually within a couple of days. The rest of the adjustment appointments will occur at the orthodontist's office.

A plaster cast is made from the impression and then a technician will fabricate the appliance.

At the orthodontist's office the appliance will be fitted and you will be given instructions in placing and removing the appliance and how to fit the various tapes and elastics.

This shows the Plastic skin or base tape that is fitted to the cheeks.

This shows the steristrips and orthodontic elastics

This is the lip tape it must be placed very tightly, ideally the lip will blanch (look white)

Sometimes denture adhesive is used help the appliance stay secure

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What do we, as parents have to do?

Clean the appliance and palate at least once per day.
Change the lip tape several times a day making sure to keep pressure on the lip and underlying tissue.
Change the base tape and steristrips as needed. The base tape can be left on for up to a week before changing it. This protects the cheeks from the more frequent changing of the lip tape and steristrips.

Photos will be taken and a copy will be given to you for your records. Sometimes the completed appliance will be delivered at this time, while in other cases the rest of the appliance will be fitted a week following. Adjustment appointments will then usually occur at weekly intervals, sometimes longer especially for out of town patients.

Babies with bilateral clefts will have some additional modifications to the appliance and taping made at about 6 weeks.

Just prior to surgery the wire component will be removed but the acrylic plate will stay in until the palate surgery at between 10 -14 months

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What is the time line?

Impression at the OR 7-14 days of age
Fit appliance several days later
Adjust appliance weekly
Remove wire component just prior to surgery
Lip repair surgery at approximately 3 months of age
Acrylic plate to stay in after lip surgery
Palate surgery at 10-14 months no need for acrylic plates any longer

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Will this hurt my baby?

Babies get used to these appliances quite quickly, it will surprise you how adaptable they are, also you will see improvements in appearance almost immediately. Although you will feel "all thumbs" to begin with it will soon become routine and very rewarding as you see the fruits of your labours in the permanent improvement you have helped make in your babies appearance!

Problems

The plate is lose. Try tightening the elastics by moving the steristrips higher on the plastic skin, or add some denture adhesive to the plate.
Skin rashes. Try to move the tape or plastic skin to different areas, or if the problems persist Phone Lorrine Scott at the Cleft Clinic she has some great ideas and remedies.
Sore, red or bleeding areas on the palate or nose. Call the orthodontist to arrange an adjustment.
Baby pulling plate out! This may happen especially later in treatment, it is important to
keep the plate in if at all possible. Use more denture adhesive, put mitts or socks on the hands. If the plate is left out the tongue can push up into the cleft possibly widening the cleft in the palate and therefore making the palate surgery more difficult and prone to complications.
Plate not fitting because of teeth coming in. Call the orthodontists office to have the plate adjusted.

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How is my baby going to look when the procedures are complete?

Every child and cleft is individual and results can vary from one baby to another for multiple reasons. However, without guaranteeing results here are some of our patients whose parents have kindly allowed us to show their babies before and after photos.

Unilateral Cases