How facial clefts are managed until the secondary early alveoplasty at the TREFLE clinic

Abstract

For many years TREFLE, The Ecully team treating labio-palatal clefts, has begun managing the care of patients with clefts at younger and younger ages. Both surgically and orthodontically we design our therapeutic interventions to change the environment of the cleft as rapidly as possible in order to improve patients' functioning that will in turn have a beneficial effect on growth and esthetics. We have found that our patients treated in this way not only have improved appearance but also less likelihood of needing orthognathic surgery. We have also found that our patients do not routinely require early bone grafts, at about 6 years of age. We determine which children will require this intervention in a re-evaluation that we undertake after the completion of the primary phase of orthopedic and orthodontic therapy.To make our technique as clear as possible throughout the course of this article we present the different stages of treatment of four children, Leslie, Jules, Nathan, and É lodie. KEY WORDSLabio-alveolar-palatal clefts, Bone graft, Early secondary alveoloplasty, Multi-disciplinary rehabilitation.

Orthopaeddontics in Cleft Treatment

“…Following the pre-surgical orthopaeddontic intervention, ideally completed around 8.5-9.5 years of age which coincides with ± ⅔ completed facial growth [3,20,21]. It is essential that the achieved result need to be obtained over the long-term.…”

“…This treatment assumes particular significance during the critical growth spurt period spanning from ages 5 to 11 years, which constitutes a pivotal phase in achieving optimal outcomes for children with congenital oro-facial structures deficiencies [2]. Unlike non-cleft children who may require early orthodontic intervention, a distinctive approach is imperative in harnessing the exceptional growth potential observed in paediatric patients with cleft anomalies to ensure the most favorable outcome by age 12 years [3]. The outcome of this treatment efficacy is then reflected in the long-term during adolescent years and adulthood, potentially necessitating fewer conventional orthodontic interventions [4,5].…”

“…The outcome of this treatment efficacy is then reflected in the long-term during adolescent years and adulthood, potentially necessitating fewer conventional orthodontic interventions [4,5]. Through orthopaeddontic treatment optimization, maximal attainment of ideal facial-occlusal-speech outcome, alongside the potential elimination of orthognathic deformity becomes possible [3,6]. This treatment phase commences with the correcting of the primary dentition and progresses into the mixed dentition period, often employing a non-extraction approach for both primary and permanent teeth, barring necessary extraction of supernumerary teeth adjacent or within the cleft defect.…”