Treatment of Unilateral Cleft Lip and Palate: Findings Obtained from a Long-term Observation Case

Abstract

Unilateral cleft lip and palate causes problems with the development of the maxilla and dentition. We treated a patient with unilateral cleft lip and palate from childhood to adulthood whose treatment ended favorably and who was stable in the long term. When treating unilateral cleft lip and palate, the characteristics of this condition that should be considered were examined by looking at the treatment of a longitudinal case.
The patient was a female with left cleft lip and palate. Lip plasty was performed at 3 months old, palatoplasty was performed at 1 year and 6 months by the pushback method, and management by orthodontics began at 5 years and 0 months old. The deciduous dentition showed inferior maxillary growth, and the mandible showed an anterior position presenting skeletal mandibular protrusion. Severe anterior and lateral stenosis of the maxillary dentition was observed, and the entire dentition was crossbite. The position of the tongue was always low. The first phase of treatment used a maxillary anterior traction device and lingual arch to promote maxillary anterior growth and to improve the anterior dental occlusion, and training for dysarthria in conjunction with oral myofunctional therapy was used to obtain normal tongue position. In the second phase of treatment, at the age of 14 years and 10 months, oral myofunctional therapy in conjunction with the multi-bracket method was used to obtain normal occlusion and maxillary lateral expansion. At 17 years and 9 months, active treatment was ended and retention began. Six years and 9 months after active treatment ended, there was a decrease in overjet and overbite, and there was little regression, so oral myofunctional therapy was performed again. At the current time of 10 years and 1 month after the end of active treatment, no skeletal changes were observed, the occlusion has almost stabilized, and her condition remains favorable.
Looking back on this case, it is necessary to make a comprehensive judgment of various issues that differ from non-cleft patients, such as the technique of palatoplasty, the timing of the start of maxillary anterior traction, the timing of the start of orthodontic treatment, the treatment plan, the degree of achievement of goals, and long-term stability in order to formulate a treatment plan. We report here several important points to consider in orthodontic treatment for patients with cleft lip and palate.