Recent Advances in Cleft Lip and Palate Orthodontics and Research

Craniofacial anomalies are found in over 700 syndromes and about 1/3 of all birth defects. Of craniofacial anomalies, orofacial clefting is the most common defect, affecting about 1 in 700 live births. The care of cleft lip and palate patients requires a team approach involving multiple specialists. This lecture will review the role of orthodontists in the management of cleft lip and palate patients. In order to achieve esthetic and functional outcomes, cleft lip and palate patients require complex and lengthy orthodontic care at multiple developmental stages: (1) Soon after the birth, the babies undergo naso-alveolar molding before the repair of cleft lip and nose. (2) In early- to mid-transitional dentition, the palate is expanded in preparation of the repair of alveolar cleft. Palatal expansion is to align alveolar ridge segments and to coordinate upper and lower arches. (3) After the repair of alveolar cleft, most patients require Phase I orthodontic treatment to manage impacted teeth, ectopic teeth, missing teeth, transposition and midface deficiency. This phase of treatment is critically important and typically takes much longer than non-cleft patients. (4) Phase II or presurgical orthodontic treatment in the permanent dentition. (5) Orthognathic surgery at the skeletal maturity. Mid face deficiency is estimated to be 40-70% in cleft lip and palate patients. Despite that the patients undergo multiple reconstructive surgeries and extensive oral rehabilitation, they may still experience less than ideal appearance and function. This lecture will introduce recent advances in cleft lip and palate research, including findings in search of genes or molecules that can be targeted to prevent cleft lip and palate formation. We will also present an in utero strategy that allows recapitulation of normal development in cleft lip and palate mouse models using inta-amniotic gene transfer.