Cleft lip and palate: Treatment of the different stages of the cleft lip and palate from primary surgeries to secondary interventions of adulthood for soft tissue and maxillary normalization.
Palatal cleft: Palatorrhaphy with muscle reconstruction to close the cleft palate. The cleft palate may occur alone, as an isolated deformity or in combination with a unilateral or bilateral cleft of the lip.
To provide the best opportunity for normal speech development, complete repair of the palate with musculature reconstruction is necessary. The optimal age for this procedure is from the year of age.
Palatine fistulas: These are holes between the oral and nasal cavity that may appear in a small percentage of patients. Not only do they cause air, fluids and food to leak between the mouth and nose, but they also make normal speech difficult. Its treatment consists of the complete closure of the nasal and oral layers to close the communication.
The majority of patients with cleft lip and palate require reconstruction of the alveolar cleft. The technique of choice is by an iliac crest bone graft. The use of minimally invasive approaches allows a short hospitalization and return to normal activity in a short time.
A high percentage of patients with cleft lip and palate require orthognathic surgery to recover of a facial harmony and correct the position of the jaws and bite. The characteristic deformity is the lower development of the upper jaw, with an inverted bite with the jaw ahead. Through incisions inside the mouth the jaws can be mobilized and fixed with miniplates. The use of 3D virtual planning allows to reduce the time of the surgery and improving the postoperative recovery.
In patients with a very small jaw relative to the maxilla, their position can be corrected by progressive advancement of the mandible. This is achieved after the placement of internal devices (distractors) without leaving scars on the skin that gradually advance the maxilla (1mm per day) to the desired position to properly occlude with the jaw. This slow progression of the bone allows a progressive adaptation of the soft tissues of the face improving the result and reducing the possibility of relapse.
The asymmetry of the tip or septum can be corrected by a rhinoplasty. In some cases cartilage grafts (from the septum, auricular pavilion or rib) may be necessary to achieve good symmetry.
Surgery can be performed from the age of 14-16 to improve the appearance of the nose and/or nasal breathing.
Due to the alveolar cleft or the absence of teeth, rehabilitation of the teeth is necessary. The most anatomical and functional way is by placing dental implants. Bone regeneration may be necessary prior to or on the day of implant placement. The optimal time for placement is once the growth is completed.