Background and Objective

The lip and palate clefts are the most frequent congenital craneofacial malformations. Their treatment must be multidisciplinary and sequential. Most cases need more than one reconstructive surgery during the patient’s childhood and can extend to additional surgery in adulthood. Dental, auditory, speech, facial growth and psychological management are required. This is why all of the professionals that work in a cleft team should always communicate to obtain the most successful results.

The objective of the present study is to standardize the management of lip and palate fissures in patients treated at the clinics located in Tijuana and Ensenada, and soon Mexicali and Hermosillo, cities located in the Northwest of Mexico.

Methods

The patients involved have been treated in clinics for clefts in Tijuana, Ensenada, and very soon in Mexicali and Hermosillo, cities located in the Northwest of Mexico. In the cleft lip and palate clinics in Tijuana and Ensenada, the collaboration between Plastic Surgery, Pediatric Odontology, Orthodontics, Otorhinolaryngology, Speech Therapy, Family Therapy, Child Psychology and other disciplines has been crucial to treat and follow up on patients during the past 10 years. The esthetic and functional results have been optimal when the surgery is complemented by these other disciplines.

Results

For this approach, the cleft lip and palate patient has to be evaluated as early as possible, and parents must be instructed in nutrition and other special needs, and in getting the patient ready for the first surgery which in most cases is the lip repair and the second, if needed, is the palate repair.

It always has to be emphasized that the pediatric odontologist and the orthodontist play an important role in molding the nasal cartilages as well as the maxillary segments before the surgery, as well as dental health. The speech therapist will have an important role when the patient’s speech development starts and an early audiologic assessment will guide the treatment with ear tubes placed by the otorhinolaryngologist in order to avoid auditory and speech problems.

Conclusions

During their lifetime, these patients may need other surgical procedures such as lip and nasal revisions, alveolar bone graft, pharyngoplasties, pharyngeal flaps, maxillary distraction or orthognatic surgery; this last one when there have been facial growth problems or malocclusions. Before any of these surgeries, the exchange of assessment and therapeutic plans by the multidisciplinary team is necessary to obtain the best results.

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