Therapeutic thoughts on the treatment of sequellae of labial-alveolar-palatal clefts in adult patients – Part 1

Abstract

With a worldwide incidence of 1/750 live births, facial clefts rank as the second most frequent congenital malformation. The term "sequelae" is used here to designate the conditions, which follow and are the result of labial-alveolar-palatal clefts. Most sequelae stem in fact from primary treatment and not from the initial malformation. However, there is no consensus regarding a management protocol. Among the 201 European centers treating this type of malformation, 194 different protocols are used for unilateral facial clefts alone! Unfortunately, primary surgery can trigger a wide range of harmful consequences. It is for this reason that secondary surgery is called for, generally after the adolescent growth spurt. The aim is to correct the damage done by primary surgery, which can affect the nose, lips, teeth and jaws and impact functions such as speech, breathing and swallowing, as well as morphological and psychological development. Nonetheless, the children concerned are sometimes lost to treatment only to re-emerge in adulthood, aware of the presence of the resultant defects and looking for facial esthetic improvement. The sequelae of labial-alveolar-palatal clefts can take on very different clinical forms according to whether the cleft has been treated or not and the type and timing of the procedures performed. The surgeon's experience will be paramount in the management of such cases, which draws heavily upon dento-maxillo-facial orthopedics. In this context, we intend, in this paper, to propose modalities for the management of labial-alveolar-palatal clefts supported by information currently available in the literature. Management of labial-alveolar-palatal clefts requires an interdisciplinary rather than a multi- or pluridisciplinary, approach. The practitioner coordinating the management must, like an orchestra conductor, ensure both the rhythm and the tempo of the treatment. The rhythm will determine the choice of chronological protocol and the tempo will govern the timing and importance given to each of the specialists involved. Practices vary from country to country but the orthodontist may be called on to assume this responsibility.