Cleft Lip And Palate Patients Research Articles

Three-dimensional evaluation of the airway spaces in patients with and without cleft lip and palate: A digital volume tomographic study.

Patients with cleft lip and palate (CLP) suffer from several esthetic and functional challenges. Comprehensive treatment of these patients involves orthognathic surgery that may lead to velopharyngeal insufficiency or reduction in lower airway. Several cases of airway insufficiency, velopharyngeal incompetence, snoring, hypopnea, and obstructive sleep apnea have been reported in subjects with CLP. The aim of this study was to compare the anteroposterior dimensions of the oropharyngeal airway at 5 levels, the height of the oropharyngeal column, and the volume of the oropharyngeal airway in subjects with and without CLP. The sample consisted of 62 patients with CLP and 42 subjects with Angle Class I malocclusion. Anteroposterior dimension, height, and volume of the oropharyngeal airway were measured using the midsagittal and axial slices obtained from 3-dimensional digital volume tomographic scans for both groups. The anteroposterior dimensions of the airway were significantly reduced in the study subjects compared with the control group at the level of the postnasal spine, the base of the tongue, and the epiglottis. The airway dimensions measured on the axial sections at the level of the palatal and epiglottic plane were also significantly lower in the study group. The height and volume of the oropharyngeal airway were also significantly smaller in patients with CLP compared with subjects without CLP. Patients with CLP showed reduced dimensions and volumes of the oropharyngeal airway in all 3 planes compared with the control group.

Effects of Primary Alveolar Grafting on Alveolar Bone Thickness in Patients With Cleft Lip and Palate.

The purpose of this study was to compare alveolar bone thickness around the teeth adjacent to the cleft using cone beam computed tomography (CBCT) in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared with CLP waiting for secondary alveolar grafting (SAG) and to determine the associations with other factors such as the patient's age, sex, and type of cleft. CBCTs of 39 CLP patients were divided into either group 1 (PAG, N = 11) or group 2 (SAG, N = 28). Measurements of bone thickness around the closest tooth to the cleft were performed on the axial sections on each subject's CBCT at 3, 6, and 9 mm apical to the cementoenamel junction along the root length. Intraclass correlation coefficients and Bland-Altman plots were used to evaluate intrarater reliability. Bone measurements with 95% confidence intervals for the mean were estimated using analysis of variance models with a random patient effect to account for correlation among multiple measurements within a patient. Similar models were used to test the associations of age, sex, and type of the graft with the bone measurements. No statistically significant associations of the factors were found with mesial or distal bone measurements. Buccal bone thickness was significantly greater only at 9 mm in the primary bone graft subjects compared with secondary bone graft subjects (P = 0.009). Unilateral cleft subjects showed significantly greater buccal bone thickness at the level of 9 mm compared with bilateral cleft subjects (P = 0.046) and lingual bone thickness at the level of 6 mm (P = 0.0026) and 9 mm (P = 0.0096). In conclusion, PAG does not add benefits to the bone width on the cleft sides of the closest teeth to the cleft as compared with children with CLP who have not undergone alveolar grafts yet.

Abstract 126: Wharton’s Jelly Induces Osteogenesis In An Alveolar Cleft Model

PURPOSE: Secondary alveolar bone grafts are the standard treatment for patients with cleft lip and palate (CLP), but remain invasive and have several disadvantages such as delayed timing of alveolar repair, donor-site complications, graft resorption and need for multiple surgeries. Earlier management of the alveolar defect would be ideal, but is limited by the minimal bony donor sites available in the infant. Wharton’s Jelly (WJ), the connective tissue matrix of the umbilical cord, is a gelatinous substance comprised of proteoglycans, collagen, and is rich in perinatal stem cells. Our hypothesis is that inclusion of WJ in the alveolar pocket of CLP patients at the time of palate repair enhances bone growth and accelerates healing, with the autologous stems cells and extracellular matrix serving as a “primary bone graft” to close the alveolar cleft. METHODS: Human umbilical cords were harvested following routine delivery and WJ was isolated and purified. In vitro, WJ derived stem cells were placed in osteogenic differentiation medium for 14 days, followed by Alizarin Red S staining to evaluate mineral deposition. In vivo, we used a rat critical-size alveolar bone defect model to investigate the use of Wharton’s Jelly (WJ) in formation of bone. WJ was implanted into a critical size (7 x 4 x 3 mm) alveolar bone defect model representative of cleft palate surgery in 10–11 week old male Sprague-dawley rats. The defects were monitored weekly with CT imaging of living animals to evaluate bone formation in time, followed by histology evaluation at week 24. RESULTS: WJ showed significant in situ osteogenic differentiation of WJ cells as evidenced by strong Alizarin Red S staining. By contrast, no staining is observed when nWJ is maintained in control medium. In vivo, CT data showed that the defect size was critical and did not lead to the union of the bones in the control animals (n=12) for the entire duration of study. New bone growth was stimulated leading to partial-to-full closure of the defect in the animals treated with WJ (n=12). 24 weeks postoperatively, the percent increase in new bone formation in the WJ treated group (156.57 ± 26.85%) was markedly higher than that in the control group (49.97 ± 12.51%) (p<0.05). Histology data also revealed significantly greater new bone formation in WJ treated vs, control animals, confirming CT findings. CONCLUSION: We show that WJ has in vitro osteogenic differentiation capacity and in vivo, enhances bone growth in animal cleft palate models indicating its potential use as a natural tissue engineering construct for regenerative clinical applications. The success of this approach would represent a paradigm shift in the treatment of CLP patients by reducing or eliminating the need for subsequent bone grafting.

DISTRIBUSI SUMBING BIBIR DAN LANGIT-LANGIT DI CLEFT LIP AND PALATE CENTER FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG INDONESIA

Objective: The purpose of this study was to investigate the distribution of different cleft pattern by the age of first operation, sex, side of cleft of Cleft Lips (CL), cleft palate (CP) and cleft lip and palate patients (CLP), and education level parents in Cleft Lip and Palate Center in Faculty of Medicine, University of Malang Muhammadiyah (CLPC FM UMM). Study design: Four hundred twenty-nine patients attending the CLPC FM UMM from January 2014 to December 2016 were studied. Most patients came from East Java, Indonesia and the surrounding areas. Result: Highest frequency of CL in CLPC FM UMM is in the age group 0-1 y.o, CP patients in the age group 1-5 y.o , while most CLP patients in the age group 1-5 y.o. Cleft lip and palate (61.31%) was most frequently found, followed by cleft lip with or without alveolus (33.33%) and cleft palate (5.36%). Cleft lip and palate, cleft lip with or without alveolus and cleft palate occurred more frequently in males. Left-sided unilateral clefts were observed in 57.34% of patients compared to right-sided unilateral clefts in 21.21%, the rest is bilateral cleft 21.45%. The unilateral complete CLP (45.22%) was most frequently found, followed by the unilateral incomplete CL (18.41%). Most of the parent’s education were elementary school graduated.Conclusion: The most frequent profile in the affected population were males, left sided unilateral complete CLP were most affected.

A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation

PurposeThe need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system ‘Analyse It Doc’ (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region. Materials and methodsAn indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared. ResultsAnalysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements. ConclusionsThe hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.

Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities.

Objectives:The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result.Materials and Methods:Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin.Statistical Analysis Used:Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level.Results:Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable.Conclusion:The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%–40% for adult CLP patients.

Long-term results of maxillary distraction osteogenesis in nongrowing cleft: 5-years experience using internal device

Patients with cleft lip and palate (CLP) related deformities frequently have maxillary hypoplasia in all dimensions. These patients usually present with class III malocclusions, retruded midfaces and narrow hard palates. The skeletal problems can be treated by means of Le Fort I maxillary procedures. Surgical and orthodontic correction of severe maxillary hypoplasia, as often seen in CLP patients, has however proved to be challenging. The magnitude of the advancement is often hampered and the post operative stability significantly affected by palatal soft tissue scarring. The slow distraction of bone and the histogenic abilities of distraction osteogenesis (DO) have made it an atractive alternative treatment option for the management of maxillary hypoplasia in these patients. This paper presents the treatment results of 15 nongrowing CLP patients with severe maxillary hypoplasia treated by means of intra oral distraction. The mean anterior distraction of the maxillas was 12.7 mm (9-15.0 mm). The long-term cephalometric and clinical evaluation after a minimum of 60 months (mean follow-up 71 months) proved to be stable. The treatment results revealed, that distraction osteogenesis in nongrowing CLP patients with severe maxillary hypoplasia proved to be a predictable and stable option (Tab. 2, Fig. 3, Ref. 26).

Clinical outcome of tooth-supported fixed partial dentures in unilateral cleft lip and palate patients: A case series.

Introduction:Cleft lip and palate (CLP) is the most frequent congenital facial abnormality and multidisciplinary treatment extending over many years is necessary to rehabilitate the affected individuals to normal function and esthetics.Objective:To evaluate the clinical treatment outcome for missing teeth with tooth supported fixed partial dentures in unilateral cleft lip and palate patients.Patients and Methods:Tooth supported fixed partial denture (T-FPD) was utilized for restoration of missing teeth in the cleft area for 9 non syndromic, unilateral cleft lip and palate patients (U-CLP). The mean age of the patients was 25±4 years. The edentulous sites were prepared to receive ovate pontic for best possible esthetic results. Survival and complications were recorded following various biologic, technical and esthetic parameters up to 10 years of follow up. A clinical comparison was also made with respect to the periodontal status and development of new carious lesion between the restored cleft side teeth and corresponding teeth of the normal side with in the same patient.Results:Three failures experienced with fixed partial dentures were a result of ceramic chipping after 10 years, functional fracture after 3 years, and fracture due to external trauma after 2 years.Discussion:CLP patients undergo a lot of treatment; therefore understanding their opinions, expectations, and perspectives towards the prosthodontic intervention was given due importance. The provisional phase was utilized to educate the patients on the achievable treatment outcome and its limitation. In the present case series, out of three failed FPDs, only one restoration failed relatively early due to functional factors. Re-treatment was successfully achieved without change in the original material and extent of the FPDs.Conclusion:The outcome accomplished endorses the integral role of T-FPDs in the overall cleft care and it will remain a viable treatment alternative in select few patients in meeting their esthetic and functional desires.

Impact of educational and socioeconomic status of parents on healthcare access in cleft patients

Introduction: There is a wide disparity in the access to treatment facilities between developed and developing countries in cleft lip and palate (CLP) management. Factors ranging from poverty and illiteracy to paucity of healthcare services affect the patient accessing these services. Objective: Information regarding the socioeconomic and educational status of the parents of CLP patients admitted in a tertiary centre in Northern India was collected and analyzed to find any correlation between the above and the age of child at the first presentation to the hospital. Methods: Data were collected from parents of 200 consecutive patients of CLP presenting for surgery. The data set included variables such as age and sex of the child, age and literary status of the parents, household income, distance to the hospital from home, and the source of information that made them visit the hospital. Results and Conclusion: There was significant association between the age of first presentation and the literary status of the mother and father (P = −0.005 and 0.02, respectively), socioeconomic status of the family (P = −0.02), and the distance from the hospital. Other observations, though impressive, were not statistically significant. This proves the impact of socioeconomic and literary status of parents on availing access to healthcare services for their children.

Algorithm of orthodontic treatment of cleft lip and palate patients before and after autogenous bone grafting

The aim of the study was to elaborate the algorithm of orthodontic treatment of cleft lip and palate (CLP) patients. One hundred and twenty-six CLP patients after CLP plasty preparing for alveolar ridge reconstruction were divided into 3 groups according to their age: 47 (37%) patients aged 6 to 11 years; 50 (40%) aged 12 to 17 years; 29 (23%) patients aged 18-27. Eighty-four (66.7%) patients had unilateral CLP and 42 (33.3%) had bilateral CLP. Complex examination revealed typical dental and maxillofacial features for each group. Clinical and diagnostic imaging data allowed formulating rationale for complex treatment approach and algorithm of treatment option choice according to patients age at the time of alveolar ridge reconstruction.

Pattern of clefts and dental anomalies in six-year-old children: a retrospective observational study in western Norway

Objectives: Clefts of the lip and/or palate (CL/P) are the most common congenital disorders of the head and neck. In Norway, the incidence is 1.9/1000 live births. The aim of this study was to investigate the frequency and distribution of various types of clefts and dental anomalies in patients treated by the cleft lip and palate (CLP) team in Bergen, Norway.Material and methods: The material comprised the records of patients 6 years of age, examined by the CLP team in Bergen from spring 1993 to autumn 2012, incomplete records were excluded. The records of 989 patients were analysed, using frequencies and Chi-square test to compare differences in percentages between groups.Results: The gender distribution was 58.8% male and 41.2% female. Isolated cleft palate (CP) was the most common condition (39.5%). Clefts of the lip, jaw and palate (CLP) constituted (30%) of cases and (30.5%) had isolated cleft lip (CL). The frequencies of agenesis, supernumerary and peg-shaped teeth were (36.5%), (17.8%) and (7.5%), respectively. Over 50% of the study population were diagnosed with one or more malocclusion. Of the CLP patients, 61.4% had Angle Class III occlusion. Statistical analysis disclosed a positive association of agenesis with Class III occlusion (OR =1.8, p≤ 0.001).Conclusions: The findings supported the hypothesis that the distribution of dental anomalies and occlusal disorders varied among patients with CL, CP and CLP. In patients with cleft, there is a twofold chance to get Class III malocclusion in the presence of agenesis.

Velopharyngeal changes after maxillary distraction in cleft patients using a rigid external distraction device: A retrospective study.

To evaluate early and late velopharyngeal changes in cleft lip and palate (CLP) patients after use of the Rigid External Distractor (RED) device and to correlate these changes to the amount of maxillary advancement. Thirty Class III CLP patients were included in the study. Maxillary advancement was performed using the RED device in combination with titanium miniplates and screws for anchorage. Lateral cephalograms, nasometer, and nasopharyngoscope records were taken before distraction, immediately after distraction, and 1 year after distraction. A paired t-test was used to detect differences at P < .05. SNA angle and A point and ANS to Y axis were significantly increased after maxillary distraction (P = .0001). Statistically significant increases in nasopharyngeal and oropharyngeal depths, velar angle, and need ratio were also found (P = .0001). Nasalance scores showed a significant increase (P = .008 for nasal text and .044 for oral text). A significant positive correlation was observed between the amount of maxillary advancement and the increase in nasopharyngeal depth and hypernasality (P = .012 and .026, respectively). Nasopharyngeal function was deteriorated after maxillary advancement in CLP patients. There was a significant positive correlation between the amount of maxillary advancement and the increase in nasopharyngeal depth and hypernasality.

Middle ear findings and need for ventilation tubes among pediatric cleft lip and palate patients in northern Finland

Middle ear problems are common in cleft patients. This study aimed to determine the need for ventilation tubes (VTs) and complications such as tympanic perforation and cholesteatoma. Data of 156 children with clefts managed in northern Finland spanning 15 years from 1997 to 2011 were collected from 6 hospitals. The following were recorded: birth date, gender, cleft type, surgery timing, surgery type, number of tube insertions, tube material, middle ear findings, and tube placement timing. Clefts were divided into 4 groups: cleft palate (CP), cleft lip and palate (CLP), cleft lip (CL), and submucous cleft palate. The prevalence of middle ear findings was reported. Mucous secretion was noted in 96.8% of CLP patients, 69.2% of CP patients, and 13.0% of CL patients. In all, 82.7% of study group had 1 or more VTs placed during follow-up. All CLP patients required more than 1 VT placement. A total of 94.5% of CP patients required VTs compared to 13.0% of CL patients. In the presence of residual oral nasal fistula, the mean number of tube insertions was 5.3. The prevalence of tympanic perforations in clefts was 35.9% and cholesteatoma in 2.6% of patients. CLP and isolated CP patients have frequent middle ear infections requiring multiple VT placements.

Risk factors for teeth aplasia and hypoplasia in cleft lip and palate children

The aim of the study was to assess the significance of environmental risk factors for teeth aplasia and hypoplasia in cleft lip and palate children. Two hundred and forty-seven cleft lip and palate (CLP) children were enrolled in the study including 105 (42.5%) with bilateral CLP and 57.5% with unilateral CLP. The mean age was 11.2±4.9 years. Teeth condition was assessed clinically and radiologically. The impact of risk factors for teeth anomalies was analyzed by retrospective data obtained from computer database (absence of preoperative orthopedic treatment, palatal defects after primary palatoplasty and type of primary procedures). Surgical trauma by early periosteoplasty (at the age of 3-4 months), excessive scarring and tissue traction due to absence of early orthopedic treatment and palatal defect were associated with significantly higher incidence of incisors hypoplasia (both developmental enamel defects and microdentia) and aplasia of central incisors not seen in the other study subgroups. Incisors aplasia and hypoplasia in CLP patients do not always have disembryogenic origin but may depend on external environmental factors, including surgical trauma.

Multidisciplinary treatment focussing on comprehensive orthodontic approach for improving facial esthetics in cleft lip and palate patients

Cleft lip and palate (CLP) is one of the most prevalent congenital craniofacial deformities. CLP may result in impairments that stigmatize the individual and have an impact on health, emotions, and social interactions. This article describes the comprehensive orthodontic approach in the treatment of unilateral cleft of the lip and the palate. It also emphasizes the importance of orthodontic intervention to improve the facial esthetics in CLP patients. The treatment planning procedures and the results are presented below.

Comparison of oral and dental health status in patients with or without cleft lip and palate deformities undergoing orthodontic treatment

Objective: To compare the oral and dental health in patients with or without cleft lip and palate (CLP) deformities, undergoing orthodontic treatment. Materials and Methods: The study group comprised fifty patients with CLP. These patients were compared with fifty matched patients (control group) who had no CLP and had undergone orthodontic treatment for other indications at the same institute. Oral hygiene was evaluated clinically according to the simplified oral hygiene index (OHI). Dental caries examination was done according to decayed, missing, and filled teeth (DMFT) index. The scores were compared between the two groups. Results: The mean OHI score in cleft patients was 4.5 and in noncleft patients was 3.9 (P < 0.001).The mean DMFT score was 0.980 in cleft patients and 0.380 in noncleft patients (P < 0.001). Conclusion: This study clearly found that oral and dental health is compromised in CLP patients undergoing orthodontic treatment compared to patients undergoing routine orthodontic treatment. This article also proves that CLP is more predominant in males than in females.

Anterior segmental distraction osteogenesis in the hypoplastic cleft maxilla: report of five cases

Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech.

Airway Obstruction and the Unilateral Cleft Lip and Palate Deformity

Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT). A 2-year retrospective review of all subjects with unilateral CLP who underwent CBCT imaging (n = 22) and age-matched controls (n = 9) who underwent CT imaging was conducted. Control CT scans were used to determine the segment of nasal septum comprised almost entirely of bone. The CBCT of the nasal airway was assessed using Dolphin software to determine the contribution of the bony septum to septal deviation and airway obstruction. The nasal septum posterior to the midpoint between anterior and posterior nasal spine is comprised of 96% bone. The nasal airway associated with this posterior bony segment was 43.1% (P < 0.001) larger by volume on the non-cleft side in patients with unilateral CLP. The average septal deviation within the posterior bony segment was 5.4 mm, accounting for 74.4% of the maximal deviation within the nasal airway. The average airway stenosis within the posterior bony nasal airway was 0.45 mm (0-2.2 mm). In patients with unilateral CLP, the bony nasal septum can demonstrate significant deviation and airway stenosis. Surgeons should consider a bony septoplasty in their treatment algorithm in unilateral CLP patients who have reached skeletal maturity.

Archwise distraction appliance: A novel approach for developing facial and dental esthetics in cleft lip and palate patients

Cleft lip and palate (CLP) is defined as a congenital deformity caused by failed fusion of medial and lateral palatine processes during 4-12thweeks of embryogenesis, resulting in an open communication between oral and nasal cavities. In CLP patients, maxillary hypoplasia, velopharyngeal insufficiency, and alveolar clefts are the major issues that have to be taken care of after labiopalatal reconstruction. Rather than several consecutive operations, such as bone-grafting and orthognathic surgery, alveolar distraction can be a better treatment option in many cases. Archwise Distraction Appliance (AWDA) is a rigid, tooth-borne, custom-made appliance that is developed to control the distraction vector with double archwire system. Our experiences show that the AWDA is a successful appliance in cases of distraction osteogenesis. Moreover, alveolar distraction has significant advantages over conventional treatment modalities for CLP patients.

DUDAK DAMAK YARIKLI HASTADA ESTETİK VE FONKSİYONEL PROTETİK REHABİLİTASYON

The Cleft Lip and Palate (CLP) is variation of a type of clefting congenital anomaly caused by abnormal facial development during pregnancy. The etiology of CLP is unknown. The CLP patient is mainly characterized by the presence of an oronasal communication, malformation or congenital agenesis of the teeth close to the cleft and deficient sagittal and transverse growth of the maxilla. CLP is needing complex treatment strategies scheduled in many years of duration. These patients require various treatments involving a multidisciplinary team, which may include a maxillofacial surgeon, an orthodontist, prosthodontist, an ear nose and throat specialist(ENT), speech therapist and all those professionals who can help provide functional and aesthetic improvement. CLP patients may reconstructed with conventional prostheses or (dental-zygomatic) implant retained prostheses. Clinicians still have some difficulties in prosthetic reconstruction. Prosthetic reconstruction of the premaxillary region is important for these patients. In this case report, to restore masticatory function and improve speech and esthetics of the 21 years old cleft lip and palate patient fixed- removable protheses is used and advantages and disadvantages of prosthetic reconstruction are discussed By applying prothetic rehabilitation the function, phonation and esthetic were reformed. As a result of these deficiencies physcosocial problems were abolished. During one year clinical observation it was constated that the patient was living without any problem