Palate Treatment Research Articles

J. Daniel Subtelny: A man of Thought, Action and Vision

‘‘I cannot teach anybody anything, I can only make them think.’’ On September 27, 2014, hundreds of alumni, faculty, administrators, and fellow Edward H. Angle Society of Orthodontists (EHASO) members came to Pittsford, NY to celebrate the life of Dr. J. Daniel Subtelny. They came from Hong Kong, Iceland, Mexico, Korea, Canada, and all points in the United States to honor and pay tribute to a man who has dedicated his life to our profession of orthodontics as a practitioner, researcher and educator. One alumnus drove from Illinois when she discovered she couldn’t get a flight because of a fire at the Chicago air traffic control center. It was standing room only during the memorial service in which Dr. Subtelny was eulogized by several colleagues and family members. In between strident organ refrains, everyone recalled his zest of life, learning, Joanne (his first wife—with whom he wrote the early books on cleft palate treatment), and the department he chaired for 55+ years. We were all reminded of how he made us better orthodontists and people. The current residents will perhaps most keenly feel this poignant grief because they will not have the benefit of his counsel for as long as the rest of us. His legacy lives on in the hundreds of former orthodontic residents he clinically educated, supervised and guided the research of —resulting in the publication of scores of important contributions to our literature. Rest assured that, even though he was 92 when his body failed to wake up on September 17th, he still had a lot to offer. He remained vibrant and active until the end. At the spring meeting of the North Atlantic Component of EHASO, in Rome, Dr. Subtelny kept up with the rest of the group as we walked 3.7 miles (a member of the group had a pedometer) up and down steps of the Vatican and the Coliseum. Immediately following the memorial service, a New Orleans style band led a processional, followed by the family and then the rest of the congregation, to Dr. Subtelny’s home for a celebration of his life. And what a rich life it was. After serving in both the US Army and the US Public Health Service, Dr. Subtelny began his career in dental education. Subtelny graduated from the University of Pennsylvania School of Dentistry, earning a Doctor of Dental Surgery degree. He received his orthodontic certificate and Master of Science degree from the University of Illinois, perhaps the most rigorous program and the world leader in orthodontic thought at the time, operating under the tutelage of Dr. Allan Brodie. In 1915, George Eastman donated the funds to build the Rochester Dental Dispensary—which later morphed into the Eastman Dental Center (EDC). In 1955, the second director, Dr. Basil Bibby, asked Dr. Dan Subtelny to organize the first accredited Department of Orthodontics. The fifth director of EDC, Dr. Cyril Meyerowitz, consolidated all branches of dental education and research at the University of Rochester under the umbrella that is now known as the Eastman Institute for Oral Health. Dr. Meyerowitz has said of Dan, ‘‘Dr. Subtelny is an excellent educator who has contributed significantly ... He is revered by his G 2015 by The EH Angle Education and Research Foundation, Inc.

Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate

ObjectiveTo address the question of whether one- or two-stage palatal treatment protocol has fewer detrimental effects on craniofacial growth in patients aged 5 years with unilateral complete cleft lip and palate. Materials and methodsForty patients with non-syndromic unilateral complete cleft lip and palate (UCCLPs) who had received primary cleft lip repair at age 6–12 months and cleft palate repair at age 18–30 months were selected in this study. Eighteen UCCLP patients who received two-stage palate repair were selected as group 1, and 22 UCCLP patients who received one-stage palate repair were selected as group 2. The control group consisted of 20 patients with unilateral incomplete cleft lip (UICL patients) whose age and gender matched with UCCLP patients. A one-sample Kolmogorov–Smirnov test was used to analyze the nature of data distribution. Bonferroni test and Kruskal–Wallis H tests were used for multiple comparisons. ResultsBoth case groups showed reduced maxillary sagittal length (ANS-PMP, A-PM, p < 0.05) and retrusion of the maxilla (S-Ptm, p < 0.05), A point and ANS point (Ba-N-A, Ba-N-ANS, p < 0.05). Patients treated with two-stage palate repair had a reduced posterior maxillary vertical height (R-PMP, p < 0.05). ConclusionsOur results indicated that maxillary sagittal length and position could be perturbed by both one- and two-stage palate repair. Vomer flap repair inhibited maxilla vertical growth. Delayed hard palate repair showed less detrimental effects on maxillary growth compared to early hard palate repair in UCCLP patients aged 5 years.

Examining factors associated with oral health-related quality of life for youth with cleft.

Patient-reported quality-of-life outcomes in cleft lip-cleft palate treatment are critical for evidence-based care. Scant data exist analyzing treatment from the patient's perspective. The authors examined the interrelationship among variables associated with oral health-related quality of life among youth with cleft. As part of an ongoing longitudinal study, clinical evaluations and research questionnaire packets were completed before surgical recommendations were made (baseline). Participants completed the Child Oral Health Impact Profile, a validated oral health-related quality-of-life measure for children with cleft. During the baseline clinical evaluations, plastic surgeons determined whether surgical interventions were recommended within the year (expert determination represents a greater degree of current clinical need). General linear models incorporating surgical recommendation, gender, and age were fit for each subscale of and for the total Child Oral Health Impact Profile. Significant interaction terms were evaluated for their effect on the subscale. Baseline assessments were obtained from 1200 participants (mean, 11.8 years; 57 percent male). Participants with a surgical recommendation had lower quality of life on all but the self-esteem subscale compared with those without a surgical recommendation (p < 0.002). Two subscales had statistically significant age-sex interactions (p < 0.003), whereas another subscale had a statistically significant surgery by sex interaction term (p = 0.027). Overall, youth for whom surgery is currently recommended had lower oral health-related quality-of-life scores on the Child Oral Health Impact Profile Total scale than those with no surgical recommendation; older female subjects had lower quality-of-life scores than male subjects. Risk, II.

Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review

BackgroundCurrent guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising.ObjectiveTo identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate.Data sourcesLiterature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction.Study selectionWe included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included.Data extractionIndependent extraction of data and quality assessments were performed by two observers.ResultsFive hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time.ConclusionAvailable evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it.Systematic review registrationInternational Prospective Register of Systematic Reviews, PROSPERO CRD42012002041

The Need For Differential Diagnosis In Cleft Palate Treatment Planning

Copyright: © 2014 Berkowitz S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Although the treatment of children with cleft lip/palate and other types of craniofacial anomalies in the United States has improved dramatically, many children with cleft lip and palate still receive care that is substantially inferior to what can or should be provided. Inadequate care results from diagnostic errors, failure to recognize and treat the full spectrum of health problems associated with complete unilateral cleft lip and palate (CUCLP) and complete bilateral cleft lip and palate (CBCLP), unnecessary and poorly timed treatment and inappropriate or poorly performed procedures. The answer to these problems lies in not obtaining longitudinal serial records of dental casts, lateral cephs, photographs and the use of the nasopharyngoscope.

Cleft Lip and Palate Treatment

Cleft lip and palate is still a very challenging facial deformity, and this special issue has shown this very clearly. Many papers came from all around the world, and the topics were very up to date and have raised very interesting points. The topics about humanitarian mission and its role and the benefits are elucidated in these articles, but the conclusion is that the world still does not have the solutions for the developing country, and there are benefits but no final and definitive answer for the problem. The balance between comprehensive cleft care and financial support is still unsolved. The genetic and the management of these patients with orocleft cleft palates raised a very interesting point about the future for prevention of these deformities. The knowledge of the genes involved in nonsyndromic cleft patients, even though the etiology is still poorly understood, could be the key for treatment. This issue reviewed all the most recent important genetic topics in cleft lip and palate. Some very interesting topics on techniques for lip repair have shown us that still some modification could improve the final cosmetic results. Some criterion on the evaluation of alveolar bone grafting could help in the final evaluation of the dental rehabilitation. At least we still have a long journey in the future when we look at protocols in cleft lip and palate; the literature is still missing a large number of papers based in real medical evidences. Only a few subjects have high level evidence supporting like the no use of infant orthopedics appliance for early palate surgery. Some points like age and technique for palatal repair are still unclear, showing that randomized controlled trials are needed. Multicentric collaborations and uniform protocols are strongly recommended. This issue was a very pleasing work and has shown us that so many new ideas and thoughts are very helpful to keep on the big challenge to solve this facial malformation in the future. Nivaldo Alonso David M. Fisher Luiz Bermudez Renato da Silva Freitas

Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public

The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.

Cleft Palate Midface Is Both Hypoplastic and Displaced

Despite significant advances in cleft lip and palate treatment, anatomical controversies remain. Some have proposed that the width of the cleft is due to alveolar segmental displacement. Others suggest that the width is due to palatoalveolar hypoplasia. Improving our understanding of cleft anatomy may have implications for presurgical orthopedics and tissue engineering therapies. Palatoalveolar impressions of 17 noncleft children and 11 children with complete (alveolar, primary, and secondary) unilateral cleft palates were taken. Maxillary tuberosity positions and maxillary volumes were compared. Tuberosity position was determined by facebow transfer of palatoalveolar casts into geodetic datum boxes, and identification of the Cartesian coordinates (x, y, z) of the tuberosities relative to the box surfaces and Frankfurt horizontal. Maxillary volume was determined by immersing the palatoalveolar casts and measuring sand displacement. A significant difference was noted in the average tuberosity to contralateral tuberosity distance between cleft and noncleft cohorts. On average, cleft palate tuberosities were laterally displaced 8.7 mm compared with noncleft palates (P < 0.05). There was neither statistically significant alveolar segment elevation nor retroversion. A significant difference was noted in the average palatoalveolar volumes. The cleft palatoalveolar volume was 5.7 cm, and the noncleft palatoalveolar volume was 7.2 cm (P < 0.05). A palatal cleft is due to both alveolar tissue displacement and deficiency. Therefore, ideal cleft palate care should involve the correction of a displaced and deficient alveolus.

Protocols in cleft lip and palate treatment: systematic review.

Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.

Modified Technique of Presurgical Infant Maxillary Orthopedics for Complete Unilateral Cleft Lip and Palate

This article introduces a modified device fabrication and facial taping method that increases the efficiency and efficacy of presurgical infant maxillary orthopedic therapy for babies born with complete cleft lip and palate. Interarch and intra-arch relationships of the maxillary and mandibular dental arches were evaluated on mounted stone models before and after treatment. The palatal plate device was custom-fabricated in a manner that bypassed the need for periodic acrylic addition and removal, thereby eliminating the risk of natural maxillary growth restriction during therapy. Elastic labial tapes were fabricated and applied in a configuration that mimicked normal function of the orbicularis oris muscle. A nasal stent wire was utilized from the initiation of therapy to enhance intraoral retention and stability of the device. Examples of infants undergoing a unilateral complete cleft lip and palate treatment protocol are presented. Treatment objectives were achieved within 7 to 8 weeks of therapy for patients who had an initial alveolar cleft size more than 10 to 12 mm. The modified protocol of presurgical infant maxillary orthopedic therapy is an effective and efficient treatment modality in reversing the pre-existing orofacial dysmorphism by redirecting the infant's natural growth.

Measuring Quality of Life in Cleft Lip and Palate Patients

Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons. The authors performed a literature review to identify questionnaires validated in cleft lip and palate patients. Qualifying instruments were assessed for adherence to guidelines for development and validation by the scientific advisory committee and for content. The authors identified 44 measures used in cleft lip and palate studies. After 15 ad hoc questionnaires, eight generic instruments, 11 psychiatric instruments, and one non-English language questionnaire were excluded, nine measures remained. Of these, four were never validated in the cleft population. Analysis revealed one craniofacial-specific measure (Youth Quality of Life-Facial Differences), two voice-related measures (Patient Voice-Related Quality of Life and Cleft Audit Protocol for Speech-Augmented), and two oral health-related measures (Child Oral Health Impact Profile and Child Oral Health Quality of Life). The Youth Quality of Life-Facial Differences, Child Oral Health Impact Profile, and Child Oral Health Quality of Life questionnaires were sufficiently validated. None was created specifically for clefts, resulting in content limitations. There is a lack of comprehensive, valid, and reliable questionnaires for cleft lip and palate surgery. For thorough assessment of satisfaction, further research to develop and validate cleft lip and palate surgery-specific instruments is needed.

Appreciation of cleft lip and palate treatment outcome by professionals and laypeople

The aim of the study was to analyse the aesthetic evaluation of head photographs of treated individuals with clefts by laypeople and professionals and to investigate how certain cephalometric variables could be related to their rating. A set of five standardized head photos (frontal, both laterals, three-quater right and left) of 12 Caucasian patients with treated unilateral cleft lip and palate were presented to 12 adult laypeople, 12 orthodontists, and 12 maxillofacial surgeons. For each set of photos the judges had to answer four questions on a visual analogue scale (VAS). The answers were analysed for intra- and inter-panel level of agreement and correlations of assessments with certain cephalometric parameters were determined. There was a high level of agreement for all assessments of each panel of raters. However, laypeople were less satisfied with lip and nose aesthetics compared to professionals. The three groups were similarly satisfied with the aesthetics of the jaws and the face. The anterior position of the maxilla (SNA) influenced positively professionals' ratings of facial aesthetics. Orthodontists were negatively influenced when the vertical dimension of the face or the distance of the lower lip to E-plane were relatively increased. The latter was the only cephalometric parameter correlated with lower aesthetic scores obtained from laypeople. Professionals report greater satisfaction from the treatment outcome and evaluate cleft consequences with less severity than laypeople. According to cephalometric findings, the relative positions of the lips seem to dominate facial aesthetics' appreciation by laypeople, while specialists appear to focus on different features of the face.

Towards a more palatable treatment for Glut1 deficiency syndrome

Towards a more palatable treatment for Glut1 deficiency syndrome

Prise en charge des fentes labiopalatines par l’équipe du Pr Hosaka à l’université de Showa, Tokyo (Japon)

We describe the particularities of cleft lip and palate treatment in the department of plastic surgery managed by Pr Hosaka at the Showa University in Tokyo. Their surgical technic inherited from Pr Onizuka, their multidisciplinary approach, and their experience with over 300cases a year were not reported in a non-Japanese journal. Therefore, we found interesting to describe their whole management.

My viewpoint on cleft lip and palate treatment

唇腭裂是口腔颌面部常见的先天性疾患之一,畸形造成了多方面的生理障碍,心理影响随着年龄增长相继出现,因此对唇腭裂患者进行团队、时间序列治疗的方法已经被广泛实施.各种复杂的修复及评价方法固然重要,但是序列治疗是成功修复方法的基础,使患者可以融入整个社会[1]。

Cleft lip and palate treatment of 530 children over a decade in a single centre

Objective We sought to evaluate the process of care and the outcomes of cleft lip and palate operations carried by a multidisciplinary team at a centre of craniofacial anomalies with a high patients’ volume. Methods A retrospective review of all cleft lips and/or palates cases treated in the centre from 1995 to 2007 was performed. Direct and long term complication rates, clinical, audiologic, speech intelligibility and dental arch assessments were analyzed. Results A total of 530 children have been operated this period in the centre (64 isolated cleft lip closures). A detailed presentation of the outcomes is performed in relation to the various types of cleft lip and palates. The majority of parents (70%) reported very good or excellent results 2–5 years after the lip closure with the Millard technique, although those with bilateral clefts were significantly less satisfied ( P < 0.002). Forty-two percent of children with cleft palate and otitis media with effusion were self-improved 2–8 months after palate reconstruction and 83.3% of children treated with the two flaps palatoplasty technique had a rather high or very high intelligibility score. Muscles’ retropositioning had a significant effect on intelligibility ( P = 0.04). Conclusions Children with cleft lips and palates have a variety of conditions and functional limitations even after the surgical correction of their problem that need to be evaluated and treated by several specialists. The treatment protocol utilized by the multidisciplinary team of our centre is efficient with a relative low percentage of complications and unfavorable results.

Role of orthognathic surgery in assisting double dentition denture in the treatment of secondary deformities of cleft lip and palate: a report of two cases

Introduction: It was generally accepted and further developed by scholars all over the world after the principle of cleft lip and palate team approach treatment had been put forward in the 1930 s. Today, the ‘team approach’ treatment has become the mainstream principle of cleft lip and palate treatment without doubt. However, it takes a longer course of treatment, more referrals, and higher cost. For patients with secondary deformities who have some difficulties in accepting ‘team approach’ treatment, we use a double dentition denture as a treatment alternative, which can correct the maxillary hypoplasia before taking nasolabial repair surgery. But in severe skeletal angle III malocclusion cases (ANB <–4°), as a result of a larger anti-overjet, it is difficult to obtain normal overjet and overbite while doing single dental treatment. In order to create conditions for prosthodontic treatment, we attempt to push mandible backward by mandibular sagittal split ramus osteotomy (SSRO), and then wear the double dentition denture.

How good are we in creating facial attractivity in cleft patients?

Discussions about outcome in cleft lip and palate treatment is mainly concentrated on the protocol of the primary procedures and how this may ultimately determine speech and occlusion. Another group of reports concentrates on improving initial poor speech and a third group on improving occlusion by means of orthodontics, orthognathic surgery, distraction osteogenesis and restorative dentistry. Finally several authors have put forward techniques to improve nasolabial residual deformity and asymmetry in young adults.

Oral‐health‐related quality of life among children with and without dental fear

This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured. The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register (n = 51) and schoolchildren (n = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule-Dental Subscale and a single question. ORHQoL was measured with CPQ(11-14). Background variables were gender and the dental care experienced. The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ(11-14 )total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics. Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.

Winds of change: Hope for cleft lip and palate patients

If patient satisfaction is a metre to calibrate specialists then the obstetrician surely scores over all others, as the overjoyed patient and her family are gifted every time with a bundle of joy. Second in this list will be the ophthalmologist as he/she transforms the dull and opaque world of the patient into a bright and colourful one. Third in this list surely is a plastic surgeon treating cleft lip and palate (CLP) patients. A 45-minute surgery transports a child from despair to delight; and anxiety to ecstasy. From being an object of curiosity, the child gets seamlessly assimilated and accepted in his play group. In short, it is a transformation from a life of ridicule to a life of hope and happiness ever after. India, undoubtedly, has a very large cleft population, which at over a million is well above the entire population of some countries! Every passing year adds another 32,000 - 35,000 to the figure. Therefore, prevention should be our goal. The omnipresence of the sonologist in the far reaches of our population has aided in early detection of CLP in the unborn foetuses, offering parents a choice in medical termination of pregnancy. Though the foetuses are not in jeopardy of life or limb, this choice is socially accepted in India, though some human rights activists term this practice of “cosmetic murder” as the extremes of eugenics. Joanna Jepson, a British clergywoman, herself afflicted with a congenital jaw deformity, has initiated a legal suit to stem this practice in the UK. Even as the genetic answer to this malady eludes humankind, the big challenge for research on cleft lip and palate is to make a quantum shift from studying individual genes to defining individual protein networks, a nexus of proteins that interact in a highly regulated manner. Since clefting is usually a sum of the combined actions of multiple gene products, it is likely that what we now call non-syndromic may have a distinct heterogeneous character, other manifestations being too subtle to manifest. Further research, however, might begin to better define these conditions. The salutary role of Government Medical Colleges and non-governmental Organizations like the Smile Train in addressing the vast backlog of patients waiting for cleft surgeries can not be overemphasized. Due to their untiring efforts, though poised on the threshold of clearing this ‘quantity challenge’ of ever-growing numbers, it is time for us to switch gears and turn our attention to ‘quality’. Only an infinitesimal proportion of our operated patients get the benefit of orthodontics and speech pathology and for the majority, orthognathic surgery is a distant dream. Many of the top paediatric hospitals are developing their own cleft clinics in order to provide patients with comprehensive multi-disciplinary care from birth through adolescence. Allowing an entire team to care for a child throughout their cleft lip and palate treatment allows for the best outcomes in every aspect of a child's care. While the individual approach can yield significant results, current trends indicate that team-based care leads to better outcomes for CLP patients. However, in a heterogenous India, we shall mostly continue to rely upon individual surgeons; and they shall harmoniously coexist with burgeoning multi-specialty centres of excellence. There is a large amount of research dedicated to the psychosocial development of individuals with cleft palate. A CLP may impact an individual's self-esteem, social skills, and behavior; and they tend to report feelings of anger, sadness, fear, and alienation from their peers. Yet these children are similar to their peers with regard to “how well they liked themselves.” Our Guest Editor, Dr. Jyotsna Murthy, has invited a galaxy of professionals working in the field of CLP to contribute to this issue and one can only marvel at both the quality and the quantity of research and clinical work under way, in all six continents, to bring back smiles to these thousands of afflicted faces.