ABSTRACT
Cleft lip and palate is a common condition affecting thousands of children in India and overseas. With an incidence of 1 in 800 live births, these cleft lip and cleft palate patients face numerous aesthetic as well as functional challenges. The condition goes untreated in many scenarios, or patients do not receive adequate treatment due to various reasons like lack of awareness, lack of specialist dentists etc. leading to permanent facial deformity with significant deterioration of quality of life. There have been many changes in the management of alveolar cleft in the past 100 years. Documentation of the first cleft lip repairs dates back to 400 BC, and was performed by Hippocrates, while the first cleft velum repair was done for the first time by a French dentist, Monnier, in 1764. The treatment protocol for the same has been upgraded with time, with better understanding of the anatomy and pathophysiology of the condition, and for better results to the patients. Alveolar bone grafting (ABG) is now becoming an integral part of managing cleft patients. There still isn’t a fixed and widely accepted protocol for ABG in the management of cleft patients, but there are various opinions of researchers around the world regarding the indications of bone grafting, the type of grafting (primary or secondary) to be employed, timing of grafting, the source of bone graft and use of various bone graft substitutes in the procedure. An increasing value of multidisciplinary approach, including maxillofacial surgeons and orthodontists, towards managing such patients, is helping improve the outcome of such patients, and hence easing the overall treatment duration for the patient and relatives. Hence, through this article, we aim to shed some light over the evolvement and current place of alveolar bone grafting in treating cleft lip and palate patients. The anatomy of involved parts, types and indications of ABG, clinical evidences on the timing of the surgery, future evaluation, results and complications, and orthodontic treatment have been mentioned in this article.
ABSTRACT
To establish speech, growth and development of maxillofacial region and hearing etc. towards normal is the aim of every professional working for cleft care. With a quest to attain and normalize the growth and development in CLP since ages, researchers and workers have invented and still inventing newer technique to treat them. The procedure of surgeries has evolved over a period of time. Controversies concerning speech and maxillofacial growth have challenged many surgeons who have come up with different views in surgical methods. Studies suggest that the palate repair is the main cause of the maxilla and growth disturbance that later is responsible for speech impairment due to fibrous tissue in anterior palate and constricted tissue in uvula due to repair. Many authors have noted that delayed hard palate repair has more positive effects on maxillary growth than that of early hard palate repair, but studies have also proved that late palate repair impair the speech with due respect. This unsolved controversy whether to opt for late/ early palatoplasty w.r.t to the improvement in speech is still unsolved controversy. The purpose of this article is to review the history of cleft palate surgery, its evolution, various surgical methods and optimal timing of cleft palate repair.