ABSTRACT
Comprehensive treatment of cleft lip/palate involves a team approach [surgeon, orthodontist, prosthodontist, speech therapist, etc.] for long-term multidisciplinary planning, to achieve proper function and esthetics of facial structures, as well as optimal hearing and intelligible speech. Our aim is to review evidence-based treatment timing in relation to key growth events. Sequence: Within the first year of life, lip adhesion and/or closure are performed; soft palate closure is indicated with or without hard palate surgery, which is not delayed beyond the age of 2 years. Feeding appliances may be given to non-thriving infants. Before school begins [age 3-5 years], the lip and columella are lengthened and the alar base is repaired if indicated. In early to mid-childhood [6-12 years], orthodontics is initiated before secondary alveolar bone grafting [ABG]: expansion appliances are used to correct posterior/anterior crossbites; maxillary segments and teeth adjacent to the cleft are aligned. The optimal time for ABG is before the dental emergence age of 10 years, as research indicates the prevalence of ectopic tooth eruption if bone is provided later. A pharyngeal flap may be needed at the same time. In the adolescent years, final revisions of the lip and soft palate, and rhinoplasty, are performed. Orthodontic treatment is completed alone or with adjunctive orthognathic surgery. Permanent cosmetic and functional dental restorations are done last. Maxillofacial orthopedic treatment of cleft lip/palate is enhanced by proper sequencing, coordinated and implemented by a team of specialists from birth to adulthood