Primary and secondary cleft palate – orthodontic management in early life based on the literature and our own experience

Introduction
Primary and/or secondary cleft palate (P/SCP) is the most common facial malformation and is diagnosed at a rate of 1.47 per 1000 births worldwide. Patients with primary and/or secondary cleft palate (P/SCP) require long-term, multiyear, multi-stage, and interdisciplinary treatment. Specialised care begins at birth and progresses with active therapy and individual follow-up periods in relation to the face and the masticatory organ.

Aim
The aim of this study is to present a protocol for orthodontic therapy of infants with complete primary and secondary cleft palate in the pre-surgical period, based on the literature and our own experience.

Material and methods
The paper contains data from specialist literature between 1994 and 2021, and presents the protocol of pre-surgical management of infants with P/SCP used in the Developmental Malformation Outpatient Clinic ACSiMS in Zabrze.

Results
At the early stage of the child’s development, an orthodontist evaluates facial and oral morphology, as well as oral functioning, in accordance with the protocol for cleft treatment in the Developmental Malformation Outpatient Clinic in Zabrze. Lip massage is recommended as part of the pre-surgical orthodontic care of infants with P/SCP. Orthodontic appliances may also be used in the early treatment of children with P/SCP, as a part of PSIO. The aim of such treatment is to modify the maxillary growth, improve the symmetry of the lip and nose, better align the alveolar ridge and palatine processes, and perform lip surgery with the least amount of tissue tension (cheiloplasty).

Conclusions
The use of appliances in the infantile pre-surgical orthopaedic management of children with P/SCP requires long-term randomised trials using a uniform protocol for surgical, orthodontic, and orthopaedic therapy.