Pre-surgical Orthopedics in a Patient with Cleft Lip and Palate: 2-Year Follow-Up

Abstract

Introduction: Cleft lip and palate is a congenital anomaly of multifactorial etiology requiring interdisciplinary and interprofessional management. The anatomical alterations in these patients result in variations affecting feeding, psychosocial aspects, hearing, and speech. One of the procedures performed at an early age is pre-surgical orthopedics, which has shown successful outcomes including proper alignment of maxillary segments, elevation of the affected nasal ala, improved feeding, and increased height and weight. Objective: to demonstrate the benefits of pre-surgical orthopedics and its interprofessional management from an early age in patients with cleft lip and palate.Case Report: A 2-year-old female patient who, at 15 days old, was admitted to the interdisciplinary clinic of the Javeriana University with a diagnosis of a complete unilateral left-sided cleft lip and palate, 8mm wide, with significant nasal depression. Treatment was initiated with pediatric dentistry, plastic surgery, speech therapy, and psychology. Extraoral tapes, an obturator plate, and NAM with a nasal stent were applied for five months prior to cheilorraphy, resulting in complete union of the alveolar ridges with proper maxillary segment alignment and noticeable improvement of the affected nasal ala. During this time, speech therapy support was provided to facilitate feeding processes, and the patient continues to have follow-up appointments with pediatric dentistry, speech therapy, and psychology, showing satisfactory results in all areas. Conclusion: Pre-surgical orthopedics is a recommended therapeutic approach before primary surgeries, yielding optimal short- and medium-term results. Interprofessional management is key to adequately maintaining the functional, aesthetic, and oral health aspects of the patients.