Cleft Palate is a facial deformity, so rare that most people have never heard of it, occurring 1 in 800 live births. Some babies are born only cleft lip and others more demonstrate more severity that includes the palate.
Treating cleft palate involves more than just a plastic surgeon to repair the cosmetic aspects. Since cleft palate often involves the ear, an otolaryngologist (ear, nose, and throat doctor), audiologist, and speech pathologist are also on the team. Also involved are an orthodontist, oral and maxillofacial surgeon, general dentist, prosthodontist, neurosurgeon, pediatrician, psychologist, and a social worker. This is called the "team approach." These special children need the coordinated talents of many specialists. Dr. Feldman has been the team orthodontist for the USF craniofacial/cleft palate team since 1984.
Dr. Feldman explains what happens with cleft palate. "The lip and palate (the hard bony plate in the roof of the mouth) fail to differentiate at critical points in the time of the developing child. Consequently, if differentiation of the tissues that make up these structures is incomplete or abnormal, the union of the lip and palate can be lacking in varying degrees. The resulting defects may be incomplete, in which only the lip and/or palate is partially involved, or complete, in which both the lip and palate are totally involved. The cleft can be unilateral (one-sided), or bilateral (occurring on both sides). Clefts occur more often in boys and normally more on the right side."
"The whole idea behind early orthodontic/orthopedic intervention is to move bones back to where they belong," states Dr. Feldman. "Newborns' bones are more pliable and are easy to move. Usually bone must be moved before any surgery can take place. Therefore, many cleft palate children are fitted with orthodontic/orthopedic appliances in the hospital before they are taken home."
Neo-natal maxillary orthopedic appliances are used to appropriately align the maxillary bones. One of them, a Latham appliance (named after the Canadian doctor who invented it), is used to align the premaxilla prior to plastic surgery closure.
In order to fabricate an appliance for neo-natal maxillary orthopedics, an impression of the child's palate is taken with an alginate material, which is the same material used in taking dental impressions. Dr. Feldman then uses this impression to fabricate the appliance that will be inserted onto the palate, in order to move the upper segments together.