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 Table of Contents  
TEACHING IMAGES
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 298-299

Complete bilateral cleft lip and palate with protruding premaxilla: A multidisciplinary approach


1 Department of Orthodontics and Dentofacial Orthopaedics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
2 Kanachur Institute of Craniofacial Anomalies, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India

Date of Web Publication27-Dec-2018

Correspondence Address:
Dr. Shafees Koya
Department of Orthodontics and Dentofacial Orthopaedics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_136_18

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  Abstract 


Cleft lip and palate constitutes one of the most common congenital anomalies. It causes a wide range of functional as well as esthetic problems. A cleft child's life becomes challenging with a lot of sociopsychological problems which require tremendous support, motivation, and a definite treatment protocol by a craniofacial team in a multidisciplinary approach. Here is a report of one such child who was treated with a multidisciplinary approach by our craniofacial team.

Keywords: Arch expansion, bilateral cleft lip and palate, multidisciplinary approach, premaxillary protrusion


How to cite this article:
Koya S, Husain A, Khader M. Complete bilateral cleft lip and palate with protruding premaxilla: A multidisciplinary approach. Arch Med Health Sci 2018;6:298-9

How to cite this URL:
Koya S, Husain A, Khader M. Complete bilateral cleft lip and palate with protruding premaxilla: A multidisciplinary approach. Arch Med Health Sci [serial online] 2018 [cited 2019 Jan 20];6:298-9. Available from: http://www.amhsjournal.org/text.asp?2018/6/2/298/248658



A 7-year, 6-month-old male patient reported to us with the chief complaint of ugly appearance [Figure 1]. Clinical examination revealed an unrepaired complete bilateral cleft lip and palate with a protruded premaxilla. His past medical history revealed no surgeries underwent till now. On extraoral examination, he had a short columella, great deformity of alar cartilages, and a protruded premaxilla. On intraoral examination of the maxillary arch, the posterior segments were collapsed with the protruded premaxilla consisting of two permanent central incisors. He had congenitally missing upper lateral incisors, but all his primary teeth were present. Overall, the patient was psychologically affected because of the scary look given by the unrepaired protruded premaxilla.
Figure 1: Pretreatment photographs

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A multidisciplinary care was provided by our cleft surgeon, orthodontist, psychologist, pediatrician, and a speech therapist. The orthodontist started with the arch expansion using a quad helix in order to correct the collapsed cleft segments. Alongside, the psychologist did the counseling of the child with his parents. Speech therapy was also commenced. Once sufficient arch expansion was achieved, the cleft surgeon performed a premaxillary setback osteotomy followed by a lip repair. Posttreatment, the facial appearance of the child was drastically improved [Figure 2].
Figure 2: Mid- and post-treatment photographs

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An unrepaired bilateral cleft lip and palate with protruded premaxilla makes the patient look ugly and scary. The protruded premaxilla may be due to the pressure exerted by the tongue and growth vomer, who cannot find the counterforce exerted under normal conditions by the orbicularis muscle.[1],[2],[3] A multidisciplinary cleft care can provide excellent treatment and improve the quality of life of cleft patients.

Declaration of the patient

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Koya S. Nasoalveolar molding: Does it benefit? Oral Health Dent 2017;1:274-6.  Back to cited text no. 1
    
2.
Míguez FL, García GM, Caramés BJ. Treatment of bilateral cleft lip with protruding premaxilla: Therapeutic alternatives. JSM Oro Fac Surg 2017;2:1004.  Back to cited text no. 2
    
3.
Koya S, Shetty S, Husain A, Khader M. Presurgical nasoalveolar molding therapy using Figueroa's NAM technique in unilateral cleft lip and palate patients: A preliminary study. J Clin Pediatr Dent 2016;40:410-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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