Pre-surgical orthopedics in newborns affected by clefts of the lip, alveolus and palate. Report of two cases

Aim Clefts of the lip and/or palate are common birth defects of complex aetiology affecting many functions (mastication, speech, etc.). Several approaches have been published on early management of the alveolar segments and the dislocated premaxilla and nowadays we are more and more confronted with a world-wide tendency in favour of the all-in one operation to close clefts of the lip, alveolus and palate. Nonetheless, it is well-known that all types and timings of surgical repair of facial clefts are detrimental to maxillary growth. The effect of infant orthopaedics on maxillary arch has been a subject of debate for many years, but controversy regarding its effect still exists. The aim of this work is to describe an orthopaedic, pre-surgical approach in the newborn to improve final outcome. Method Palatal plate project has been integrated with the application of guide planes and elastic bands aimed at controlling the position of the premaxilla and the width of the cleft. Results Two cases are illustrated with the step-bystep management of the palatal plate. Clinical data are discussed. Conclusion The palatal plate molds the alveolar segments into a better arch form and prevents the tongue from positioning in the cleft, improving so dentomaxillary development. This will result in better pre-surgical control of the soft tissues with better aesthetic and functional results.