This is a trascript taken from an informational video that Dr. Magraw filmed recently:
“The most common type of facial cleft we see is a cleft lip with or without palate. And most of these children are otherwise happy healthy individuals and they have a soft tissue and bony deformity that often includes the upper lip the nose the upper jaw and the roof of the mouth or the palate. Most cleft lips are now diagnosed prenatally during the anatomic ultrasound which is usually done around 18 to 20 weeks of gestation. One of the common referrals i receive is for a prenatal consult for a family that has a baby in utero who has a diagnosis of a cleft lip with or without palate involvement. It’s a big part of my practice and what i like to do is sit down and explain to them what their child’s journey will look like and give them a better understanding as to what to expect when the baby arrives. As you can imagine, having a diagnosis of a prenatal cleft lip and or without palate involvement can be very anxiety provoking for families and so it’s incredibly important for them to have the opportunity to meet a surgeon who actually treats these problems and have a better understanding as to what to expect. Craniofacial conditions often have complex needs including difficulties with speech, swallowing problems, hearing issues, more complex dental needs, and many have pretty significant psychosocial concerns as well. And so that’s one of the reasons that it’s recommended that these children are treated in an interdisciplinary fashion so that we can address all the needs as a team instead of as individual providers.”
“The stage reconstructive approach for a child with the cleft lip and palate involves three surgeries: cleft lip repair, cleft palate repair, and bone graft reconstruction of the upper jaw. It’s very important to consider the effect of surgery on growth. Because of the child, you’re always dealing with a moving target. The child hasn’t reached skeletal maturity yet and so when you operate on them, you have to anticipate that there will be some changes. There’s substantial evidence to support that the less time a child spends in active orthodontic care, the better their outcome. And so as the surgeon who often leads some of these discussions in regards to when to intervene surgically, it’s important that you are conservative in regards to your approach as to when you intervene and only do so when absolutely necessary. We tend to complete bone graft reconstruction based on dental development and so as the permanent teeth are starting to erupt into the mouth we need bone in that area to support those teeth and so if you’re able to put the bone graft in right before usually the canine tooth erupts then as that tooth erupts the bone graft actually matures around it and it’s much more successful. Completing this procedure when someone is an adult is much less successful than it is during the mixed dentition stage or around age eight to twelve. And so it’s very important as teams and providers that we get patients in to have the treatment they need at the age appropriate time to really optimize their success long term.”
