Oral and Maxillofacial Surgery

This discipline is concerned with the occlusion and facial form of patients with cleft and craniofacial anomalies. They work with other members of the team to ensure harmonious and appropriate dental arch form and facial form. Although there may be overlap with plastic surgery and otolaryngology and head and neck surgery in some areas, the oral and maxillofacial surgeon manages the alveolar cleft and skeletal problems related to cleft and craniofacial anomalies such as maxillary hypoplasia and other skeletal malocclusions.

  1. Prenatal: May counsel families regarding prenatal diagnosis and implications.
  2. Neonatal: May be involved in airway management. See Otolaryngology section for details.
  3. Infant: Early bone grafting of the cleft alveolus has been performed by some at this time but this is a controversial procedure that has been associated with poor mid-facial growth and class III dental malocclusion.
  4. Toddler: Occasionally primary teeth in the line of the alveolar cleft will need extraction at this age.
  5. Preschool: See Toddler section above.
  6. School-Aged
    1. Bone grafting of the alveolar cleft is usually done during the period of mixed dentition.
      1. Age 6 to 10.
      2. Orthodontic care prior to bone grafting to align the dental arches on either side of the cleft.
      3. Sometimes teeth in and around the cleft can be salvaged with bone grafting saving the need for prosthetic dentistry later.
      4. Depending on the size of the cleft in the alveolus the source of the bone graft may be the iliac crest, calvaria, or bone bank.
  7. Adolescents
    1. It is during this time when skeletal maturity is reached that consideration is given to maxillary or mandibular osteotomies to normalize occlusion and facial form.
    2. Patients with cleft lip and palate have a significant incidence of class III skeletal malocclusion with mid-face hypoplasia.
    3. This can be corrected with a Lefort I osteotomy of the maxilla sometimes combined with an osteotomy of the mandible. For slight anterior dental cross bites and orthodontic mid-facial protraction, a facial mask may be used.
    4. Distraction osteogenesis has been used to correct these skeletal occlusal problems as well.
    5. Skeletal surgery may be carried out in adulthood as well.

Core Curriculum for Cleft Palate and Other Craniofacial Anomalies

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