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Babies born with cleft lip and palate often have defects in their gums due to bone irregularities. Even after cleft lip repair surgery, these gum issues persist. The affected area commonly involves the location of the lateral incisor, leading to missing or underdeveloped side incisors. Nearby canine teeth are also impacted, potentially failing to erupt or becoming loose without sufficient bone support.
Without gum surgery, individuals may face challenges such as leakage between the mouth and nose, food buildup, difficulty cleaning the mouth, tooth decay, misaligned teeth, and unstable gums. Nasal allergies are also prevalent.
Clinically, some patients who had early cleft lip surgery but skipped gum procedures return later with dental issues or chronic sinusitis. Oral bacteria can spread to the nasal cavity, causing infections that affect quality of life. While this surgery doesn't impact appearance or speech from prior cleft lip and palate repairs, it remains essential.
Some may wonder why gum defects aren't addressed during initial cleft lip surgery. It's possible to suture them then, but long-term studies show early intervention can hinder palate development. Most global medical centers opt for surgery between ages 9 and 11, when dentists monitor tooth growth. Typically, this occurs as lateral incisors erupt and affected canine teeth begin to emerge, marking the ideal window for gingival suturing.
Preoperative correction aims to align teeth around the cleft for easier surgery. It helps maintain appropriate spacing. Surgeons face challenges if gaps are too narrow, wide, or obstructed by teeth. Successful cleft lip and palate gum surgery relies on patient cooperation (oral hygiene and gum health), orthodontic expertise (creating suitable cleft spacing), and surgical skill.
Traditional gum surgery involves harvesting bone marrow from the hip to fill the cleft. This causes significant pain, requiring bed rest for days, while gum wounds are less painful. Recent observations revealed that some patients without bone grafts developed bone naturally after simple suturing. A prospective study (involving children from 2015 and 2016 surgeries) tracked outcomes over a year, finding no statistical difference in bone growth compared to grafted groups. Benefits include reduced pain from bone harvesting, no infection risk from grafts, and shorter hospital stays.
Children with cleft lip and palate usually visit a craniofacial clinic around ages 8 to 9 for preoperative correction assessment. If needed, dentists apply for orthodontic subsidies and coordinate with surgeons for device scheduling. Correction lasts about six months. Two months pre-surgery, surgeons confirm alignment progress, then schedule inpatient admission and exams, typically between ages 9 and 10.