E CleftLip

REFERENCE MANUAL
V 37 / NO 6
15 / 16
Policy on Management of Patients with Cleft Lip/

Palate and Other Craniofacial Anomalies
Originating Committee
Clinical Affairs Committee
Review Council
Council on Clinical Affairs
Adopted
1999
Revised
2003, 2008, 2012
Reaffirmed
2007
The American Academy of Pediatric Dentistry (AAPD), in its

efforts to promote optimal health for children with cleft lip/
palate and other craniofacial anomalies, endorses the current
statements of the American Cleft Palate-Craniofacial Association (ACPA).1,2

A child born with cleft lip/palate or other craniofacial
anomalies has multiple and complex problems, including early
feeding and nutritional concerns, middle ear disease, hearing
deficiencies, deviations in speech and resonance, dentofacial
and orthodontic abnormalities, and psychosocial adjustment
problems.
Reports by the US Surgeon General3,4 on children with
special needs issued in 1987 and 2005 stressed that the care
of these children should be comprehensive, coordinated, culturally sensitive, specific to the needs of the individual, and readily
accessible. Recognizing that children with clefts and other
craniofacial anomalies have special needs, the Maternal and
Child Health Bureau in 1991 provided funding to ACPA to
develop parameters of care for these patients through a series
of consensus conferences among a multidisciplinary group
of specialists.1 In addition, the ACPA joined with the Cleft
Palate Foundation to create standards for approval of teams
to ensure that care is provided in a coordinated and consistent
manner, including an appropriate sequence of evaluations
and treatment for the patients overall developmental, medical,
and psychological needs.2
As part of the parameters1 and standards2, several fundamental principles were identified as critical to optimal cleft/
craniofacial care. These principles are:

1. Management of patients with craniofacial anomalies
is best provided by an interdisciplinary team of spe cialists.1 These teams are composed of qualified health

professionals from medical, surgical, dental, and allied
health fields working together in a coordinated sys tem. A designated patient care coordinator should be

350
ENDORSEMENTS
included in the team to assist in coordinated care for

patients and their families/caregivers.2
2. Optimal care for patients with craniofacial anomalies
is provided by teams that see sufficient numbers of
these patients each year to maintain clinical expertise

in diagnosis and treatment.
3. The optimal time for the first evaluation is within the
first few weeks of life and, whenever possible, within
the first few days. However, referral for team evalua tion and management is appropriate for patients of
any age.1
4. From the time of first contact with the child and
family, every effort must be made to assist the family
in adjusting to the birth of a child with a craniofacial
anomaly and the consequent demands and stress

placed upon that family.1
5. Parents/caregivers must be given information about

recommended treatment procedures, options, risk fac tors, benefits, and costs to assist them in: (1) making
informed decisions on the childs behalf, and (2) pre paring the child and themselves for all recommended

procedures. The team should actively solicit family par ticipation and collaboration in treatment planning.1,2

When the child is mature enough to do so, he or

she should also participate in treatment decisions.1
6. Treatment plans should be developed and imple
mented on the basis of team recommendations.1
7. Care should be coordinated by the team, but should

be provided at the local level whenever possible; how
ever, complex diagnostic or surgical procedures should
be restricted to major centers with appropriate treat
ment facilities and experienced care providers.
8. It is the responsibility of each team to be sensitive to

linguistic, cultural, ethnic, psychosocial, economic, and
physical factors that affect the dynamic relationship

between the team, the patient, and his/her family.1
AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
9. It is the responsibility of the team to monitor both

short-term and long-term outcomes. Thus, longitu dinal follow up of patients, including appropriate

documentation and record-keeping, is essential.1
10. Evaluation of treatment outcomes must take into
account the satisfaction and psychosocial well-being
of the patient, as well as effects on growth, function,
and appearance.1
Patients with craniofacial anomalies require dental care
throughtout life as a direct result of their condition and as an
integral part of the treatment process. A dental home should be
established within six months of eruption of the first tooth and
no later than 12 months of age. It includes oral health examinations, caries control, and preventive, restorative, and prosthetic
dental treatment as needed. Patients should be closely monitored for periodontal disease and anomalies in dentition and
eruption. Prosthetic appliances such as an obturator may help
to close a fistula or aid in speech. Orthodontic treatment is
also an integral part of the habilitative process and often takes
place in phases. The skeletal and dental components should be
regularly evaluated. When indicated, orthodontic treatment
prepares a child for alveolar bone grafting of the cleft maxilla,
correcting malocclusions, and preparation for jaw surgery.1 As
members of the interdisciplinary team of physicians, dentists,
speech-language pathologists, and other allied health professionals, pediatric dentists should provide dental services in
close cooperation with their orthodontic, oral and maxillofacial
surgery, and prosthodontic colleagues.1,2 All dental specialists
should ensure that1:

1. Dental radiographs, cephalometric radiographs, and
other imaging modalities as indicated should be
utilized to evaluate and monitor dental and facial

growth and development.
2. Diagnostic records, including properly occluded den tal study models, should be collected at appropriate
intervals for patients at risk for developing maloc
clusion or maxillary-mandibular discrepancies.
3. As the primary dentition erupts, the team evaluation
should include a dental examination and, if such
services are not already being provided, referral to
appropriate providers for caries control, preventive

measures, restorative care, and space management.

4. Before the primary dentition has completed eruption,
the skeletal and dental components should be evalu ated to determine if a malocclusion is present or
developing.

5. Depending upon the specific goals to be accomplished
and also upon the age at which the patient is initially
evaluated, orthodontic management of the maloc-
clusion may be performed in the primary, mixed, or

permanent dentition. In some cases, orthodontic

treatment may be necessary in all three stages.

6. While continuous active orthodontic treatment from
early mixed dentition to permanent dentition should
be avoided, each stage of orthodontic therapy may
be followed by retention and regular observation.
Orthodontic retention for the permanent dentition

may extend into adulthood.
7. For some patients with craniofacial anomalies, func
tional orthodontic appliances may be indicated.

8. For patients with craniofacial anomalies, orthodontic
treatment may be needed in conjunction with sur gical correction (and/or distraction osteogenesis) of

the facial deformity.
9. Congenitally missing teeth may be replaced with a
removable appliance, fixed restorative bridgework, or
osseointegrated implants.
10. Patients should be closely monitored for dental and
periodontal disease.
11. Prosthetic obturation of palatal fistulae may be

necessary in some patients.
12. A prosthetic speech device may be used to treat

velopharyngeal inadequacy in some patients.
References
1. American Cleft Palate-Craniofacial Association. Parameters
for Evaluation and Treatment of Patients with Cleft Lip/
Palate or Other Craniofacial Anomalies. Chapel Hill, NC:
The Maternal and Child Health Bureau, Health Resources
and Services Administration, US Public Health Service,
DHHS; November 2009. Grant #MCJ-425074. Available
at: http://www.acpa-cpf.org/resources/acpa_publications/.
Accessed June 26, 2012.
2. American Cleft Palate-Craniofacial Association Commission on Approval of Teams. Standards for Approval of
Cleft Palate and Craniofacial Teams. American Cleft
Palate-Craniofacial Association; 2010. Available at: http://
www.acpa-cpf.org/uploads/site/Standards_2010.pdf .
Accessed June 26, 2012.
3. US Dept of Health and Human Services. A Report of
the Surgeon General: Children with Special Health Care
Needs. Rockville, Md: Office of Maternal and Child
Health, US Dept of Health and Human Services; 1987.
4. US Dept of Health and Human Services. The Surgeon
Generals Call to Action to Improve the Health and Wellness of Persons with Disabilities. Rockville, MD. US Dept
of Health and Human Services, Office of the Surgeon
General; 2005.
ENDORSEMENTS
351

E CleftLip

Uploaded by

Copyright:

Available Formats

E CleftLip

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

E CleftLip

Uploaded by

Copyright:

Available Formats

REFERENCE MANUAL

Policy on Management of Patients with Cleft Lip/

The American Academy of Pediatric Dentistry (AAPD), in its

included in the team to assist in coordinated care for

AMERICAN ACADEMY OF PEDIATRIC DENTISTRY

9. It is the responsibility of the team to monitor both

clusion may be performed in the primary, mixed, or

You might also like