Bilateral cleft lip and palate: presurgical treatment

Patients with bilateral cleft lip and cleft palate problems may present with severe tissue disparities. A good surgical repair without tension may be difficult to achieve. With proper presurgical orthodontic management the tissues can be brought into good relationships, permitting a one-stage surgical repair under optimal conditions. An appliance can be used to secure the lateral arches in proper position. Then external gradual traction can reposition the lateral arch and central arch segment relationships, establishing a more normal arch. After lip repair the "artificial palate" denture is worn until palate repair. The common types of situations encountered are categorized and illustrated with case reports. Not only is this approach more advantageous surgically, but it also helps feeding, provides and maintains good early arch form, and theoretically could contribute to speech. It avoids lip adhesions and can be accomplished within the time that is usually allowed before lip repair.