How The Face Changes ?

 Posted By : Dr.Sanjay Kalra, MDS(prostho), [[Implantology]] & [[Cosmetic Dentist]]

In your lifetime you have seen the faces of thousands of people and each face is recognizable to you as distinctively individual. Consider, relatively how few parts compose a face – a lower jaw and a chin, cheek bones, a mouth and an upper jaw, a nose and two orbits. Add a forehead and supraorbital ridges for the neuroeranial parts of the face. Amazing how so few components underline such a great variation in the facial form! A very sight alteration in the configuration of any part can make a substantial difference in the appearance and character of one’s face as a whole. 

“The human face” , a dynamic growing part of the human body, can have growth aberration because of heredity and environmental reasons. The cleft-clip-and-palate is one such common growth aberration and requires a comprehensive management protocol, based on the individual presentation. 

In a team approach towards the management of the cleft-lip-and-palate patients, the team includes: 

• A plastic surgeon. 
• A dental specialist (paedodontist, orthodontist, prosthodontist). 
• Speech pathologist. 

They have a true peer relationship with shared interaction aimed at achieving the optimul result for the patient. 

The plastic surgeon is usually the first to be seen when a child is born with cleft deformity. He gives information about the morphology, tissue reaction, tolerance and the timing of the elective surgical procedures. He alleviates the parents fear about their child, reassuring them that their child would be a normal being. Although he may require a number of surgical procedure till he reaches adulthood. The number of survical procedure will vary depending on the child’s presentation. However, these procedures are well tolerated by them without any detrimental effect. 

As the team surgeons and head, he follows the patients longitudinally and is involved with the patients from birth to adulthood. His primary function are lip repair, closure of alveolar cleft (cleft in the gums), secondary palatal and pharyngeal procedures and later surgical improvements in the lip and the nose. Some children may even require movement of the jaws to improve the profile, which is also undertaken by him. All the above procedures are timed to maximize the possibility of attaining adequate structure function and the appearance for normal physiological and psychological development. 

The interaction of the plastic surgeon and the dental specialist begins early. A variety of dental problems may be found in the patient cleft lip and palate. These range from trivial dental rotations to major dentoskeletal dysharmonies. Some of these deformities are due to the cleft malformation whereas others are secondary deformities resulting from specific management options taken in childhood. Working as a team having close interaction, the incident of secondary deformities is reduced. 

After the alignment of the arch of the upper jaw, the alveolar cleft (cut in the gums) is closed allowing the normal teeth to erupt through the repaired cleft area. Such a procedure if not done, leads to improper teeth eruption and the loss of good healthy teeth. Progressive orthodontics allows for the proper alignment of the teeth in the upper jaw, obviating the need for prosthetic teeth replacement later. 

It continues through out the growing period in consideration with occlusal factors, and primary and secondary dentition. In some cases, a combination of orthodontics and orthognathic surgery (jaw surgery) is necessary to correct the deformity i.e. normalize the dentition, the facial skeleton and the appearance. 

In his relationship with the orthodontist, the speech pathologist has specific information to offer. When orthodontic appliances are necessary for management, they must be planned so as not to interfere with the speakers articulation. 

In consultation with the surgeon, the speech pathologist/therapist should emphasis the complete primary physical management that should be accomplished before the age of three years to enable each child to develop adequate speech and language and to avoid the frequent cleft palate stigmata. His/her primary responsibility to the team lies in the deep assessment of velar adequacy for speech. He/she emphasises on three methods of obtaining information – direct testing, information response and examiner observation. With the information obtained by these tests, the cleft-lip-and-palate child is given specific therapy. 

The child may have voice problems along with impaired articulation. There will be excessive nasality, i.e. hypernasality and the person may seem to be speaking through his nose. The speech seem to be punctuated by the little “catches of the breath”. Some may have delayed language development, i.e. show in the development of the vocabulary and the length of utterance. His goal of treating a cleft-lip-and-palate child is to decrease the nasal emission, the hypernasality, the defective articulation, the improvement of adequate oral pressure and oral airflow, the elimination of abnormal foci of tension, the abnormal nostril contraction, etc.e. 

In conclusion, as evident from the above discussion, the cleft-lip-and-palate child requires comprehensive treatment as he or she grows into adulthood. This is best achieved through a team approach, having a close and possitive interaction between the team members, striving to give their best to this unfortunate group. 

By: Dr. Y. Kaplash 

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