Editing Cleft lip and cleft palate (section)

===Cleft palate===

[[File:Repairedcleftpalate.JPG|thumb|A repaired cleft palate on a 64-year-old female]]
Often a cleft palate is temporarily covered by a [[palatal obturator]] (a prosthetic device made to fit the roof of the mouth covering the gap). This device re-positions displaced alveolar segments and helps reduce the cleft lip separation. The obturator will improve speech as there's now proper airflow and improve feeding and breathing as the gap in the hard and soft palate is closed over so cannot affect it.<ref name="Gill_2011">{{Cite book| vauthors = Gill DS, Naini FB |title=Orthodontics: Principles and Practice|year=2011|pages=257}}</ref>{{rp|257}}

Cleft palate can also be corrected by [[Alveolar cleft grafting|surgery]], usually performed between 6 and 12 months. Approximately 20–25% only require one palatal surgery to achieve a competent velopharyngeal valve capable of producing normal, non-[[hypernasal speech]]. However, combinations of surgical methods and repeated surgeries are often necessary as the child grows. One of the new innovations of cleft lip and cleft palate repair is the [[Latham appliance]].<ref>{{cite journal | vauthors = Fukuyama E, Omura S, Fujita K, Soma K, Torikai K | title = Excessive rapid palatal expansion with Latham appliance for distal repositioning of protruded premaxilla in bilateral cleft lip and alveolus | journal = The Cleft Palate-Craniofacial Journal | volume = 43 | issue = 6 | pages = 673–677 | date = November 2006 | pmid = 17105324 | doi = 10.1597/05-109 | s2cid = 34126577 }}</ref> The Latham is surgically inserted by use of pins during the child's fourth or fifth month. After it is in place, the doctor, or parents, turn a screw daily to bring the cleft together to assist with future lip or palate repair.

If the cleft extends into the maxillary alveolar ridge, the gap is usually corrected by filling the gap with bone tissue. The bone tissue can be acquired from the individual's own chin, rib or hip.

At age 1–7 years the child is regularly reviewed by the cleft team.<ref name="Gill_2011" />{{rp|257}}

Age 7–12 years, for the children born with alveolar clefts, they may need to have a secondary alveolar bone graft. This is where autogenous [[cancellous bone]] from a donor site (often the pelvic bone) is transplanted into the alveolar cleft region. This transplant of bone will close the osseous cleft of the alveolus, close any oro-nasal [[fistula]]e and will become integrated with the [[maxillary bone]]. It provides bone for teeth to erupt into and to allow implants to be placed as a possible future treatment option. The procedure should be carried out before the upper canine has erupted. Ideally the root of the canine should be one to two-thirds formed and that there is a space available to place the bone graft. [[Radiography|Radio-graphs]] are taken to determine the quantity of missing bone in the cleft area.<ref name="Gill_2011" />{{rp|258}}

==== Other surgeries ====
[[Orthognathic surgery]] – surgical cutting of bone to realign the upper jaw ([[osteotomy]]). The bone is cut then re-positioned and held together by wires or rigid fixation plates to ensure there's no anterior-posterior discrepancy, also to reduce scarring as it reduces growth. Single piece or multi-piece osteotomy exist. Single piece osteotomy is carried out where there is sufficient alveolar continuity achieved from a successful bone graft. Multi piece osteotomy is performed when there is a notable residual alveolar defect with a dental gap and oronasal fistula (communication between the oral and nasal cavities). The goal of both single and multi piece osteotomy is to displace the maxilla forward to obtain adequate occlusion as well to provide better support for upper lip and the nose and to close any [[fistula]]e.<ref name=":2">{{cite journal | vauthors = Kloukos D, Fudalej P, Sequeira-Byron P, Katsaros C | title = Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | pages = CD010403 | date = August 2018 | pmid = 30095853 | pmc = 6513261 | doi = 10.1002/14651858.CD010403.pub3 }}</ref>

[[Distraction osteogenesis]] – bone lengthening by gradual distraction. This involves cutting bone and moving ends apart incrementally to allow new bone to form in the gap. This consists of several phases. After attachment of the distracting device and the bone cuts, there is a latency phase of 3–7 days when a [[Callus (cell biology)|callus]] forms. In the activation phase distraction of the callus induces bony ingrowth which can last up to 15 days depending on the required distraction. Once the required bone length is reached, the distraction device is left to remain in situ as it acts as a rigid skeletal fixation device until the new bone has matured (known as the consolidation period).<ref name=":2" />