Individuals affected with cleft deformities, especially those of the palate, show skeletal discrepancies between the size, shape, and position of their jaws. Class III malocclusion. seen in most cases, is caused by many factors.
A common finding is mandibular prognathism, which is frequently relative and is caused mo\e by the retrusion of the maxilla than by protrusion of the mandible (i.e., pseudoprognathism) (Fig. 27-6). Missing or extra teeth
may partially contribute to the malocclusion. However, retardation of maxillary growth is the factor most responsible for the malocclusion. Generally the operative trauma of the cleft closure and the resultant fibrosis (i.e., scar contracture) severely limit the amount of maxillary growth and development that can take place. The maxilla may be deficient in all three planes of space, with retrusion, constriction, and vertical underdevelopment common. Unilateral palatal clefts show collapse of the cleft side of the maxilla (i.e., the lesser segment) to the center of the palate, which produces a narrow place arch. Bilateral palatal clefts show collapse of all omention or may have constriction of the posterior segments and protrusion of the anterior segment.
Orthodontic treatment may be necessary throughout the individual’s childhood and adolescent years. Space maintenance and control is instituted during childhood. Appliances to maintain or increase the width of the dental arch are frequently used. This treatment is usually begun with the eruption of the first’ maxillary permanent molars. Comprehensive orthodontic care is. deferred until later, when most of the permanent teeth have erupted. Consideration for orthognathic surgical intervention for
correction of skeletal discrepancies and occlusal disharmonies is frequently necessary at this time.