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he orthodontic and maxillofacial technicians work closely with
other health care staff at Addenbrooke's to support the treatment
and care for people who have cleft lip and/or palate. Most of these
are babies and young children but their treatment often extends
into adulthood.
'Photo of an impression of a baby's face showing
a cleft upper lip and a cleft hard palate'
Why do you take impressions of faces and mouths for people who
have cleft lip and palate?
People who have a cleft palate can either have a gap in the soft
palate alone (at the back of the roof of the mouth only) and/or
of the hard palate (ie the gap is further forward and involves
the bony roof of the mouth). These can be complete (the gap goes
right through) or incomplete (ie just a notch or ridge).
It is very useful for planning and review of treatment to know
what shape the cleft is before and after any surgery to correct
it. We do this using a dental impression in soft material, which
is cast in plaster to give an accurate 3D model of the mouth.
Many people who have a cleft palate also have a cleft lip and,
again, it is useful to know what shape this is before and after
corrective surgery. Again, we do this using a modified soft dental
impression material, which is cast in plaster to give an accurate
3D model of the face (see photo above).
Photographs are also very useful and these are taken by our Medical
Photography Department at Addenbrooke's.
What is your role during the first stages of treatment?
We start to take impressions of the mouth and/or face from birth
to about six months of age.
This first impression is usually done in the operating theatre
just before the first corrective operation of the affected person.
This surgery is usually performed on young babies who will be
anaesthetised during the procedure for safety and comfort.
After the first operation a second impression is often taken.
This helps us check later developments. The actual impressions
taken depend on the type and severity or the cleft.
'Photo of a cleft expansion appliance - this
has a spring to gently increase the width of the upper palate'
What role do you play in orthodontic treatment following a cleft?
Most people who have had corrective surgery for cleft lip or
palate will require some kind of orthodontic treatment to correct
misalignments of the teeth and help shape the roof of the palate.
This treatment usually involves the construction of one or more
orthodontic appliances, which can be fixed (physically attached
to the teeth), removable or a combination of both. As orthodontic
technicians, we play an essential role in casting of impressions
and the construction of these appliances.
Each appliance is tailor made to suit the individual; often we
need to make more than one.
'Photo of a retainer appliance - showing the
choice of colours available'
Often, at the end of treatment, we will make one or more retainer
appliances (see photo above), which hold the teeth in the desired
position.
This treatment is co-ordinated and planned by the Joint Cleft
Clinic, usually consisting of a team of maxillofacial surgeons,
plastic surgeons and orthodontists.
Typically, young people who have had cleft lip or palate will
attend this clinic until their early 20s.
What role do you play in orthognathic surgery and osteotomy
planning?
Orthognathic surgery is a branch of oral surgery in which the
underlying bony structures of the face and jaws are modified to
assist the orthodontic treatment or to improve the function and
appearance of the jaws and face.
Often, the oral surgeons and orthodontists will want to plan
the actual surgery in advance using accurate 3D models. They can
test the results of various changes to the jaws on these models
to help them during surgery. Impressions are taken to make dental
models and once the surgery is planned, we make customised splints
to aid the surgeon during and after the operation. These splints
hold the teeth and jaws in place to support healing.
Usually, orthodontists then carry out some additional treatment
using appliances to fine tune the alignment of the teeth. We work
with them to produce further dental models and appliances.
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