Cleft Lip and Palate Treatment

Cleft lip and cleft palate are facial malformations in which the parts of the face that form the upper lip and mouth remain split, instead of sealing together before birth. Similar splits can occur in the roof of the mouth, known as cleft palate. These conditions affect how the jaws and teeth develop, which means orthodontic treatment is a meaningful part of the overall care plan — often spanning childhood through early adulthood. Both Dr. Chang and Dr. Chung hold Master of Science degrees in Craniofacial Biology, providing a rigorous clinical foundation for managing the orthodontic component of cleft lip and palate treatment within a coordinated team of specialists.

What Makes Cleft Treatment Different from Routine Orthodontics

Cleft lip and palate cases involve more than crowded or misaligned teeth. The underlying bone structure, the position of the upper jaw, and the relationship between the dental arches can all be affected by the cleft itself and by the surgeries used to repair it. That means the orthodontist's role is not just to straighten teeth — it's to help prepare the mouth for surgery, support healing after surgery, and guide jaw and tooth development across multiple stages of growth.

Because the treatment unfolds over years, families benefit from working with an orthodontist who understands craniofacial development in depth, not just standard bite correction. That specialized background is why Dr. Chang and Dr. Chung pursued graduate study specifically in Craniofacial Biology.

The Typical Treatment Timeline

Orthodontic involvement in cleft care generally follows a phased approach tied to a child's growth and surgical schedule:

• **Early childhood (infant orthopedics):** Some children with clefts wear a presurgical nasoalveolar molding (NAM) appliance or similar device before their initial lip repair surgery. This is typically managed by a craniofacial team, which may or may not involve an orthodontist depending on the program.
• **Mixed dentition phase (roughly ages 6–10):** Before alveolar bone grafting — a procedure that fills the gap in the upper gum ridge with bone — the orthodontist often expands the upper arch and moves teeth to create the right conditions for a successful graft.
• **Adolescent phase:** Once the adult teeth have erupted, full orthodontic treatment aligns the teeth and coordinates the bite. If jaw surgery is planned, the orthodontist works closely with the oral surgeon to position the teeth correctly before and after the procedure.
• **Retention:** Like all orthodontic treatment, the final phase involves retainers to hold the corrected position long term.

Each patient's timeline varies depending on the severity of the cleft, the number of surgeries involved, and how growth progresses.

Working Within a Specialist Team

Cleft lip and palate treatment is never managed by one provider alone. The orthodontist works alongside oral and maxillofacial surgeons, plastic surgeons, speech-language pathologists, pediatric dentists, and sometimes other specialists depending on the individual case. For families in Los Alamitos and the surrounding area, having an orthodontist with formal craniofacial training means clearer communication across that team and a deeper understanding of how each phase of treatment connects to the next.

Dr. Chang coordinates with referring specialists and participates in treatment planning conversations so that the orthodontic work is timed correctly relative to surgeries and other interventions.

What to Expect at Your Appointments

Initial appointments focus on documenting the current state of the teeth, jaws, and bite through photographs, X-rays, and models or digital scans. From there, a treatment plan is built around the patient's specific cleft type and surgical history. Appointments during active treatment — whether that involves an expander, braces, or aligners — run similarly to standard orthodontic visits, typically 30 to 60 minutes, with longer appointments scheduled around significant treatment milestones.

Parents are included in the conversation at every stage. For younger patients especially, understanding what's coming next and why reduces anxiety and helps the whole family stay on the same page.

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Frequently Asked Questions

**At what age should a child with a cleft first see an orthodontist?** An initial orthodontic evaluation is often recommended around age 6 to 7, roughly when the first adult teeth begin to erupt. Some children are referred earlier if an expander or other early intervention is being considered before a bone graft.

**Does a child with a cleft always need jaw surgery?** Not necessarily. Some patients achieve a functional, well-aligned bite through orthodontics alone. Others — particularly those with significant discrepancy between the upper and lower jaws — may benefit from orthognathic (jaw) surgery in their late teens once growth is complete. This is assessed case by case.

**How long does the orthodontic phase of cleft treatment last?** It varies widely. Some patients have two or three shorter phases of treatment separated by periods with no appliances. Others move through a more continuous course of treatment in adolescence. A realistic timeline is discussed at the consultation once the full picture of the patient's history and current development is clear.

**Will my child need braces and other appliances?** Most patients in active treatment use some combination of palate expanders, braces, and retainers. The exact appliances depend on what needs to be accomplished at each stage.

**Does Chang Orthodontics accept patients who have already had some cleft surgeries?** Yes. Patients often come to the practice mid-treatment, having already completed early surgeries. Dr. Chang reviews prior records and works with the existing specialist team to continue care from wherever the patient currently is in their treatment journey.