# Cleft Lip and Palate Orthodontics

> Cleft lip and palate for BDS Orthodontics: incidence, Veau classes, timing of repairs, nasoalveolar moulding, expansion, alveolar bone grafting and surgery.

- Canonical URL: https://prepelephant.com/topics/bds/orthodontics/cleft-ortho-basics
- Exam / course: BDS · Subject: Orthodontics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Cleft Lip and Palate Orthodontics", PrepElephant, https://prepelephant.com/topics/bds/orthodontics/cleft-ortho-basics

## Direct answer

Cleft lip and palate, among the commonest congenital craniofacial anomalies, is quoted at roughly one per 700-1000 live births with higher reported rates in Asian populations; cleft lip with palate is commoner in males while isolated cleft palate predominates in females. Orthodontics runs through the whole timeline: presurgical infant orthopaedics or nasoalveolar moulding in the first weeks aligns the segments and sculpts the nose before lip repair at about three months (the rule of tens — ten weeks of age, ten pounds weight, ten grams per decilitre of haemoglobin), palate repair by 12-18 months for speech, and then the mixed-dentition phase — expansion of the collapsed maxillary segments, crossbite correction — followed by secondary alveolar bone grafting at eight to eleven years, timed to the canine root (one-half to two-thirds formed), with comprehensive fixed treatment in adolescence and orthognathic correction of the scar-restricted maxilla after growth. Every intervention trades against the next, and the orthodontist's job is staged compensation.

## What you must remember

- **Numbers:** roughly one per 700-1000 live births worldwide, with higher reported incidences in Asian and Indian populations (estimates vary by registry — hedge when quoting); unilateral left cleft lip and palate is the commonest of the complete unilateral forms.
- **Classification:** Veau's four classes — soft palate only; hard and soft palate; complete unilateral cleft; complete bilateral cleft — with LAHSHAL notation the modern recording system for lip, alveolus, hard and soft palate.
- **Infancy:** nasoalveolar moulding (NAM) or presurgical orthopaedics in the first weeks narrows the cleft, moulds the alar cartilage and aligns segments before surgery.
- **Surgical clock:** lip repair around three months (Millard rotation-advancement or Tennison techniques) under the rule of tens; palate repair by 12-18 months (Von Langenbeck, Veau-Wardill-Killner pushback, or Furlow double-opposing Z-plasty) prioritising velopharyngeal competence for speech.
- **ENT constant:** otitis media with effusion is near-universal in cleft palate — grommets (ventilation tubes) and audiology surveillance are part of the protocol, not an option.
- **Mixed dentition:** expand the collapsed maxilla (quad helix or RME), correct anterior and posterior crossbites, align the rotated and malformed laterals bordering the cleft.
- **Alveolar bone graft (secondary):** iliac crest cancellous bone at 8-11 years with the canine root one-half to two-thirds formed — graft before the canine erupts through the cleft, so it erupts into grafted bone with a functional periodontium.
- **Adulthood sequence:** comprehensive fixed appliances in the permanent dentition (often with prosthetic replacement of hypoplastic laterals), Le Fort I maxillary advancement or distraction after growth completes for the skeletal Class III, and retention planning that accounts for prosthetic and speech needs.

## Following one child through the timeline

A newborn with complete unilateral left cleft lip and palate enters the protocol in week one: a feeding plate plus nasoalveolar moulding for the first months narrows the alveolar gap and lifts the flattened nostril, so the surgeon closes the lip at three months over better-aligned foundations. The palate is repaired at fourteen months, and speech therapy with grommets carries the preschool years. At eight, with the maxillary segments collapsed, orthodontics resumes: expansion with a quad helix, alignment of the border teeth, and a diagnostic records review timed to the canine — when its root reaches about half to two-thirds formation, the plastic surgeon grafts cancellous iliac crest bone into the alveolar cleft, and the canine later erupts through the graft into a stable, keratinised arch. Adolescence brings full fixed appliances, management of the missing or peg-shaped lateral, and honest planning for the scarred maxilla: a proportion of these teenagers finish in Le Fort I advancement after growth ceases.

## How the exam frames cleft care

Theory questions ask for incidence, aetiology (multifactorial genetic-environmental), classification (Veau, LAHSHAL) and the timed sequence of management — the rule of tens and the grafting window (8-11 years, canine root half to two-thirds formed) are the two facts examiners hunt for by number. Vivas probe the orthodontist's specific contributions: infant moulding, mixed-dentition expansion, pre-graft alignment and post-adolescent orthognathic planning, plus the team-care convention — surgeon, orthodontist, speech therapist and ENT as one unit — followed explicitly in Indian cleft centres. MCQ constants: the commoner sex distribution patterns, the timing of palate repair (by 12-18 months for speech), the donor site for alveolar grafting (iliac crest) and the timing of maxillary advancement (after growth completion).

## Frequently asked questions

### What is the incidence of cleft lip and palate?

Roughly one in 700 to 1000 live births, with higher reported figures in Asian populations; isolated cleft palate is less common and commoner in females.

### What does the rule of tens govern?

The timing of primary lip repair — about ten weeks of age, ten pounds (about 4.5 kg) of weight and ten grams per decilitre of haemoglobin.

### When is secondary alveolar bone grafting performed?

At eight to eleven years, timed to the canine root at one-half to two-thirds formation, grafting the alveolar cleft with iliac crest cancellous bone before the canine erupts through it.

### Why does the repaired maxilla become deficient?

Palatal repair scarring restrains maxillary growth, producing a retrusive maxilla with anterior crossbite and Class III tendency that often needs Le Fort I advancement after growth.

### What is nasoalveolar moulding?

Presurgical infant orthopaedics using a moulding plate and nasal stents in the first weeks to align the alveolar segments and shape the nasal cartilage before lip repair.