Comprehensive orthodontic management of cleft lip and palate: Case series

Cleft lip and palate are one of the most common congenital craniofacial anomalies worldwide. It is frequently associated with significant functional, esthetic, and psychological challenges, including maxillary hypoplasia, malocclusion, and speech difficulties. Orthodontic management in cleft patients is crucial to restore facial harmony and occlusal balance, especially in growing individuals. This article presents two case reports of unilateral cleft lip and palate managed through a structured two-phase orthodontic approach involving early orthopedic correction followed by fixed appliance therapy. In both cases, patients presented with severe skeletal Class III malocclusion, constricted maxillary arches, anterior and posterior crossbites, and significant reverse overjet. The treatment protocol focused first on orthopedic maxillary expansion using quad helix appliances, followed by protraction with facemask therapy to leverage growth potential and correct maxillary hypoplasia. Comprehensive fixed appliance treatment was then undertaken to address crowding, space management, and final occlusal detailing. Therapeutic extractions and specific mechanics such as piggyback wires, open coil springs, and E-chains were employed where necessary. Post-treatment outcomes showed notable maxillary advancement, establishment of positive overjet and overbite, and a transition to a more favorable molar relationship. Retention was achieved using Hawley’s retainers. Both patients experienced improved esthetics and function, reflecting the effectiveness of this treatment approach in cleft management. Timely, growth-modification-based orthodontic management in cleft patients can significantly improve skeletal and dental relationships, even in resource-limited settings.