In this second issue devoted to labio-maxillo-palatal clefts, we shall continue to emphasize the informational aspect that characterized the first issue. After presenting the specific fundamentals of management or clefts, we shall carefully consider the complementary disciplines that share in the overall care of cleft palate patients.

Since 2005 in France, the national technical committee of prenatal ultra-sound screening (CNTE) has recommended that pregnant women have a routine second trimester ultrasound screening for facial clefts. The view on the coronal reference plane visualizes the continuity of the upper lip, and makes it possible to detect most facial clefts, but not isolated palatal clefts.

Treatment teams use different approaches for correcting the alveolar cleft sector of labio-palatal clefts. Age of patient, whether or not bone grafts are used, and the type of bone grafted are some of the differences. Our team performs a gingivoperioplasty with a graft of iliac cancellous bone on patients 4 to 6 years old. This procedure is carried out within the framework of orthodontic treatment designed to restore transverse dimension pre-operatively with a quad helix and to retain the expansion with 6 months of retention. The gingivoperioplasty is accomplished in a zone free of any scar tissue that might have resulted from a primary cheiloplasty followed by closure of the palatal cleft. In our view all teams must eventually utilize cone beam X-rays for their radiographic evaluations because they are the only tool that provides results of objective analysis that are of high quality and have demanded a very low level of radiation.

Objectives: dental anomalies are more frequent for individuals with clefts than for the general population. Our objective is to evaluate the prevalence of dental ageneses in a sampling from Alsace made up of 124 children with clefts (81 boys and 43 girls, average age 12.5 years old).

Method: clinical and radiographic exams make it possible to specify the dental formula as well as the type of clefts that are divided into 4 groups: simple Labial Clefts (LC – 12.9%), Labio-Alveolar Clefts (LAC – 4%), Labio-Palatal Clefts (LPC – 49.2%) and Palatal Clefts (PC – 33.9%).

Results: 63% of the patients present one or more ageneses mainly involving the maxillary lateral incisors (54%) and the maxillary or mandibular second premolars (32%). The percentage of children with congenitally missing teeth is, in ascending order, minimal in the case of LC (33%), average in the case of PC (54%) and highest in cases of LPC (79%). The frequency of ageneses increases proportionally with the severity of the cleft. The left side is most affected (p < 0.01) regardless of the side of the cleft.

Conclusions: dental ageneses are more frequent on the left side, regardless of the side of the cleft. The greater prevalence on the left side could suggest the intervention of overlapping etiopathogenic factors when clefts and dental ageneses are involved.

With an average frequency of 1/800 births in France, labio-maxillo-palatal clefts (LMPC) are among the most frequent congenital malformations. They raise functional, esthetic, psychological and socio-familial problems that must be managed with an interdisciplinary approach. Within the medical team, the dentist must, by way of prosthetic restorations, compensate for certain sequelae and deficiencies. According to the severity of the case and the success of the treatments, the typical restoration can be limited to replacing the missing lateral incisor, or the restoration may require undertaking comprehensive treatments involving a much more specialized arsenal of surgical and prosthetic procedures.

The author presents the sequelae of labio-maxillo-palatal clefts in the specific framework of one surgeon’s professional experience in an overseas community; in terms of their surgical anatomy, showing the palatal, maxillary, and labio-nasal sequelae in order, emphasizing the intimate relationship of the lesions, which are most intricate in cases of complete labio-palatal clefts, and also the necessity of the treatment team’s taking a global approach in the techniques of facial surgery so the results will be well adapted to the social needs of patients.

Just 25 years after Pierre Fauchard published his pioneering work, The Surgeon Dentist or Treatise on the Teeth in 1728, James Lind, a Scottish physician, presented the results of his study on scurvy, the first clinical experiment in the history of medicine, which provided the methodological foundation for modern medicine.