Cleft Lip & Palate — Management Timeline
Cleft care is staged and multidisciplinary. Key timings are high-yield.
- Presurgical (NAM — nasoalveolar moulding) — first weeks, aligns alveolar segments and improves nasal form.
- Lip repair — around 10 weeks (classic Rule of 10: ~10 weeks old, ~10 lb weight, ~10 g/dL haemoglobin).
- Palate repair — around 9-18 months (before key speech development).
- Alveolar bone graft — ~9-11 years (mixed dentition, before canine eruption).
- Definitive orthodontics and possible orthognathic surgery in adolescence.
Embryology
Cleft lip = failure of fusion of the maxillary and medial nasal processes; cleft palate = failure of palatal shelf fusion.
Exam Tips ⭐
Rule of 10 for lip repair; palate ~18 months; alveolar graft 9-11 yr; NAM is presurgical.
📝 Practice MCQs — Cleft Lip & Palate — Orthodontic Management
Q1. The 'Rule of 10' applies to the timing of:
A. Palate repair
B. Lip repair
C. Bone grafting
D. Orthognathic surgery
Show Answer
✅ Answer: B
Lip repair: ~10 weeks, ~10 lb, ~10 g/dL Hb.
Q2. Alveolar bone grafting in cleft patients is ideally done at:
A. Birth
B. 10 weeks
C. 9-11 years (mixed dentition)
D. 18 years
Show Answer
✅ Answer: C
Secondary alveolar grafting is timed to mixed dentition, before canine eruption.
Q3. NAM (nasoalveolar moulding) is a:
A. Surgical repair
B. Presurgical infant orthopedic therapy
C. Retention appliance
D. Bone graft
Show Answer
✅ Answer: B
NAM is a presurgical procedure to align segments and shape the nose.
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