A Unique Approach to the Interceptive Orthodontic Treatment of Cleft Lip & Palate Patients
Michael K. DeLuke, DDS, MDS

Traditional interceptive orthodontic treatment of patients with cleft lip and palate (CL&P) involves rapid maxillary expansion (RME) using a hyrax-type appliance to expand the maxilla in preparation for placement of an alveolar bone graft. However, many of these patients do not present with a posterior maxillary transverse discrepancy and instead have a narrow, V-shaped maxillary arch which is broad posteriorly across the molars and narrow in the middle and anterior thirds. Additionally, these patients are often premaxillary deficient. As such, traditional RME often over-expands the posterior segments and under-expands the middle and anterior thirds of the arch, distorting the maxillary arch form and creating arch coordination issues with the opposing mandibular arch.

Traditional RME-type expanders also present numerous challenges such as discomfort, food impaction, speech issues, compliance, decalcification of banded teeth, and permanent teeth erupting into the appliance. In addition, parents often have difficulty turning the hyrax key to activate the appliance. All these factors can make appliance placement and maintenance challenging both for the practitioner and the patient/parent(s).

Furthermore, it is typically not possible for the surgeon to perform fistula closure and/or osseous grafting with a traditional hyrax-type RME in place. Thus, the appliance must be removed prior to surgery and the patient must be retained, typically with a removable appliance. After surgery, the removable retainer cannot be worn until the surgical site(s) heal, frequently resulting in relapse of the transverse deficiency and the need to repeat expansion during comprehensive/Phase II orthodontic treatment.

In this webinar, an innovative approach to the interceptive treatment of preadolescent patients with CL&P using only braces and wires will be presented and contrasted with the traditional means of performing RME with a hyrax-type appliance. Advantages of this alternative approach will be discussed, and sample cases will be reviewed.

Learning Objectives:

1. Review the different iterations of the traditional rapid maxillary expansion (RME) appliances that are most frequently used in patients with CL&P, highlighting the numerous challenges they present.
2. Describe an unconventional approach to the interceptive treatment of preadolescent patients with CL&P using only braces and wires to gently and predictably develop and expand the arches.
3. Demonstrate the numerous advantages of this unconventional approach including ease of use for the patient, parent(s), and practitioner, accessibility by the plastic surgeon for fistula repair and/or alveolar bone graft placement, and stability.

Dr. Michael DeLuke is a Board Certified Orthodontist who obtained his DDS from SUNY Brook, where he graduated as class valedictorian, and his Certificate of Proficiency in and Master of Dental Science (MDS) from the University of Connecticut, where he was Resident in his final year.

Dr. DeLuke has served as the orthodontist on the prestigious Cleft Craniofacial Team at Albany Medical Center, as a clinical professor at the Ellis Hospital Practice Residency, and as an adjunct professor at the University of Connecticut Health Department of Orthodontics. He is currently an adjunct professor at the NSU College of Medicine in the Department of Orthodontics. Dr. DeLuke started, owned, and operated DeLuke Orthodontics in Upstate NY from 2005 – 2023 and launched DeLuke Orthodontic Coaching in 2022 with the mission of helping his succeed both personally and professionally. He has been the featured presenter at and regional meetings across the country over the past 20 years, has published articles in orthodontic journals, and is the creator and host of The DOC Podcast which helps dental professionals lead a happier and more prosperous life both personally and professionally.

1 CE credit available to AAPMD members