Cleft and Craniofacial Orthodontic Care

Children born with a cleft lip or palate, and patients with craniofacial conditions affecting the jaws and face, need orthodontic care that is planned around surgery, growth, and the work of several other clinicians. Dr. Wakas Abdulrazzaq, the orthodontist at The Orthodontic Gallery in Riverview, trained in cleft and palate care at Children’s National Hospital in Washington, DC during his residency, and provides it to families across the greater Tampa Bay area.

Families who have been through this already know it is not a single treatment. It is a sequence that runs from infancy into the late teens. A surgeon, an orthodontist, often a speech pathologist, an ENT, and a general dentist are all involved along the way. The orthodontic part has to fit into that sequence rather than run on its own schedule.

Where the Orthodontist Fits

1. Infancy. Before lip repair, some infants receive presurgical infant orthopedics or nasoalveolar molding. These appliances guide the segments of the gum and nose into a better position before the surgeon’s work. Specialist teams usually do this at the treating hospital.
2. Ages 6 to 10. The first orthodontic phase in most cleft cases. The upper arch is typically narrow, and often collapsed on the cleft side, so expansion prepares it. Most cleft patients also need an alveolar bone graft. The orthodontist prepares the arch beforehand and manages the teeth erupting into the grafted site afterward. Timing is dictated by the canine’s root development, not by the calendar.
3. Adolescence. Comprehensive orthodontic treatment once the permanent teeth are in. Missing or malformed teeth in the cleft area are common. That means deciding early whether to close a space orthodontically or hold it open for an implant or bridge later.
4. Late teens and adulthood. The jaws often grow into a significant discrepancy after cleft repair. A narrow upper arch that is still collapsed at this stage may need bone-anchored expansion before anything else can be planned. Those cases are planned jointly with an oral and maxillofacial surgeon. See surgical orthodontics.

Other Craniofacial Conditions

The same principles apply to a broader group of conditions affecting facial and jaw development. Craniosynostosis syndromes and hemifacial microsomia are examples, along with other conditions where the jaws are asymmetric or underdeveloped. What these cases share is that orthodontics is one component of a plan owned by a team. Timing matters more than technique.

Working With a Cleft Team

Most children with clefts in this region are followed by a multidisciplinary cleft and craniofacial team, and that is exactly as it should be. Team care produces better outcomes than piecemeal care. It is also the standard recommended by the American Cleft Palate Craniofacial Association.

We are not a cleft team and we do not present ourselves as one. What we offer is an orthodontist in Riverview who has worked inside that model and understands the sequencing. We can provide the orthodontic component locally while communicating properly with the rest of your team. For a family in southeast Hillsborough already driving into Tampa for surgical appointments, having the orthodontic visits close to home is worth something.

If you are not currently with a team and you think you should be, tell us and we will help you get connected. If the appointment itself is the hard part, the same adaptations we make in special-needs orthodontics apply here.

What to Bring to a First Consultation

Your surgical history, including dates and the surgeon’s name. Any records or imaging from your team. A sense of what has been planned and when. If you have none of it, come anyway; we will start by finding out where things stand rather than assuming.