美国唇腭裂协会指南（Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies_Rev_2009）

Orthodontic Services
Patients with craniofacial anomalies require orthodontic services as a direct result of the medical condition and as an integral part of the habilitative process. Treatment often takes place in phases which may include treatment in infancy, the primary dentition, the transitional dentition, and the permanent dentition. The skeletal and dental components should therefore be regularly evaluated to see if a malocclusion is present or developing. Diagnosis and treatment planning requires a variety of diagnostic records as well as clinical examination. Records are obtained in a serial fashion to monitor dentofacial growth and development as well as the results of ongoing treatment. When indicated, orthodontic treatment prepares a patient for alveolar bone grafting of the cleft maxilla, for correcting malocclusions and for preparation of jaw surgery. In summary, orthodontic care may include primary orthopedic treatment in infancy and can extend through adulthood.
• Dental films, cephalometric radiographs, photographs and computer imaging as indicated should be utilized to evaluate and monitor dental and facial growth and development.
• For patients at risk for developing malocclusion or maxillary-mandibular discrepancy, diagnostic records including properly occluded dental study models should be collected at appropriate intervals.
• As the primary dentition erupts, each team evaluation should include a dental examination and referral to appropriate providers for caries control, preventive measures and restorative dental treatment, and space management if such services are not being provided.
• Before the primary dentition is completed, the skeletal and dental components should be evaluated to determine if a malocclusion is present or developing.
• Depending upon the goals to be accomplished, and also upon the age at which the patient is first seen, orthodontic management of malocclusion may be performed in the primary, mixed or permanent dentition. In some cases, orthodontic treatment may be necessary in all three stages.
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• While continuous active orthodontic treatment from early mixed dentition to permanent dentition should be avoided, each stage of therapy may be followed by orthodontic retention and regular observation; the orthodontic retention period for the permanent dentition may extend into adulthood.
• For some patients with craniofacial anomalies, functional orthodontic appliances may be indicated.
• For patients with craniofacial anomalies, orthodontic treatment may be needed in conjunction with surgical correction (and/or distraction osteogenesis) of the facial deformity.
• Congenitally missing teeth may be replaced with a removable appliance, fixed restorative bridgework, or osseointegrated implants.
• Patients should be closely monitored for periodontal disease.
• Prosthetic obturation of palatal fistulae may be necessary in some patients.
• A prosthetic speech appliance may be used to treat velopharyngeal inadequacy in some patients.