For many years TREFLE, The Ecully team treating labio-palatal clefts, has begun managing the care of patients with clefts at younger and younger ages. Both surgically and orthodontically we design our therapeutic interventions to change the environment of the cleft as rapidly as possible in order to improve patients’ functioning that will in turn have a beneficial effect on growth and esthetics. We have found that our patients treated in this way not only have improved appearance but also less likelihood of needing orthognathic surgery. We have also found that our patients do not routinely require early bone grafts, at about 6 years of age. We determine which children will require this intervention in a re-evaluation that we undertake after the completion of the primary phase of orthopedic and orthodontic therapy.

To make our technique as clear as possible throughout the course of this article we present the different stages of treatment of four children, Leslie, Jules, Nathan, and Élodie.