The controversy about timing of cleft palate surgical procedures is fo
cused on early palatoplasty for improved speech versus delayed hard pa
late repair fbr undisturbed facial growth. Timing and technique of pal
ate repair are the most important influences on speech and facial grow
th, yet there is no consensus on the age or technique for surgery. The
Oxford Cleft Palate Study was initiated to evaluate critically the lo
ng-term follow-up of 44 patients with early versus late closure of the
hard palate. A multidisciplinary approach was used to determine the i
ncidence of speech deficiencies, palatal fistulas, maxillofacial growt
h disturbances, and hearing abnormalities and to assess objectively th
e long-term effects of two different treatment modalities on the cleft
palate patient. The 44 patients were selected randomly, interviewed,
and examined by the multidisciplinary Oxford Cleft Palate Study team.
The average age at follow-up in the early closure group was 17.0 years
versus 18.2 years in the late closure group. There was a similar numb
er of unilateral and bilateral clefts in both the early and late closu
re groups. The hard palate was closed in the early group at an average
age of 10.8 months versus 48.6 months in the late closure group. All
operative procedures in each group were performed by the same senior p
lastic surgery consultant. Both consultants have since retired and did
not participate in the study. Each patient was evaluated by the same
plastic surgeon, speech pathologist, orthodontist, and otologist. All
examiners were blinded in that they were unaware of the type or timing
of the surgical technique and had no prior knowledge of or access to
the patient's medical records. Furthermore, none of the examiners part
icipated in the initial care and surgery of these patients. Statistica
lly significant greater speech deficiencies were noted with delayed ha
rd palate closure, especially in articulation, nasal resonance, intell
igibility, and substitution pattern assessment (overall intelligibilit
y, p < 0.01). Likewise, the persistent palatal fistula rate in the lat
e closure group was 35 percent in comparison with 5 percent for the ea
rly closure group (p < 0.02). No significant differences in hearing or
maxillofacial growth impairment were delineated in either group. Our
data suggest that delaying hard palate closure results in significant
speech impairment without a beneficial maxillofacial growth response.