Comprehensive management of cleft lip and palate deformities

Purpose: The controversy regarding the timing of repair of the deformities associated with cleft tip and palate stiff exists. The goal of this article is to present a versatile, universal philosophy of management of these def ormities involving early repair. Patients and Methods: Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bi lateral cleft lip and palate patients. The remaining patients (1,018) had i solated palatal clefts. All patients were operated according to the same pr otocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty a t 3 months, followed by soft and hard functional palatoplasty at 9 months. Results: All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growt h retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedure s were performed on time and according to the protocol, there was minimal g rowth retardation of the maxilla. When early gingivoperiosteoplasty was per formed in 25% of the patients there was a sufficient amount of alveolar bon e for eruption of the primary and permanent dentition. This negated the nee d for secondary alveolar bone grafting. The development of the upper lip wa s harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal. Conclusion: Optimal rehabilitation of the patients was achieved by followin g the principles and treatment strategies described. If the treatment princ iples are not incorporated in the functional repair (ie, joining of the pri mary and the secondary growth centers during corrective procedures), compro mised results are to be expected. (C) 2001 American Association of Oral and Maxillofacial Surgeons.