Abstract
This chapter outlines the aims of palate repair, including normal speech, normal facial growth, normal hearing, and the ability to feed comfortably without nasal regurgitation. The evolution of various palate repair protocols and the variation of these protocols are discussed, including the merits and disadvantages of staging both the hard palate closure and the soft palate closure at varying time points in a child’s life. The impact of these staging protocols with regard to both facial growth and speech development is explained, including the evidence base behind this. The evolution of the two-stage technique and the supporting evidence is rationalized, as well as the gradual return to a single-stage technique in many countries, based on more recent evidence.
Similar content being viewed by others
References
Bardach J, Morris HL, Olin WH (1984) Late results of primary veloplasty: the Marburg project. Plast Reconstr Surg 73:207
Bishara SE (1981) Longitudinal cephalometric standards from 5 years of age to adulthood. Am J Orthod 79(1):35–44
Borelli MR (2018) What is the role of plastic surgery in global health? A review. World J Plast Surg 7(3):275–282
Cosman B, Falk AS (1980) Delayed hard palate repair and speech deficiencies: a cautionary report. Cleft Palate J 17(1):27–33
Fudalej PS, Wegrodzka E, Semb G, Hortis-Dzierzbicka M (2015) One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: craniofacial outcomes. J Craniomaxillofac Surg 43:1224–1231
Goodacre TEE, Hentges F, Moss TLH, Short V, Murray L (2004) Does repairing a cleft lip neonatally have any effect on the longer term attractiveness of the repair. Cleft Palate Craniofac J 41(6):603–608
Hammarstrom IL, Nyberg J, Alaluusua S, Rautio J, Neovius E, Berggren A, Persson C, Willadsen E, Lohmander A (2020) Scandcleft project trial 2 comparison of speech outcome in 1- and 2-stage palatal closure in 5-year-olds with UCLP. Cleft Palate Craniofac J 57(4):458–469
Hodges SC, Hodges AM (2000) A safe protocol for anaesthesia for cleft lip and palate surgery in developing countries. Anaesthesia 55(5):436–441
Kaplan EN (1981) Cleft palate repair at three months? Ann Plast Surg 7(3):179–190
Ladiera PRS, Alonso N (2012) Protocols in cleft lip and palate treatment: systematic review. Plast Surg Int 2012:562892. https://doi.org/10.1155/2012/562892. Epub 2012 Nov 1
Lee Y-H, Liao Y-F (2013) Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review. Br J Oral Maxillofac Surg 51:851–857
Liao Y-F, Yang I-Y, Wang R, Yun C, Huang C-S (2010) Two-stage palate repair with delayed hard palate closure is related to favorable maxillary growth in unilateral cleft lip and Palate. Plast Reconstr Surg 125:1503
Mars M, Houston WJB (1990) A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J 27(1):7–10
Murthy J, Sendhilnathan S, Hussain SA (2010) Speech outcome following late primary palate repair. Cleft Palate Craniofac J 47(2):156–161. https://doi.org/10.1597/08-230_1
Nishio J, Yamanishi T, Kohara H, Hirano Y, Sako M, Adachi T, Mukai T, Miya S (2010) Early two-stage palatoplasty using modified Furlow’s Veloplasty. Cleft Palate Craniofac J 47(1):73–81
Noordhoff MS, Kuo J, Wang F (1987) Development of articulation before delayed hard palate closure in children with cleft palate: a cross-sectional study. Plast Reconstr Surg 80:518
Ozgediz D, Jamison D, Cherlan M, McQueen K (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 86(8):577–656
Ozturk S, Karagoz H, Zor F, Inangil G, Kara K (2016) Fetal cleft lip/palate surgery: end of a dream? Fetal Pediatr Pathol 35:277–281
Peet E (1961) The oxford technique of cleft palate repair. Plast Reconstr Surg Transplant Bull 28:282–294
Randall P, LaRossa DD, Fakhraee SM, Cohen MA (1983) Cleft palate closure at 3 to 7 months of age: a preliminary report. Plast Reconstr Surg 71(5):624–628
Reardon JB, Brustowicz KA, Marrinan EM, Mulliken JB, Padwa. Bl. (2015) Anatomic severity, midfacial growth, and speech outcomes in Van der Woude/Popliteal Pterygium syndromes compared to nonsyndromic cleft lip/Palate. Cleft Palate Craniofac J 52(6):676–681
Reddy RR, Reddy SG, Vaidhyanathan A, Bergé SJ, Kuijpers-Jagtman AM (2017) Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review. J Cranio-Maxillofac Surg. https://doi.org/10.1016/j.jcms.2017.03.006
Reddy RR, Reddy SG, Chilakalapudi A, Kokali S, Bronkhorst EM, Kummer AW, Bergé SJ, Kuijpers-Jagtman AM (2018) Effect of one-stage versus two-stage palatoplasty on hypernasality and fistula formation in children with complete unilateral cleft lip and palate: a randomized controlled trial. Reconstr Surg 142(1):42e–50e
Robertson NRE, Jolleys A (1974) The timing of hard palate repair. Scand J Plast Reconstr Surg 8:49–51
Rohrich RJ, Love EJ, Byrd HS, Johns DF (2000) Optimal timing of cleft palate closure. Plast Reconstr Surg 106:423
Sandy J, Williams A, Murphy T, Bearn D, Shaw B, Sell D, Devlin B, Murray J (1998) The Clinical Standards Advisory Group (CSAG) cleft lip and palate study. Br J Orthod 25:21–30
Sell DA, Grunwell P (1990) Speech results following late palatal surgery in previously unoperated Sri Lankan adolescents with cleft palate. Cleft Palate J 27(2):162–168; discussion 174–5
Shaffer AD, Ford MD, Losee JE, Goldstein J, Costello BJ, Grunwaldt LJ, Jabbour N (2019) The association between age at palatoplasty and speech and language outcomes in children with cleft palate: an observational chart review study. Cleft Palate Craniofac J 57:1–13
Shaw WC, Semb G, Nelson P, Brattstrom V, Molsted K, Prahl-Anderson B, Gundlach KKH (2001) The Eurocleft project 1996–2000: overview. J Cranio-Maxillofac Surg 29:131–140
Shaw WC, Semb G, Lohmander A, Persson C, Willadsen E, Clayton-Smith J, Trindade IK, Munro KJ, Gamble C, Harman N, Conroy EJ, Weichart D, Williamson P (2019) Timing Of Primary Surgery for cleft palate (TOPS): protocol for a randomised trial of palate surgery at 6 months versus 12 months of age. BMJ Open 9:e029780. https://doi.org/10.1136/bmjopen-2019-029780
Strong EB, Buckmiller LM (2001) Management of the cleft palate. Facial Plast Surg Clin North Am 19(1):15–25
Witzel MA, Salyer KE, Ross RB (1984) Delayed hard palate closure: the philosophy revisited. Cleft Palate J 21:263
Yaminishi T, Nishio J, Kobara H, Hirano Y, Sako M, Yamanishi Y, Adacbi T, Miya S, Mukai T (2009) Effect on maxillary arch development of early 2-stage palatoplasty by modified Furlow technique and conventional 1-stage palatoplasty in children with complete unilateral cleft lip and palate. J Oral Maxillofac Surg 67:2210–2216
Yang I-Y, Liao Y-F (2010) The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review. Int J Oral Maxillofac Surg 39:945–950
Yang Y, Li Y, Wu Y, Gu Y, Yin H, Long H, Shi B, Zheng Q (2013) Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type. J Craniofac Surg 24(3):923–928
Yang CH, Lai JP, Lee AC, Cheng LH, Hwang CF (2019) Prognostic factors for hearing outcomes in children with cleft lip and palate. Plast Reconstr Surg 143(2):368e–374e
Zhao S, Xu Y, Yin H, Zheng Q, Wang Y, Zhong T, Li Y, Shi B (2012) Incidence of postoperative velopharyngeal insufficiency in late palate repair. J Craniofac Surg 23(6):1602–1606
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Singapore Pte Ltd.
About this entry
Cite this entry
Hill, C., Martin, S. (2022). Rationale of Cleft Palate Repair. In: Fayyaz, G.Q. (eds) Surgical Atlas of Cleft Palate and Palatal Fistulae. Springer, Singapore. https://doi.org/10.1007/978-981-15-3889-6_26-1
Download citation
DOI: https://doi.org/10.1007/978-981-15-3889-6_26-1
Received:
Accepted:
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-3889-6
Online ISBN: 978-981-15-3889-6
eBook Packages: Springer Reference MedicineReference Module Medicine