[Improved treatment of cleft lip and palate is now available].
When cleft lip and palate treatment was introduced at Gothenburg in 1957, the procedure used was early bone grafting (EBG). By 1965, EBG had been omitted from the regimen, bone grafting being postponed until the appearance of mixed dentition. Analysis of the results of both techniques showed maxillary retrusion of different degrees. Accordingly, this routine was abandoned in 1975, being replaced by a procedure which is characterised by delayed closure of the hard palate (DCHP). Thus, the surgical procedure comprised the following steps: 1, lip closure at 1-2 months of age; 2, soft palate repair at 6-8 months; 3, final lip-nose surgery at 12 months; and 4, closure of the left in the hard palate, and bone grafting to the alveolar process during mixed dentition at about 8-10 years of age. Follow-up has shown the majority of patients to manifest acceptable speech development during childhood, though problems may occur in some cases. Maxillary growth has been found to be improved after DCHP, and at present the need of maxillary advancement surgery has been reduced to approximately 5% of cases, as compared with the former rates of 50% of cases among those treated with EBG, and of 25% among those treated with the vomer flap procedure.
Lilja
J
J
Plastikkirurgiska kliniken, Sahlgrenska Universitetssjukhuset, Göteborg.
Friede
H
H
Lohmander-Agerskov
A
A
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000000981:diagnostic imaging / Q000601:surgery*; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000601:surgery*; D003758:Dental Implantation, Endosseous; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008445:Maxillofacial Development; D008875:Middle Aged; D008953:Models, Anatomic; D010348:Patient Care Team; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013060:Speech; D013518:Surgery, Plastic / Q000379:methods*