Modifying the two-stage cleft palate surgical correction.
OBJECTIVE
This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon.


METHODS
Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months).


METHODS
The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps.


RESULTS
Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions.


CONCLUSIONS
A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.
Chait
Laurence
L
Plastic and Reconstructive Surgery, School of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Gavron
Gerald
G
Graham
Cathy
C
Noik
Errol
E
De Aguiar
Gavin
G
D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008312:Malocclusion, Angle Class II / Q000209:etiology; D008313:Malocclusion, Angle Class III / Q000209:etiology; D016155:Oral Fistula / Q000209:etiology; D009970:Orthodontics; D010033:Otitis Media / Q000209:etiology; D010156:Palatal Muscles / Q000601:surgery; D021362:Palate, Hard / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D010348:Patient Care Team; D010521:Periosteum / Q000601:surgery; D011183:Postoperative Complications; D013064:Speech Disorders / Q000209:etiology; D013066:Speech-Language Pathology; D013515:Surgery, Oral; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome