title: Management of the impaired adult cleft patient: the last chance.
abstract: OBJECTIVE
  Unfortunately, not all patients receive the benefits of a well-trained, experienced, multidisciplinary cleft team, and a significant number of patients reach adulthood with severe neglected cleft related problems. The vast majority of this group have made their way through several surgical procedures, usually performed by different surgeons in different centers, and still carry the original cleft stigmata aggravated by variable degrees of maxillary hypoplasia, fistulae, scarring, muscle pull, soft tissue tension, lost teeth, dental adaptation, and instability of bony fragments. Adult patients who reach this stage with their original deformities have, in most instances, lost their best opportunity to be properly treated. With this assumption in mind, an aggressive surgical plan focused mainly on the deformities that can objectively achieve functional and aesthetical improvement should be individualized for each patient. In this article, experience with 38 consecutive adult patients with cleft managed following a two-stage protocol used at our cleft clinic for the last 4 years is presented.
  
  
  CONCLUSIONS
  An algorithm to help definitively solve these deformities is suggested.
authors.affiliation: Plastic and Reconstructive Surgery of The Universidad Nacional Autonoma de México, México. jacofele@aol.com
authors.forename: J
authors.initials: J
authors.lastname: Felemovicius
authors.forename: F
authors.initials: F
authors.lastname: Ortiz-Monasterio
mesh_terms: D000328:Adult; D000465:Algorithms; D016025:Bone Transplantation; D002971:Cleft Lip / Q000150:complications* / Q000601:surgery*; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000209:etiology / Q000628:therapy; D008437:Maxilla / Q000601:surgery*; D008844:Micrognathism / Q000209:etiology / Q000601:surgery; D016155:Oral Fistula / Q000209:etiology / Q000601:surgery; D019647:Oral Surgical Procedures; D009971:Orthodontics, Corrective; D012086:Reoperation; D012225:Rhinoplasty; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery