title: Maxillary growth controversies after two-stage palatal repair with delayed hard palate closure in unilateral cleft lip and palate patients: perspectives from literature and personal experience.
abstract: OBJECTIVE
  To analyze published papers dealing with delayed hard palate repair within a two-stage palatal surgery protocol in treatment of cleft lip and palate. Timing of the procedures, methods used, as well as growth results were considered.
  
  
  METHODS
  By utilizing this information in relation to knowledge about normal maxillary development, efforts were made to explain differences in growth outcome between different investigations. Particularly, follow-up reports of unilateral cleft lip and palate patients with records up to at least 10 years of age were studied.
  
  
  RESULTS
  Most papers reported an excellent or very good maxillary growth outcome after their delayed hard palate closure protocols. Where unsatisfactory results were published, reasonable explanations were found accounting for why the method had failed the expectation of good maxillary growth.
  
  
  CONCLUSIONS
  Based on the published reports and the experience from a cleft team where the studied protocol has been practiced since 1975, recommendation for method as well as timing for the two-stage protocol is laid out in some detail.
authors.affiliation: Department of Orthodontics, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. friede@odontology.gu.se
authors.forename: Hans
authors.initials: H
authors.lastname: Friede
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D002985:Clinical Protocols; D005500:Follow-Up Studies; D006801:Humans; D008437:Maxilla / Q000254:growth & development*; D021362:Palate, Hard / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome