title: Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth.
abstract: BACKGROUND
  Hard palate cleft closure has been associated with maxillary hypoplasia. The Schweckendiek procedure offers delayed hard palate closure to avoid early subperiosteal dissection and palatal scarring. This study sought to compare single-stage versus delayed hard palate closure for speech outcome and maxillary growth.
  
  
  METHODS
  A retrospective outcome study was performed of unilateral cleft lip and palate patients with either delayed hard palate repair with a pinned-retained speech prosthesis (Schweckendiek repair) (group 1, delayed hard palate repair, 1978 to 1983) or single-stage cleft palate repair (group 2, single-stage repair, 1983 to 1988). Patients with complete records to maturity at the University of Pittsburgh Cleft Palate Craniofacial Center (n = 82, two equal groups of 41 patients) were studied. Comparative data were collected from multidisciplinary evaluations, perceptual speech scores, speech tests, and cephalometric analysis.
  
  
  RESULTS
  Single-stage cleft palate repair had a lower fistulization rate (11 percent) compared with delayed hard palate repair (58 percent). It also had better speech outcomes compared with delayed hard palate repair: mean speech score, 3.1 versus 7.8; final speech score, 0.9 versus 2.9; velopharyngeal incompetency, 21 percent versus 66 percent; failed video fluoroscopy or nasoendoscopy, 18 percent versus 52 percent; and need for secondary speech procedure, 20 percent versus 63 percent. Single-stage repair showed less maxillary growth disturbance, with class III malocclusion, 31 percent versus 66 percent; cephalometric SNA, 78.2 versus 74.8; need for Le Fort I advancement, 24 percent versus 42 percent; and amount of maxillary advancement required, 6 mm versus 9 mm.
  
  
  CONCLUSIONS
  The delayed cleft palate repair led to worse speech outcomes; thus, the authors' center abandoned this technique in favor of single-stage repair. In addition, their data showed that the delayed cleft palate repair led to deleterious maxillary growth.
authors.affiliation: Pittsburgh, Pa.; and Los Angeles, Calif. From the Divisions of Plastic and Reconstructive Surgery of the University of Pittsburgh and the University of California, Los Angeles.
authors.forename: Sarah
authors.initials: S
authors.lastname: Holland
authors.forename: Joubin S
authors.initials: JS
authors.lastname: Gabbay
authors.forename: Justin B
authors.initials: JB
authors.lastname: Heller
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Hara
authors.forename: Dennis
authors.initials: D
authors.lastname: Hurwitz
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Ford
authors.forename: Amy S
authors.initials: AS
authors.lastname: Sauder
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002971:Cleft Lip / Q000175:diagnosis / Q000601:surgery*; D002972:Cleft Palate / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008445:Maxillofacial Development; D019340:Osteotomy, Le Fort / Q000009:adverse effects / Q000379:methods*; D011336:Probability; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013064:Speech Disorders / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000517:prevention & control*