xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

Volume 153, Number 2 • Cleft Palate Surgery

Dental and Maxillary Growth Alteration A craniofacial surgeon should be cognizant of the affects that surgical repair of cleft palate can have on maxillary growth. Common long-term complications following primary palatoplasty include midface retrusion, maxillary hypopla sia, and distortion and collapse of the dentoal veolar structures. 82,83 Studies have documented improved maxillary growth in unoperated cleft lip and palate and reinforced surgical timing of hard palate repair as an important predictive factor to minimizing maxillary retrusion. 82,83 A minority of cleft palate patients, roughly 20%, require surgi cal correction of maxillary hypoplasia with a Le Fort procedure at the time of skeletal maturity. 84 Arun K. Gosain, MD Division of Pediatric Plastic Surgery Ann & Robert H. Lurie Children’s Hospital 225 East Chicago Avenue, Box 93 Chicago, IL 60611 argosain@luriechildrens.org ACKNOWLEDGMENTS The authors wish to thank Marina Lentskevich and Alice Yau for their help in preparing the CME review questions. REFERENCES 1. Chepla KJ, Gosain AK. Evidence-based medicine: cleft pal ate. Plast Reconstr Surg . 2013;132:1644–1648. 2. Mitchell LE. Genetic epidemiology of birth defects: non syndromic cleft lip and neural tube defects. Epidemiol Rev . 1997;19:61–68. 3. Habib Z. Genetic counselling and genetics of cleft lip and cleft palate. Obstet Gynecol Surv . 1978;33:441–447. 4. Derijcke A, Eerens A, Carels C. The incidence of oral clefts: a review. Br J Oral Maxillofac Surg . 1996;34:488–494. 5. Vu GH, Warden C, Zimmerman CE, et al. Poverty and risk of cleft lip and palate: an analysis of United States birth data. Plast Reconstr Surg . 2022;149:169–182. 6. Woo AS. Evidence-based medicine: cleft palate. Plast Reconstr Surg . 2017;139:191e–203e. 7. Deshpande AS, Goudy SL. Cellular and molecular mecha nisms of cleft palate development. Laryngoscope Investig Otolaryngol . 2019;4:160–164. 8. Somerville N, Fenlon S. Anaesthesia for cleft lip and palate surgery. Pain 2005;5:76–79. 9. Zhang B, Guo C, Yin H, Zheng Q, Shi B, Li J. The corre lation between consonant articulation and velopharyngeal function in patients with unoperated submucous cleft pal ate. J Craniofac Surg . 2020;31:1070–1073. 10. Hammond NL, Dixon MJ. Revisiting the embryogenesis of lip and palate development. Oral Dis . 2022;28:1306–1326. DISCLOSURE The authors have no financial information or con flicts of interest to disclose.

11. Burdi AR, Faist K. Morphogenesis of the palate in normal human embryos with special emphasis on the mechanisms involved. Am J Anat . 1967;120:149–159. 12. Allori AC, Mulliken JB, Meara JG, Shusterman S, Marcus JR. Classification of cleft lip/palate: then and now. Cleft Palate Craniofac J . 2017;54:175–188. 13. Houkes R, Smit J, Mossey P, et al. Classification systems of cleft lip, alveolus and palate: results of an international sur vey. Cleft Palate Craniofac J . 2021;60:189–196. 14. Burg ML, Chai Y, Yao CA, Magee W III, Figueiredo JC. Epidemiology, etiology, and treatment of isolated cleft pal ate. Front Physiol . 2016;7:67. 15. Yao CA, Vartanian ED, Nagengast E, McCullough M, Auslander A, Magee WP. The smile index: part 3. A simple, prognostic severity scale for unilateral cleft palate. Plast Reconstr Surg Glob Open 2021;9:e3870. 16. Allori AC. Striped-Y redux: redesigning pictographic nota tional systems for the digital age. Dent Oral Craniofac Res . 2017;3:1–8. 17. Okhiria AC, Jabbari F, Hakelius MM, Johansson MMB, Nowinski DJ. Greater palatal cleft width predicts an increased risk for unfavorable outcomes in cleft palate repair. Cleft Palate Craniofac J . 2022;59:1030–1037. 18. Rossell-Perry P, Caceres Nano E, Gavino-Gutierrez AM. Association between palatal index and cleft palate repair outcomes in patients with complete unilateral cleft lip and palate. JAMA Facial Plast Surg . 2014;16:206–210. 19. Nahai FR, Williams JK, Burstein FD, Martin J, Thomas J. The management of cleft lip and palate: pathways for treatment and longitudinal assessment. Semin Plast Surg . 2005;19:275–285. 20. Han HH, Choi EJ, Kim JM, Shin JC, Rhie JW. The impor tance of multidisciplinary management during prenatal care for cleft lip and palate. Arch Plast Surg . 2016;43:153–159. 21. Webb AA, Watts R, Read-Ward E, Hodgkins J, Markus AF. Audit of a multidisciplinary approach to the care of children with unilateral and bilateral cleft lip and palate. Br J Oral Maxillofac Surg . 2001;39:182–188. 22. Gonzalez LP, Pignaton W, Kusano PS, Módolo NSP, Braz JRC, Braz LG. Anesthesia-related mortality in pediatric patients: a systematic review. Clinics (Sao Paulo) 2012;67:381–387. 23. Naidu P, Yao CA, Chong DK, Magee WP. Cleft palate repair: a history of techniques and variations. Plast Reconstr Surg Glob Open 2022;10:e4019. 24. Kalmar CL, Patel VA, Zapatero ZD, Kosyk MS, Taylor JA. Optimal timing of palatoplasty in infants with comorbidities. Cleft Palate Craniofac J . 2021;58:937–942. 25. Dorf DS, Curtin JW. Early cleft palate repair and speech out come. Plast Reconstr Surg . 1982;70:74–81. 26. Willadsen E. Influence of timing of hard palate repair in a two stage procedure on early speech development in Danish chil dren with cleft palate. Cleft Palate Craniofac J . 2012;49:574–595. 27. Graber TM. Changing philosophies in cleft palate manage ment. J Pediatr . 1950;37:400–415. 28. De Mey A, Franck D, Cuylits N, Swennen G, Malevez C, Lejour M. Early one-stage repair of complete unilateral cleft lip and palate. J Craniofac Surg . 2009;20:1723–1728. 29. Richard B, Russell J, McMahon S, Pigott R. Results of ran domized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. Cleft Palate Craniofac J . 2006;43:329–338. 30. Katzel EB, Basile P, Koltz PF, Marcus JR, Girotto JA. Current surgical practices in cleft care: cleft palate repair techniques and postoperative care. Plast Reconstr Surg . 2009;124:899–906. 31. Peck CJ, Gowda AU, Shultz BN, et al. The effect of surgi cal timing on 30-day outcomes in cleft palate repair. Plast Reconstr Surg . 2021;147:131–137.

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