Recent Changes, Surgical Successes in Cleft Palate Procedures

Surgical Rounds®, January 2014,

In a new paper, Kyle J. Chepla, MD, and Arun K. Gosain, MD, evaluated the management of orofacial cleft in the wake of the 2010 Maintenance of Certification in Plastic Surgery article on the subject.

Each year in the United States, approximately 7,000 babies are born with orofacial clefts, which can occur separately or together. The resulting cleft lip and cleft palate deformity creates feeding and speech challenges and causes serious dental problems.

In a new paper published in Plastic and Reconstructive Surgery, Kyle J. Chepla, MD, and Arun K. Gosain, MD, evaluated the management of orofacial cleft in the wake of the 2010 Maintenance of Certification in Plastic Surgery article on the subject. The researchers targeted studies on craniofacial growth, speech outcomes, and obstructive sleep apnea (OSA).

The authors found that surgeons who perform cleft palate surgery on affected children select techniques based on patients’ unique degrees of palatal involvement and the distance between the palatal shelves. The authors also discussed the repair of the hard palate using various axial pattern flaps and common techniques.

Their findings include:

  • Consensus has not been reached concerning the proper timing of repair, number of stages, or surgical technique(s) that will maximize speech outcomes and minimize impact on long-term skeletal growth and facial development.
  • A single-stage repair of the hard and soft palate should take place between 9-12 months of age.
  • Regular orthodontic follow-up using a multidisciplinary team should begin at age 3, with palatal expansion performed when mixed dentition begins, if necessary.
  • Speech outcomes can be affected by timing of surgery, with earlier surgery superior to late surgery.
  • Although patients with cleft palate are significantly more likely to have OSA than normal controls, no recent studies indicate how cleft palate surgery can affect this disorder.

The paper was accompanied by 2 videos demonstrating cleft palate surgical procedures.