A.9. Discuss indications and timing of closure of cleft lip and palate.
Answer:
Functional goals of cleft palate surgery are normal speech, hearing, and maxillofacial growth. It is thought that speech and hearing are improved by early cleft palate repair (before 24 months of age). This is balanced against delayed closure (after 4 years), which is associated with less retardation of midfacial growth. There is no absolute consensus on the timing of lip and palate closure. These variations likely reflect the anatomic variabilities in different patients, as well as the personal preferences of the surgeon. An early two-stage palate repair is advocated in the management of these patients. The recommended sequence involves closure of the soft palate at 3 to 6 months of age with secondary closure of the residual hard palate at 15 to 18 months of age. This sequence takes advantage of the early physiology and growth that occurs in the soft palate, which is vital in the development of speech. Furthermore, it avoids the potential pitfalls of the growth disturbance related to early periosteal undermining of palatal and vomerine tissue. This repair sequence also provides total palatal closure before speech evolves. If the soft palate is repaired at the time of lip repair, an additional anesthetic is avoided.
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