Clinical Study for the Early Normalization of Children with Cleft Palates – A Preliminary Report
Abstract
Cleft lip and cleft palate are the most common congenital anomalies in the human second only to club foot. The incidence is about 1:500 of live births and they are reported to be most frequent among mongoloid populations14.
There is much disagreement concerning timing for surgical repair of the cleft palate patients. Most of the medical centers in North America recommend repair of cleft palate at the age of 12 to 18 months to prevent the development of false speech, but most of the centers in Europe prefer to delay surgery up to the age of 4-12 year or even later when the facial growth is adequate. The latter school gives the responsibility of correcting false speech to the speech therapist.
When a child with cleft lip and palate does not have the palate repaired surgically, there is abundant evidence that the face grows adequately2,7,10,13,18,20,24. The evidence is overwhelming that repair of the cleft palate by any of the popular surgical techniques will result in an inhibition of the growth of the mid-face5-8,11,12,15,16,22,23.
As a result of palatal surgery, a thick band of scar tissue frequently appears on either side of posterior palate inhibiting the sutural growth of bones-maxilla, palatine bone, and the pterygoid plates of the sphenoid, creating a condition which could be termed ''maxillary ankylosis”.
A second direct effect of palatal surgery is the distortion of dentoalveolar growth. Most techniques of palatoplasty leave an area of denuded bone close to the gum which is rapidly covered by scar tissue. The initial contraction of the tissue results in a medial movement of the maxillary segments and a medial tipping of the teeth and alveolar bone. As further tooth eruption and vertical development of the alveolar process occur, the area of scar tissue adjacent to the alveolar process resists growth and thereby induces a medial and posterior deflection of the dento-alveolar structures and the collapse of the dental arch.
The secondary effects of palatal surgery are associated with a large number of other factors of abnormal physiology which together cause a dramatic change in the posture and form of the mandible.
References
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