SpringerLink
Log in

Early Soft Palate Repair with Delayed Hard Palate Repair

  • Reference work entry
  • First Online:
Surgical Atlas of Cleft Palate and Palatal Fistulae

  • 108 Accesses

Abstract

Late hard palate repair should, in theory, be less damaging than early hard palate repair on the basis that the more maxillary growth that has occurred, the less there remains to be disturbed. The idea of postponing hard palate repair as a less traumatic procedure to maxillary growth was first suggested by the finding that the earlier the surgery was performed, the greater the maxillary deformity would be in patients with clefts who had early surgical repair of the hard palate. The protocol for repair of the palate is crucial for normal speech development and adequate long-term midfacial growth in individuals affected with cleft lip and palate (CLP). There is no consensus about the technique and timing of soft and hard palate repair, although the literature points out that early closure of the palate seems to improve speech but generally impairs maxillary growth increasing the need for orthognathic surgery at the completion of growth. In this chapter, we are trying to present the concept and rational of this technique and compare it with the conventional one stage repair.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 799.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 849.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Bardach J, Morris HL, Olin WH (1984) Late results of primary veloplasty: the Marburg project. Plast Reconstr Surg 73:207–215

    Article  CAS  PubMed  Google Scholar 

  • Blocksma R, Leuz CA, Mellerstig KE (1975) A conservative program for managing cleft palates without the use of mucoperiosteal flaps. Plast Reconstr Surg 55:160–169

    Article  CAS  PubMed  Google Scholar 

  • Boyne PJ, Sands NR (1972) Secondary bone grafting of residual alveolar and palatal defects. J Oral Surg 30:87–92

    CAS  PubMed  Google Scholar 

  • Braithwaite F, Maurice DG (1968) The importance of the levator palatini muscle in cleft palate closure. Br J Plast Surg 21:60–61

    Article  CAS  PubMed  Google Scholar 

  • Brattstrom V, Molsted K, Prahl-Andersen B et al (2005) The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate, part 2: craniofacial form and nasolabial appearance. Cleft Palate Craniofac J 42:69–77

    Article  PubMed  Google Scholar 

  • Brusati R, Mannucci N (1992) The early gingivoalveoloplasty: preliminary results. Scand J Plast Reconstr Surg Hand Surg 26:65–70

    Article  CAS  PubMed  Google Scholar 

  • Brusati R, Mannucci N (1999) Primary repair of the lip and palate using the Delaire philosophy. In: Ward BP, Schendel SA, Hausamen JE (eds) Maxillofacial surgery. Churchill Livingstone, Edinburgh, pp 1026–1047

    Google Scholar 

  • Brusati R, Meazzini MC, Rezzonico A et al (2018) Evaluation of a sample of patients with unilateral cleft lip and palate treated with a two-stage protocol. J Craniofac Surg 29(8):2058–2064

    Article  PubMed  Google Scholar 

  • Chapman K, Hardin-Jones M, Halter KA (2003) The relationship between early speech and later speech and language performance for children with cleft lip and palate. Clin Linguist Phon 17:173–197

    Article  PubMed  Google Scholar 

  • Cosman B, Falk AS (1980) Delayed hard palate repair and speech deficiencies: a cautionary report. Cleft Palate J 17:27–33

    CAS  PubMed  Google Scholar 

  • Daskalogiannakis J, Mercado A, Russell K et al (2011) The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate, part 3. Analysis of craniofacial form. Cleft Palate Craniofac J 48:252–258

    Article  PubMed  Google Scholar 

  • Delaire J (1975) La cheilo-rhino-plastie pour fente labio-maxillaire congenitale unilaterale. Essai de schematisation d’une technique. Rev Stom 76:193–215

    CAS  Google Scholar 

  • Dingman RO, Argenta LC (1985) The correction of cleft palate with primary veloplasty and delayed repair of the hard palate. Clin Plast Surg 12:677–684

    Article  CAS  PubMed  Google Scholar 

  • Enemark H, Bolund S, Jorgensen I (1990) Evaluation of unilateral cleft lip and palate treatment: long term results. Cleft Palate J 27:354–361

    CAS  PubMed  Google Scholar 

  • Friede H, Moller M, Lilja J et al (1987) Facial morphology and occlusion at the stage of early mixed dentition in cleft lip and palate patients treated with delayed closure of the hard palate. Scand J Plast Reconstr Surg Hand Surg 21:65–71

    CAS  PubMed  Google Scholar 

  • Fudalej P, Obloj B, Miller-Drabikowska D et al (2008) Midfacial growth in a consecutive series of preadolescent children with complete unilateral cleft lip and palate following a one-stage simultaneous repair. Cleft Palate Craniofac J 45(6):667–673

    Article  PubMed  Google Scholar 

  • Fudalej P, Katsaros C, Dudkiewicz Z et al (2012) Dental arch relationships following palatoplasty for cleft lip and palate repair. J Dent Res 91:47–51

    Article  CAS  PubMed  Google Scholar 

  • Fudalej P, Katsaros C, Dudkiewicz Z et al (2013) Cephalometric outcome of two types of palatoplasty in complete unilateral cleft lip and palate. Br J Oral Maxillofac Surg 51:144–148

    Article  PubMed  Google Scholar 

  • Gillies HD, Fry WK (1921) A new principle in the surgical treatment of “congenital cleft-palate”, and its mechanical counterpart. Br Med J 1:335–338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hardin-Jones MA, Chapman KL, Wright J, Halter KA, Schulte J, Dean JA, Havlik RJ, Goldstein J (2002) The impact of early obturation on consonant development in babies with unrepaired cleft palate. Cleft Palate Craniofac J 39:157–163

    Article  PubMed  Google Scholar 

  • Hathaway R, Daskalogiannakis J, Mercado A et al (2011) The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate, part 2: dental arch relationships. Cleft Palate Craniofac J 48:244–251

    Article  PubMed  Google Scholar 

  • Hotz M, Gnoinski W (1976) Comprehensive care of cleft lip and palate children at Zürich university: a preliminary report. Am J Orthod 70:481–504

    Article  CAS  PubMed  Google Scholar 

  • Jackson IT, McLennan G, Scheker LR (1983) Primary veloplasty or primary palatoplasty: some preliminary findings. Plast Reconstr Surg 72:153–157

    Article  CAS  PubMed  Google Scholar 

  • Katzel EB, Basile P, Koltz PF et al (2009) Current surgical practices in cleft care: cleft palate repair techniques and postoperative care. Plast Reconstr Surg 124:899–906

    Article  CAS  PubMed  Google Scholar 

  • Kemp-Fincham SI, Kuehn DP, Trost-Cardamone JE (1990) Speech development and timing of primary palatoplasty. In: Bardach J, Morris HL (eds) Multidisciplinary management of cleft lip and palate. WB Saunders, Philadelphia, pp 736–745

    Google Scholar 

  • Kriens OB (1970) Fundamental anatomic findings for an intravelar veloplasty. Cleft Palate J 7:27–36

    CAS  PubMed  Google Scholar 

  • Kulewicz M, Dudkiewicz Z (2010) Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a preliminary study. Int J Oral Maxillofac Surg 39:122e128

    Article  Google Scholar 

  • Lohmander A, Persson C (2008) A longitudinal study of speech production in Swedish children with cleft palate and two-stage palatal repair. Cleft Palate Craniofac J 45:32–41

    Article  PubMed  Google Scholar 

  • Lohmander A, Lillvik M, Friede H (2004) The impact of early infant jaw-orthopedics on early speech production in toddlers with unilateral cleft lip and palate. Clin Linguist Phon 18:259–285

    Article  PubMed  Google Scholar 

  • Malek R, Psaume J (1983) Nouvelle conception de la chronologie et de la technique chirurgicale du traitement des fentes labio-palatines. Resultats sur 220 cas. Ann Chir Plast 28:237–247

    CAS  Google Scholar 

  • Markus AF, Smith WP, Delaire J (1993) Primary closure of cleft palate: a functional approach. Br J Oral Maxillofac Surg 31:71–77

    Article  CAS  PubMed  Google Scholar 

  • Mars M, Houston WJ (1990) A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J 27:7–10

    CAS  PubMed  Google Scholar 

  • Meazzini MC, Tortora C, Morabito A, Garattini G, Brusati R (2007) Alveolar bone formation in patients with unilateral and bilateral cleft lip and palate after early secondary gingivoalveoloplasty: long term results. Plast Reconstr Surg 119:1527–1537

    Article  CAS  PubMed  Google Scholar 

  • Meazzini MC, Giussani G, Morabito A, Semb G, Garattini G, Brusati R (2008) A cephalometric intercenter comparison of patients with unilateral cleft lip and palate: analysis at 5 and 10 years of age and long term. Cleft Palate Craniofac Surg 45:654–660

    Article  Google Scholar 

  • Meazzini MC, Rossetti G, Garattini G, Semb G, Brusati R (2010) Early secondary gingivo-alveolo-plasty in the treatment of unilateral cleft lip and palate patients: 20 years experience. J Craniomaxillofac Surg 38:185–191

    Google Scholar 

  • Meazzini MC, Corno M, Novelli G, Autelitano L et al (2016) Long-term computed tomographic evaluation of alveolar bone formation in patients with unilateral cleft lip and palate after early secondary gingivoalveoloplasty. Plast Reconstr Surg 137(2):365–374

    Article  Google Scholar 

  • Molsted K, Brattstrom V, Prahl-Andersen B et al (2005) The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate, part 3: dental arch relationships. Cleft Palate Craniofac J 42:78–82

    Article  PubMed  Google Scholar 

  • Oller DK, Eilers RE, Neal AR, Cobo-Lewis AB (1998) Late onset canonical babbling: a possible early marker of abnormal development. Am J Ment Retard 103:249–263

    Article  CAS  PubMed  Google Scholar 

  • Owman-Moll P, Katsaros C, Friede H (1998) Development of the residual cleft in the hard palate after velar repair in a 2-stage palatal repair regimen. J Orofac Orthop 59:286–300

    Article  CAS  PubMed  Google Scholar 

  • Rohrich RJ, Love EJ, Byrd HS et al (2000) Optimal timing of cleft palate closure. Plast Reconstr Surg 106:413–421

    Article  CAS  PubMed  Google Scholar 

  • Ross RB (1970) The clinical implications of facial growth in cleft lip and palate. Cleft Palate J 7:37–47

    CAS  PubMed  Google Scholar 

  • Ross RB (1987) Treatment variables affecting growth in unilateral cleft lip and palate, part 7: an overview of treatment and facial growth. Cleft Palate J 24:71–77

    Google Scholar 

  • Scherer NJ, Williams AL, Proctor-Williams K (2008) Early and later vocalization skills in children with and without cleft palate. Int J Pediatr Otorhinolaryngol 72:827–840

    Article  PubMed  Google Scholar 

  • Schweckendiek H (1955) Zur zweiphasigen Gaumenspaltenoperation bei primärem Velumversluss. Fortschr Kiefer Gesichtschir 1:73–76

    Google Scholar 

  • Schweckendiek W (1978) Primary veloplasty: long-term results without maxillary deformity. A twenty-five-year report. Cleft Palate J 15:268–274

    CAS  PubMed  Google Scholar 

  • Schweckendiek W (1981a) Two-stage closure of cleft palate: rationale for its use. In: Kehrer B, Slongo T, Graf B et al (eds) Long term treatment in cleft lip and palate. Huber, Bern, pp 254–262

    Google Scholar 

  • Schweckendiek W (1981b) Speech development after two-stage closure of cleft palate. In: Kehrer B, Slongo T, Graf B et al (eds) Long term treatment in cleft lip and palate. Huber, Bern, pp 307–314

    Google Scholar 

  • Semb G (1991) A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP team. Cleft Palate Craniofac J 28:1–21

    Article  CAS  PubMed  Google Scholar 

  • Silva Filho OG, Calvano F, Assuncao AG et al (2001) Craniofacial morphology in children with complete unilateral cleft lip and palate: a comparison of two surgical protocols. Angle Orthod 71:274–284

    CAS  PubMed  Google Scholar 

  • Sommerlad B (2003) A technique for cleft palate repair. Plast Reconstr Surg 112:1542–1548

    Article  PubMed  Google Scholar 

  • Talmant JC (1993) Nasal malformations associated with unilateral cleft lip. Scand J Plast Reconstr Surg Hand Surg 27:183–191

    Article  CAS  PubMed  Google Scholar 

  • Walter JD, Hale V (1987) A study of the long-term results achieved by the Gillies Fry procedure. Br J Plast Surg 40:384–390

    Article  CAS  PubMed  Google Scholar 

  • Willadsen E, Albrechtsen H (2006) Phonetic description of babbling in Danish toddlers born with and without cleft lip and palate. Cleft Palate Craniofac J 43:189–200

    Article  PubMed  Google Scholar 

  • Witzel MA, Salyer KE, Ross RB (1984) Delayed hard palate closure: the philosophy revisited. Cleft Palate J 21:263–269

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Coordinator, Cleft Lip & Palate Regional Center Milan, San Paolo University Hospital, Milan, Italy

    Luca Autelitano

  2. Plastic Surgery, Plastic Surgery Department, Assiut University, Assiut, Egypt

    Tarek Raief

  3. Plastic Surgery, Plastic Surgery Department, Al-Azhar University, Cairo, Egypt

    Ahmed Taha

  4. Plastic Surgery Department, Assiut University, Assiut, Egypt

    Mohamed El-Shazly

  5. Middle East & North Africa, Operation Smile International, Virginia Beach, VA, USA

    Mohamed El-Shazly

  6. Operation Smile, Virginia, VA, USA

    Mohamed El-Shazly

Authors
  1. Luca Autelitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarek Raief
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed Taha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed El-Shazly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Autelitano .

Editor information

Editors and Affiliations

  1. Department of Plastic Surgery, Services Institute of Medical Sciences/ CLAPP Hospital, Lahore, Pakistan

    Ghulam Qadir Fayyaz

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Autelitano, L., Raief, T., Taha, A., El-Shazly, M. (2022). Early Soft Palate Repair with Delayed Hard Palate Repair. In: Fayyaz, G.Q. (eds) Surgical Atlas of Cleft Palate and Palatal Fistulae. Springer, Singapore. https://doi.org/10.1007/978-981-15-8124-3_131

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-8124-3_131

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-8123-6

  • Online ISBN: 978-981-15-8124-3

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation