Timing of Cleft Palate Closure Should Be Based on the Ratio of the Area of the Cleft to That of the Palatal Segments and Not on Age Alone

  title={Timing of Cleft Palate Closure Should Be Based on the Ratio of the Area of the Cleft to That of the Palatal Segments and Not on Age Alone},
  author={Samuel Berkowitz and R C Duncan and Carla A. Evans and Hans Friede and Anne Marie Kuijpers-Jagtman and Birte Prahl-Anderson and Sheldon W. Rosenstein},
  journal={Plastic and Reconstructive Surgery},
Background: Retrospective and prospective serial spatiotemporal investigations were carried out primarily to determine whether the ratio of the size of the posterior cleft space relative to the palatal surface area limited laterally by the alveolar ridges can be used to select the appropriate time for surgical closure of the palatal cleft space. Two subsamples were compared to determine whether the size of the palate and velocity of palatal development in well growing cases differ from those in… 

A Review of the Cleft Lip/Palate Literature Reveals That Differential Diagnosis of the Facial Skeleton and Musculature is Essential to Achieve All Treatment Goals

Even though patients have the same cleft type and have received the same surgical treatment, usually between 18 and 24 months, the ratio of cleft and palatal size of 15% to 20% is critical to obtain good palatal development.

The Facial Growth Pattern and the Amount of Palatal Bone Deficiency Relative to Cleft Size Should Be Considered in Treatment Planning

  • S. Berkowitz
  • Medicine
    Plastic and reconstructive surgery. Global open
  • 2016
Staged orthodontic/surgical treatment limiting premaxillary retraction forces to lip adhesion or forces that cause only premaxilla ventroflexion produce the best results.

Evaluation and analysis of formation of bone at the palate in patients with cleft lip and palate after palatoplasty based on computed tomograms and three-dimensional data

  • H. SaijoY. Mori T. Takato
  • Medicine
    Scandinavian journal of plastic and reconstructive surgery and hand surgery
  • 2010
The width of the fissure at the first molar became significantly less, suggesting that osteogenesis had occurred, and given the results of previous studies, bony regeneration from the periosteum most likely happens together with Regeneration from the margins of thefissure.

Factors that affect variability in impairment of maxillary growth in patients with cleft lip and palate treated using the same surgical protocol

Investigation of 5-year-old children with unilateral cleft lip and palate found inherent tissue hypoplasia, possibly the lack of lateral incisors, seems to be the most important non-iatrogenic factor for impairment of maxillary growth.

Initial cleft severity and maxillary growth in patients with complete unilateral cleft lip and palate.

  • Yu-Ting ChiuY. LiaoP. Chen
  • Medicine
    American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics
  • 2011

Association between palatal index and cleft palate repair outcomes in patients with complete unilateral cleft lip and palate.

The palatal index was a good predictor of fistula development in the studied group and there was an association between the cleft severity and tissue deficiency (estimated using this index) and presence of palatal fistula.

Three-Dimensional Morphological Changes of the True Cleft under Passive Presurgical Orthopaedics in Unilateral Cleft Lip and Palate: A Retrospective Cohort Study

This cohort study quantifies the morphological changes in the palatal cleft and true cleft areas with passive plate therapy using a new analysis method based on three-dimensional standardized reproducible landmarks and proposes using the vomer edge to establish a validated measuring method for the width, area, and height of thetrue cleft.

3-D shape analysis of palatal surface in patients with unilateral complete cleft lip and palate.

Cleft Palate Midface Is Both Hypoplastic and Displaced

A palatal cleft is due to both alveolar tissue displacement and deficiency, therefore, ideal cleft palate care should involve the correction of a displaced and deficient alveolus.



Timing cleft palate closure--age should not be the sole determinant.

  • S. Berkowitz
  • Medicine
    Journal of craniofacial genetics and developmental biology. Supplement
  • 1985
Serial studies of 36 unilateral (UCLP) and 29 bilateral (BCLP) cleft lip and palate cases with good speech demonstrated that conservative palatal surgery is conducive to good speech as well as palate and facial development.

Growth sites and growth mechanisms at risk in cleft lip and palate.

  • H. Friede
  • Medicine
    Acta odontologica Scandinavica
  • 1998
Certain aspects of growth of the middle third of the face in both normal and cleft subjects are reviewed and ways to reduce the development of palatal scars and their negative effects on growth are discussed.

Two-stage closure of cleft palate (progress report).

  • M. Perko
  • Medicine
    Journal of maxillofacial surgery
  • 1979

Speech development and maxillary growth in relation to technique and timing of palatoplasty.

A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft).

It is concluded that IO only has a temporary effect on maxillary arch dimensions that does not last beyond surgical soft palate closure, and infant orthopaedics as a tool to improvemaxillary arch form could be abandoned.

Orthopaedic growth guidance and stimulation for patients with cleft lip and palate.

  • J. Weil
  • Medicine
    Scandinavian journal of plastic and reconstructive surgery and hand surgery
  • 1987
15 years' experience with the treatment of cleft patients applying "growth stimulators" combined with postponing surgical corrections is reported, and the results of this treatment method are compared with those found in literature, implying that the development of maxillary morphology is normalised, leading to an improvement of the oro-nasal functions including speech development.

Cleft Craft: The Evolution of Its Surgery, vol 1: The Unilateral Deformity

This remarkable book is the first of three volumes on cleft lip, cleft palate, and associated deformities written by one of the foremost authorities in the specialty of plastic surgery today. In

Cleft Palate Repair at Three Months?

  • E. Kaplan
  • Medicine
    Annals of plastic surgery
  • 1981
&NA; Evidence has been presented that soft palate repair at 3 to 6 months results in the best speech. Controversy remains as to the value of delayed hard palate repair or simultaneous early repair of

Facial clefts and their surgical management in view of recent research.

The clinical data herein presented is based on records from the University of Wisconsin, School of Medicine, Madison, Wisconsin, and from the Division for Service to Crippled Children, State of Wisconsin.

Cleft palate speech.

  • M. Moerman
  • Medicine
    Acta oto-rhino-laryngologica Belgica
  • 2000
The aim of this paper is to give a brief overview of the pathology itself and its consequences particularly in speech, at this point the velar and velopharyngeal function are stressed.