Studies On The Results Of Early Repair Of Cleft Palate

Despite extensive research and voluminous publications on the timing of cleft palate surgical procedures, significant controversies still exist. The controversy is focus on early palatoplasty for improved speech versus delayed hard palate repair undisturbed facial growth. After decades of research, at present, the advantage of better speech with early surgery has been weighed against the risk of facial growth inhibition. The relative importance of speech versus maxillofacial growth has led to the present controversy regarding the best time for palate repair. There are four recommended approaches: 1. Delayed complete palate repair (12-24 months). The reason here is that speech results are nearly as good as with early repair and that facial growth disturbance is less. This approach is the most common in china. 2. Late complete palate repair (2-5 years). The emphasis is on preventing facial-dental growth inhibition and accepting the poorer speech results. 3. Early complete palate repair (6-12 months). The emphasis is on achieving maximal speech results, with minimal or correctable facial growth alterative. 4. Early soft palate repair (6-12 months) and delayed hard palate repair (5-15 years). This attempt aims to achieve good speech results by repair of soft palateand to avoid facial-dental deformity by delaying repair of the hard palate.Most physiolological functions are best learned at early age. Neuromuscularly control and integration into the neurological system should occur at the optimal time; otherwise ineffective coordination and abnormal compensation and habits results. Similarly, it is probable that palate speech function have an optimal time for normal development, and uncorrectable pattern occur if the palate is repair at a late age. So, the earlier the palate is repair, the soon the soft palate can begin normal functioning and speech can begin integrating and developing without abnormal patterns.There seem to be a sensitive period for development in a number of areas, including the development of speech motor control and consequently phonetic development, that occur at 4-6 months of age. It may be important to close the palate prior to or during this period if the infant is to benefit optimally from this state of readiness. Furthermore, if the onset of meaningful speech is not to be delayed and if maladaptive articulation are to be avoided completely, oronasal structures may need to be intact during this period between 4-6 months of age. Similarly, the potentially adverse effects of hospitalization may be minimized if surgery is performed the 4-6 months period. The ideal of developmentally determined surgical intervention may not always be possible. The size of the palate, general health consideration, or limitations of surgical facilities available for pediatric surgery may prelude palate closure during the 4-6 months period. The management of children with cleft lip and palate, therefore, requires an an individualizied treatment program in which all of the above factors are considered. The degree of...