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Original Article

Surgical management of cleft palate. A review of the literature

2012, Volumen 42, Número 2
Christodoulos P. Laspos, Alexandros Stratoudakis
Doctor en Cirugía Dental. Experto en Cirugía Dental (ortodoncista, especialista en malformaciones craneofaciales). Director del Centro Cyprus de paladar hendido y deformaciones faciales, Chipre
 

Cleft palate and its management vary from patient to patient. There are a variety of surgical techniques appropriate for the initial closure of the palate, often referred to as “primary surgery”. The results of the studies are still controversial, and the decision for the type of surgical management is based on the individuality of each case. The major reason for performing surgery to close a cleft palate is to create a velopharyngeal valving mechanism that is capable of separating the oral from the nasal cavities during speech. The patient, however, will also benefit from the surgery by having less upper respiratory infections, easier intake of food and improvement of the status of the middle ear. The problem of inhibition of the midfacial growth as a result of an early-performed palatal surgery is discussed widely in the literature, and the question that arises is: “What is more important speech or growth?”. The production of normal speech is suggested to be the most important objective in surgery of the cleft lip and palate by the speech pathologists, more important than appearance and more important than occlusion or midfacial growth3. The importance of the last two objectives, however, must not be considered of less importance but instead be integrated into the plan of treatment. Children with speech that is unintelligible or distorted by many ways mainly hypernasality or distorted articulation patterns have a disability which is more severe than a less-than-perfect appearance or dentition. A patient with a maxillary deformity is easier to be surgically corrected by a second orthognathic procedure than if the patient has distorted articulation patterns and distorted speech development. It was the purpose of this paper to review the literature regarding the various surgical techniques as well as their benefits and destructions on cleft individuals. We will also introduce the technique that we are using in The Hellenic Craniofacial Center and The Cyprus Center for Clefts and Facial Deformities.  (Rev Esp Ortod. 2012;42(2):078-086)

 
 
Key words:
Cleft palate. Primary surgery. Speech impairment.
 
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