Abstract
Love R, Walters MJ, Southall P, Singer S, Gillett DA. Dental arch relationship outcomes in children with complete unilateral cleft lip and palate, treated at Princess Margaret Hospital for children, Perth, Western Australia. Cleft Palate Craniofac J. In press.
Contrary to Professors Friede, Lilja, and Lohmanders' assertion, we do believe that surgical protocol is a key determinant of facial growth. That is the reason we undertook a review of our patients to determine whether there was a need to change our surgical protocol.
Of 71 patients in this study, 68 underwent palatoplasty using unipedicled mucoperiosteal flaps. The design of the flaps was most similar to that described independently in 1937 by William Wardill from Newcastle and Pomfret Kilner from London. However, the flaps were raised to provide improved access to the soft palate musculature and not for palatal elongation. The palatoplasty was not a push-back, and the lateral incisions were loosely closed to minimize exposed bone, similar to what we do in a von Langenbeck palatoplasty. In view of this small difference between surgical techniques and the very small number of von Langenbeck procedures, we decided to include both for statistical analysis. This also enabled us to report on a consecutive series of cases to comply with the methods of Mars and recommendations of Eurocleft for reporting Goslon scores (Mars et al., 1987; Shaw et al., 2005).
We are aware of the reported superior growth results of delayed hard palate repair (DHPR). We are not attempting to argue that a push-back procedure at 9 months of age gives better growth results. We are presenting our growth results to add to the available pool of information that can be used to determine what protocol best serves cleft patients.
Surgical protocols need to consider multiple outcomes, in particular speech and growth. Several authors have reported a high incidence of speech problems with DHPR (Holland et al., 2007; Lohmander and Persson, 2008). Lohmander et al. (2006) reported that in Gothenburg, the age for delayed hard palate closure was changed from 8.5 years to 3 years of age due to speech concerns, and we believe that it has subsequently been reduced further to 18 months of age. We await the publication of the long-term follow-up of speech outcomes in patients treated according to the Gothenburg protocol. If it can be demonstrated that the speech results with DHPR are comparable with results from an early palate repair protocol this would certainly encourage consideration of this protocol.