Current Trends in the Treatment of Bilateral Cleft Lip and Palate

Abstract

Surgery alone in a primary synchronous repair is able to correct the nasal deformity in bilateral cleft lip and palate at 6 months of age. The patency of the nostrils and the elongation of the columella are and remain good when a nasal retainer is maintained during the first 3 to 4 months. There is no need for presurgical nasoalveolar molding or lip adhesion. I believe it is important to know that presurgical infant orthopedics are not necessary to lengthen the columella and that it is not a good argument to justify their use. Wealthy countries perhaps can bear the high cost of procedures such as presurgical nasoalveolar molding with the subsequent risk of a narrow anterior maxillary arch that increases orthodontic treatment time and cost and the probability of LeFort I osteotomy. In countries in which the cost must be reduced it is possible to correct the cleft lip-nose deformity in one operation with good results and to delay the first orthopedic treatment up to 4 years of age to perform the gingivoperiosteoplasty with a bone graft at approximately 5 years of age, so that the width and the relationships of the maxillary arch are normal at the time of the mixed dentition.