Effects of early maxillary orthopaedics in coordination with delayed surgery for cleft lip and palate

Abstract

Summary In the coordinated management of cleft lip and palate patients as carried out in Zurich since 1969/70, early maxillary orthopaedic treatment is indispensable in order to: meet functional requirements while surgical intervention is postponed in order to minimize subsequent growth disturbance, create optimal conditions for the maxillary segments to develop their entire growth potential, maintain or improve arch form, control effects of surgical lip closure. The orthopaedic appliance used is a plate of compound soft and hard acrylic resin. Lip surgery is performed at about 6 months of age, velar at closure at 18 months. The hard palate is left untouched up to an age when growth of the anterior maxillary arch is practically completed, timing of hard palate closure depending on speech proficiency as well as on dental development. In spite of a wide variation of arch size and width at birth, normalization of arch form occurs within the first one and a half years of life, due to the considerable growth rate, which is similar to that in normals. At the 5 year age level, the median values of postgingival width and alveolar crest length closely approximate those of a non-cleft sample. Speech development is not relevantly impaired by two-stage palatal closure.