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Comprehensive management of cleft lip and palate deformities.
J Oral Maxillofac Surg 2001; 59(9):1062-75; discussion 1075-7JO

Abstract

PURPOSE

The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. The goal of this article is to present a versatile, universal philosophy of management of these deformities involving early repair.

PATIENTS AND METHODS

Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty at 3 months, followed by soft and hard functional palatoplasty at 9 months.

RESULTS

All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla. When early gingivoperiosteoplasty was performed in 25% of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition. This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal.

CONCLUSION

Optimal rehabilitation of the patients was achieved by following the principles and treatment strategies described. If the treatment principles are not incorporated in the functional repair (ie, joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected.

Authors+Show Affiliations

Department of Maxillofacial Surgery, Elmhurst Hospital Center, Mount Sinai School of Medicine, New York, NY 11737, USA. anastassov@aol.comNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11526580

Citation

Anastassov, G E., and U Joos. "Comprehensive Management of Cleft Lip and Palate Deformities." Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, vol. 59, no. 9, 2001, pp. 1062-75; discussion 1075-7.
Anastassov GE, Joos U. Comprehensive management of cleft lip and palate deformities. J Oral Maxillofac Surg. 2001;59(9):1062-75; discussion 1075-7.
Anastassov, G. E., & Joos, U. (2001). Comprehensive management of cleft lip and palate deformities. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 59(9), pp. 1062-75; discussion 1075-7.
Anastassov GE, Joos U. Comprehensive Management of Cleft Lip and Palate Deformities. J Oral Maxillofac Surg. 2001;59(9):1062-75; discussion 1075-7. PubMed PMID: 11526580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comprehensive management of cleft lip and palate deformities. AU - Anastassov,G E, AU - Joos,U, PY - 2001/8/30/pubmed PY - 2001/9/21/medline PY - 2001/8/30/entrez SP - 1062-75; discussion 1075-7 JF - Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons JO - J. Oral Maxillofac. Surg. VL - 59 IS - 9 N2 - PURPOSE: The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. The goal of this article is to present a versatile, universal philosophy of management of these deformities involving early repair. PATIENTS AND METHODS: Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty at 3 months, followed by soft and hard functional palatoplasty at 9 months. RESULTS: All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla. When early gingivoperiosteoplasty was performed in 25% of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition. This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal. CONCLUSION: Optimal rehabilitation of the patients was achieved by following the principles and treatment strategies described. If the treatment principles are not incorporated in the functional repair (ie, joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected. SN - 0278-2391 UR - https://www.unboundmedicine.com/medline/citation/11526580/Comprehensive_management_of_cleft_lip_and_palate_deformities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-2391(01)59292-7 DB - PRIME DP - Unbound Medicine ER -