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Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate.
Cleft Palate Craniofac J. 2006 May; 43(3):329-38.CP

Abstract

OBJECTIVE

To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first.

DESIGN

Randomized controlled trial.

SETTING

The Regional Cleft Service of West Nepal.

PATIENTS

Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair.

INTERVENTIONS

Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later.

MAIN OUTCOME MEASURES

Analysis of dental study models, weight gain, and speech recordings.

RESULTS

Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation.

CONCLUSION

Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery.

Authors+Show Affiliations

Western Regional Hospital, Pokhara, Nepal. bruce.richard@bch.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16681406

Citation

Richard, Bruce, et al. "Results of Randomized Controlled Trial of Soft Palate First Versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate." The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association, vol. 43, no. 3, 2006, pp. 329-38.
Richard B, Russell J, McMahon S, et al. Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 2006;43(3):329-38.
Richard, B., Russell, J., McMahon, S., & Pigott, R. (2006). Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association, 43(3), 329-38.
Richard B, et al. Results of Randomized Controlled Trial of Soft Palate First Versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate. Cleft Palate Craniofac J. 2006;43(3):329-38. PubMed PMID: 16681406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate. AU - Richard,Bruce, AU - Russell,Joyce, AU - McMahon,Siobhan, AU - Pigott,Ron, PY - 2006/5/10/pubmed PY - 2006/7/13/medline PY - 2006/5/10/entrez SP - 329 EP - 38 JF - The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association JO - Cleft Palate Craniofac J VL - 43 IS - 3 N2 - OBJECTIVE: To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first. DESIGN: Randomized controlled trial. SETTING: The Regional Cleft Service of West Nepal. PATIENTS: Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair. INTERVENTIONS: Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later. MAIN OUTCOME MEASURES: Analysis of dental study models, weight gain, and speech recordings. RESULTS: Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation. CONCLUSION: Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery. SN - 1055-6656 UR - https://www.unboundmedicine.com/medline/citation/16681406/Results_of_randomized_controlled_trial_of_soft_palate_first_versus_hard_palate_first_repair_in_unilateral_complete_cleft_lip_and_palate_ L2 - https://journals.sagepub.com/doi/10.1597/05-065.1?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -