Cleft Palate Surgery Recommended at Older Age

New research, which suggests that the optimal time to close the cleft palate be delayed until the patient is older, is changing the way cleft palate surgeries are performed.

Researchers at the Lawson Health Research Institute (LHRI, London, ON, Canada) studied a group comprising 136 children over a period of 20 years. The researchers compared one group of children that had the cleft repair performed early with another large group of children who had the repair performed when they were older. Using the compiled research data, the researchers determined that the best time to close the cleft at the tooth alveolus level in patients with either one or two sided clefts is at eight or nine years of age, prior to eruption of the permanent canine tooth. The findings were presented at the American Cleft Palate Association (ACPA) meeting, held during April 2008 in Philadelphia (PA, USA). At the meeting, a panel discussion regarding the research ensued, where the lead author recommended the later closure. The overall majority of the participants voted to endorse this view, leading to a change in the recommended guidelines on the way cleft palates will be treated in hospitals around the world.

"Cleft is the most common facial anomaly and the second most common congenital anomaly among children,” said lead author and presenter of the study Dr. Damir Matic, M.D., a craniofacial plastic surgeon at London Health Sciences Center, and a professor in the department of surgery at The University of Western Ontario (UWO, Canada). "Our research is clinically based in terms of looking at how we can make our repairs better in light of our current knowledge and past discoveries. Based on our data, the downside of early closure is much worse than any potential benefits, and repairing the cleft prior to this time (7-9 years) will damage facial growth.”

Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined. The soft palate is in these cases cleft as well. In most cases, cleft lip is also present The cleft lip is usually closed at three months of age, the palate is closed at one year of age, but the alveolar crest and gingival closure are usually delayed until age eight or nine, a time that corresponds to permanent tooth eruption.


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Lawson Health Research Institute