[Cleft lip and palate: retrospective study of 35 years of management]

The author having treated more than 2,000 C.L. (P) cases, and recognized his errors, delivers his main conclusions: 1--The Cupid-s bow always complete on the healthy side is to be strictly respected; 2--The nasal floor muscles should be identified and set in due place, especially the oblique part of the orbicularis oris, responsible for the nasal equilibrium; 3--The long muscular loop (orbicularis, buccinator, superior pharyngii constrictor) should be closed within the neo-natal period; 4--The velum should be closed and set back before the ninth month; in order to minimize scarring, only mucosal flaps should be taken from the palatal shelves; 5--If the velum deserves lengthening, tissue transfer by superiorly based pharyngeal flap, to be cut six months later; 6--Leave alone the bone until 7 or 8 years of age, close the gap with a Campbell flap; 7--Consider that no forceful orthopaedics can overwhelm the strength of scars developed over and between the palatal shelves. So, be light and late on the bone; 8--No addiction to any skin design provided some sort of Z-plasty is used; 9--Think muscle. Spare the bone.