Facial growth of adults with unoperated clefts

Studies of adult patients with unoperated complete unilateral cleft lip and palate indicate that there is normal potential for maxillary growth. The maxilla in the unoperated patient is normally positioned or protruded. The protrusion of maxilla in the unoperated adult cleft patient is limited to the non-cleft side, contributing to hemifacial maxillary prognathism. Surgical scar tissue is known to interfere with the growth of the midface. Palatal surgery has more significant influence on the growth of the mid-face than the lip surgery; therefore, it is important to reduce the effect of surgery by delaying the timing of palatal surgery or changing the location of the surgical scar from the sutural areas. Delaying palatal surgery until the maxillary growth is complete is desirable but could lead to poor speech development. Therefore, it is essential to perform the palatal surgery before speech development. The other variables that affect the midface are the development genetic make-up of the cleft child, the amount of tissue deficiency, timing of surgery, surgical technique, and the skill of the surgeon. Surgeries continue to have some inhibitory effect on maxillary growth, but it is essential to recognize and perform those surgical procedures that have the least effect on growth of the maxilla. This will help minimize extensive orthodontic treatment and eliminate major secondary orthognathic surgery for correction of the abnormal growth of the maxilla.