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From birth to maturity: a group of patients who have completed their protocol management. Part II. Isolated cleft
David J David1, Peter J Anderson, Drew E Schnitt
1Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Insights
This study on isolated cleft palate patients found that the pushback surgical technique did not adversely affect facial growth. Outcomes for speech and hearing were generally positive, with most patients achieving normal results.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Optimal management of cleft palate patients presents a challenge.
- Multidisciplinary team management is established, but long-term outcome data is sparse.
- This study presents results from a 29-year protocol management of isolated cleft palate patients.
Purpose of the Study:
- To evaluate long-term outcomes in patients with isolated cleft palate.
- To assess the impact of protocol management on facial growth, speech, and hearing.
- To determine the efficacy of the pushback technique in palate reconstruction.
Main Methods:
- Retrospective study of 32 isolated cleft palate patients (1974-2003).
- Outcomes assessed for facial growth (cephalometric analysis), speech, and hearing.
- Patients managed by protocol at the Australian Craniofacial Unit.
Main Results:
- Cephalometric analysis showed a range of facial growth; only two patients required maxillary advancement.
- Speech assessments at maturity indicated 18 of 32 patients were within normal limits.
- Hearing levels were within -20 dB in all but two patients.
Conclusions:
- Facial growth was not adversely affected by the pushback technique for palate reconstruction.
- The study confirms acceptable outcomes for facial growth, speech, and hearing in isolated cleft palate patients managed by protocol.
- Results support the long-term efficacy of the pushback technique in cleft palate repair.
Background:
The optimal management of the cleft palate patient from birth to completion of treatment continues to present a formidable challenge to the plastic surgeon. The management by multidisciplinary teams is well established, but long-term outcome data of cases managed by protocol remain sparse. This study continues to present the results of the Australian Craniofacial Unit of patients with isolated cleft palate who completed protocol management at the unit under the care of the senior author (D.J.D.) during the 29-year period from 1974 to 2003.
Methods:
A retrospective study of the outcomes in relation to facial growth, speech, hearing, and occlusion is presented of patients with an isolated cleft palate.
Results:
Thirty-two cases were identified from the departmental database, involving 17 female patients and 15 male patients. Cephalometric analysis at skeletal maturity revealed a range of facial growth, and maxillary advancement surgery was deemed necessary in just two cases. Speech results were evaluated using speech therapy assessments during development and at maturity. At maturity, 18 of 32 patients were assessed as being within normal limits. The hearing was within -20 dB, with just two exceptions.
Conclusion:
Overall, these is a range of outcomes, but the results confirm that facial growth does not appear to be adversely affected by use of the pushback technique to reconstruct the palate.
