Timing cleft palate closure--age should not be the sole determinant

Attainment of normal speech, facial and palatal development, and dental occlusion is possible without compromising one objective for another. Although speech development may benefit from early palatal closure, there are instances when cleft closure should be postponed to a later age to permit conservative palatal surgery. Increase in palatal size with the spontaneous narrowing of the cleft space can occur early, late, or not at all, and, in rare instances, the cleft may even widen. Nonphysiological surgery causes facial and palatal maldevelopment by extensive undermining and displacement of mucoperiosteum, fracture of bone, or destruction of blood supply. To avoid these consequences, timing of palatal closure should be related to the anatomical and functional assets in the individual and not determined by age alone. Serial studies of 36 unilateral (UCLP) and 29 bilateral (BCLP) cleft lip and palate cases with good speech demonstrated that conservative palatal surgery is conducive to good speech as well as palate and facial development. Speech appliances may be necessary as an interim device after 2 years of age.