Evolution of Cleft Lip and Palate Surgery and the Pursuit for Consensus on Standardized Algorithms of Care

Cleft lip and palate (CLP) surgery has evolved over centuries in an attempt to achieve anatomical closure while optimizing speech and limiting fistulas and midface hypoplasia. Masters of cleft surgery and early pioneers inspired generations of surgical innovators to refine techniques and timing to improve surgical outcomes. Constant modification has resulted in significant diversity of cleft surgical protocols across institutions. Unlike many other surgical conditions, there is no gold-standard algorithm of care for CLP. Several international consortiums, including Eurocleft, Americleft, and Scandcleft, aimed to investigate the ideal cleft care protocol. Despite the inclusion of multiple institutions and attempts at long-term follow-up, these studies were limited by small sample sizes, lack of diversity in patient population, poor long-term follow-up, lack of standardized measurement tools, and inability to control for confounders such as severity. This article aimed to present the findings of these early pioneer consortiums in their pursuit for the optimal CLP surgical protocol and recommend a direction for future research with a global consortium of experts in cleft care.