Craniofacial analysis of patients with complete clefts of the lip and palate

The timing of habilitative treatment in the individual with cleft lip and palate has received a great deal of attention, but the most judicious age for performing primary palatoplasty is still a contested issue. Some reports in the literature speak of "early" and "traumatic" surgery as being analogous, while other investigators find early surgery entirely compatible with normal growth and development. Records were obtained on 19 patients with unilateral and 9 with bilateral clefts of the lip and palate operated upon at the same age by the same surgeon and utilizing the same surgical technique. Cephalometric tracings were recorded, measured, and analyzed by an Amdahl 470-V computer. Results indicate that, in both unilateral and bilateral clefts, there is a definite decrease in overall mid-facial growth, both horizontally and vertically, but that there is an apparent tendency for the components of the lower face, especially the mandibular body, to "compensate" for changes in midface development. Although skeletal structures of the cleft subjects are significantly altered when compared to non-cleft control subjects, the general clinical appearance of the patients does not substantiate the criticisms of those opposed to "early" surgical intervention.