Delayed hard palate repair and speech deficiencies: a cautionary report

In the management of patients with complete palatal clefts early repair of the soft palate (before 1 year of age) and delayed repair of the hard palate (after five or six years of age) has been advocated on the basis that good speech will develop following soft palate closure and that avoidance of trauma to the hard palate will obviate maxillary growth disturbance. In addition, it is said that many of the remaining hard palate fistulas will close spontaneously and that residual hard palate openings will be easy to close. Thirty-two cases treated in this way are reviewed, and a decade of experience with this technique is presented. A majority of cases failed to develop acceptable speech spontaneously. A very high percentage suffered both anterior and posterior air escape and a strikingly high proportion required pharyngeal flaps. Spontaneous complete closure of the hard palate was infrequent. The hard palate openings were not easy to close. The speech deficiencies associated with this technique are clear. The method's possible advantages in relationship to maxillofacial growth remain difficult to prove and were not specifically investigated in this study.