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Published on: September 19, 2015
Classification, recording, and cleft palate surgery at the Uppsala Cleft Palate Centre
M Larson1, R Hellquist, O P Jakobsson
1Eastman Institutet, Stockholm, Sweden.
Insights
This study details a refined classification and longitudinal recording system for isolated cleft palate in children. Surgical techniques evolved from one-stage to two-stage procedures, optimizing timing for better outcomes.
Area of Science:
- Pediatric Surgery
- Craniofacial Anomalies
- Plastic Surgery
Background:
- Uppsala Cleft Palate Centre utilizes a detailed classification system for isolated cleft palate.
- A longitudinal registration system, established in 1967, tracks patient progress from primary surgery through 20 years of age.
- The system emphasizes therapeutic aspects, reducing radiation exposure by recording every three years.
Purpose of the Study:
- To describe the classification system, recording methods, and surgical techniques for isolated cleft palate in Uppsala.
- To detail the evolution of surgical timing and procedures for cleft palate repair.
- To present a refined approach to managing pediatric cleft palate.
Main Methods:
- Classification based on Kernahan and Stark, and American Cleft Palate Association systems, with hard palate divided into thirds.
- Longitudinal data collection at 5, 8, 11, 14, 17, and 20 years post-primary surgery.
- Surgical techniques evolved from one-stage to two-stage procedures, with adjusted timing for soft and hard palate closure.
Main Results:
- A detailed classification system allows for precise description of cleft morphology.
- The two-stage surgical technique, with soft palate closure at 6 months and hard palate at 2 years, is now standard for children born in 1975 and later.
- Reduced radiation exposure achieved through triennial follow-ups without compromising data reliability.
Conclusions:
- The described classification and longitudinal recording system provide a comprehensive approach to managing isolated cleft palate.
- The evolution of surgical techniques, particularly the two-stage approach with optimized timing, has improved treatment protocols.
- This methodology ensures detailed assessment and effective management of cleft palate in pediatric patients.
Abstract:
This paper describes the classification system, method of recording, and surgical techniques used in Uppsala for children with isolated cleft palate. The classification is based on the system described by Kernahan and Stark and the more detailed system described by the American Cleft Palate Association. Separation of the hard palate into thirds, and into right and left sides, assures a detailed description of the cleft, and separates small morphological differences. The longitudinal registration system was introduced into the Uppsala Cleft Palate Centre in 1967. After the initial recording at the time of primary surgery, it is repeated at 5, 8, 11, 14, 17, and 20 years. By emphasising the therapeutic aspects of various stages of growth, it has been possible to limit the recording to once every third year. This has resulted in an important reduction in the dose of radiation without compromising the reliability of the results. Children born before 1975 had clefts of both the soft and hard palate closed at 18-24 months in a one-stage procedure. For children born in 1975 and later a two stage technique has been used, while clefts limited to the soft palate only have been closed entirely in the first operation. At first, the soft palate cleft was closed at 18 months of age and the hard palate at 4 to 5 years. The timing was changed in several steps to the present soft palate closure at 6 months and hard palate closure at 2 years of age.
