Delayed Hard Palate Closure: The Philosophy Revisited

Abstract

Delaying surgical closure of the hard palate in children with cleft lip and palate has become increasingly popular. This essay is a review of the rationale and supporting evidence for this procedure, with emphasis on its effect on speech, particularly articulation and velopharyngeal function. We have concluded that the assumptions on which this method is based have never been proven, and that the deleterious effects on speech often noted have not received appropriate attention. The goals of treatment for patients with cleft lip and palate—normal speech, normal appearance and normal occlusion—are closely related. The achievement of normal speech is not only contingent on velopha— ryngeal closure, but also on a closed hard palate, reasonable occlusal relationships and many other factors. The timing and technique of palate repair may be the single most important treatment influence on speech and facial morphology, yet there is no consensus on the preferred age or technique for surgery. This paper is an examination of the history , rationale and evidence available on one widely used technique of palate repair: the early soft palate-late hard palate closure.