Analysis of Dental Arch Relationships in Swedish Unilateral Cleft Lip and Palate Subjects: 20-Year Longitudinal Consecutive Series Treated with Delayed Hard Palate Closure

Abstract

Delayed hard palate closure as practiced in Goteborg since 1979 has produced the best GOSLON Yardstick ratings in a consecutive series of patients ever recorded worldwide, since the Yardstick was first used in 1983. However, it is noteworthy that a new protocol has been introduced in Goteborg since 1994, in which hard palate closure is done at 3 years due to concerns regarding speech.

Which index should be used to measure primary surgical outcome for unilateral cleft lip and palate patients?

“…It is important to first note what is considered as acceptable reliability in the wider literature. Published weighted Kappa scores have a wide range from 0.56 to 1.00 (7, [13][14][15][16][17]. Ideally, in large multi-centre studies intra-examiner weighted Kappa scores should be >0.8 and inter-examiner >0.7 to ensure results are reliable.…”

The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review

“…Evidence for the benefit of this staged palate repair on maxillary growth has been scanty, though LILJA et al 13 provided some evidence that maxillary growth using the staged repair with hard palate closure at 9 years of age was superior, and SILVERA et al 24 found that patients who had staged repair with hard palate closure at 6 years of age had more favourable maxillary growth than did those who underwent 1-stage repair at 1.5 years of age. FRIEDE et al 3 questioned whether it is necessary to delay closure until 9 years of age rather than 5 years, because similar and satisfactory maxillary growth was found in two samples in which patients underwent surgery at the two different ages.…”

Predictors of poor dental arch relationship in young children with unilateral cleft lip and palate

“…Infants sleeping in prone position could reduce cleft size [31]. Previous studies also showed that a later palate repair results in favorable maxillary growth because possible interference with maxillary growth is postponed to a later age when less growth remains [27,28,[32][33][34] and that a staged palatal closure by starting closure of the soft palate with a posterior vomer flap incorporation may narrow the size of the remaining cleft spontaneously [35] or by starting closure of the hard palate with a single layer vomer flap may facilitate a smaller later palate repair [1].…”