Cleft Palate Closure in the Neonate: Preliminary Report

Abstract

Our recent experience with cleft palate closure in the neonatal period (within 28 days of birth) is reviewed in this study. The research involved a series of 21 neonates who presented with untreated cleft palates and underwent a modified Veau-Wardill-Kilner palate closure by a single surgeon between 1991 and 1994. The postoperative clinical follow-up ranged from 8 to 37 months (mean 18 months). All complications discussed do not seem to occur more frequently when surgery is done at this age than at an older age. Our findings demonstrate that cleft palate closure can be safely performed in the neonatal period; we do not, however, recommend that the standard approach should be changed based on this preliminary report.

Perioperative complications in infant cleft repair

“…The potential benefits of cleft closure in infants regarding developmental and social-emotional factors must be weighed against the surgical risks because the risk of early cleft repair is basically the risk of surgery in early infancy [6,10]. Our study revealed frequent complications during cleft surgery.…”

“…Timing of cleft lip and palate closure remains controversial in the literature [6]. A compromise must be made on the age at surgery and the surgical outcome concerning facial growth, scarring, speech, language development, and psychological factors [7].…”

“…Until the last decade, primary cleft operations were usually carried out in the first three years of age [6]. Today, CLP repair is done within the first 12 months of life.…”

Timing of Palatal Surgery and Speech Outcome

“…A majority of reports addressing timing of surgery have focused on the influence of age at time of palatal surgery on speech outcome (e.g., Holdsworth, 1954;Jolleys, 1954;McWilliams, 1960;Peet, 1961;Cleveland and Falk, 1970;Koberg and Koblin, 1973;Evans and Renfrew, 1974;Kaplan et al, 1974Kaplan et al, , 1980Kaplan et al, , 1982Curtin, 1982, 1990;Desai, 1983;Randall et al, 1983;Barimo et al,1987;O'Gara and Logemann, 1988;Copeland, 1990;Rohrich and Byrd, 1990;Haapanen and Rantala, 1992;O'Gara et al, 1994;Denk and Magee, 1996;Rohrich et al, 1996Rohrich et al, , 2000Marrinan et al, 1998;Ysunza et al, 1998;Kirschner et al, 2000;Sandberg et al, 2002;Rohrich and Gosman, 2004;Hardin-Jones and Jones, 2005).…”

“…In fact, ''early'' surgery may have been performed anywhere from 1 day (Denk and Magee, 1996) to 2 years of age (Jolleys, 1954). Interestingly, although the independent variable in the studies described above was typically age at time of surgery, it was not chronological age per se that was at issue.…”