Unilateral cleft lip and palate : treatment outcome and long-term craniofacial growth

Treatment results of children with a complete Unilateral Cleft Lip and Palate (UCLP) from the Cleft Palate Craniofacial Unit of the Radboud University Nijmegen Medical Centre were evaluated and compared with prominent European cleft centers. Treatment outcome of the Nijmegen patients with UCLP and treated with 2-staged palatal closure including delayed closure of the hard palate was comparable to the results of the European cleft centers with the best outcome. Moreover, this study revealed that cleft centers with surgeons with a high annual caseload achieved the best treatment results. Long-term evaluation of the craniofacial development of these patients showed a retrusive growth pattern for the maxilla and mandible, and a rather vertical growth pattern for the lower face. Concerns regarding speech and additional burdens of care might justify a 2-staged palate repair with an earlier closure of the hard palate than the age of 9 years, which is the current age at which hard palate closure is performed for the Nijmegen patient group. However, prospective, well-designed controlled studies, especially on long-term results, are urgently needed to take an evidence-based decision on timing of hard palate repair