Treatment Outcome in Cleft Lip and Palate: Issues and Perspectives

Abstract

In the last 40 years, great progress has been made toward a better understanding of many aspects of the cleft lip and palate defect, but there is still a long way to go before there is agreement on the optimal treatment procedures. With regard to the primary operations, it can be stated, in a somewhat simplified form, that there are two main schools of thought in cleft treatment. One advocates early closure of the lip and palate, a procedure which imparts a high priority to early speech function. The other recommends delayed closure of the hard palate, thereby according a high priority to the growth of the maxilla A number of intercenter and multicenter studies have been carried out recently in an effort to elucidate which procedures give the best result, both esthetically and functionally. The results are ambiguous, and this has led a number of researchers to suggest that the randomized clinical trial is the only way to resolve the ambiguity, The fact that it has proved difficult to identify the optimal procedures in the field of cleft lip and palate treatment need not only be due to a less than optimal research design, a contributory factor might also be the great variability in craniofacial morphology and in the response to treatment in patients who have exactly the same cleft lip and palate diagnosis. Intensive research has made it possible to state categorically that clefts occur due to many different factors in an interplay between genetics and environment. Therefore, it is not likely that a single gene can be responsible for clefting. Since scar tissue presents many problems-for instance, impairment of growth-the reduction or prevention of scar formation has long been a desirable goal. The discovery that a fetus can heal without scar formation has led to many animal experiments. The timing of the surgical intervention on fetuses is critical, since lategestation fetuses heal with adult-like scarring. There are still many unsolved problems connected with fetal surgery, and at present prenatal surgery for repair of cleft lip and palate is not ethically defensible in humans. On the other hand, it appears that there are considerable possibilities for the reduction of human scarring after surgery with the introduction of various woundhealing medications.

One- or Two-Stage Palate Closure in Patients with Unilateral Cleft Lip and Palate: Comparing Cephalometric and Occlusal Outcomes

“…What is actually controversial is not the surgical procedure but its timing (Horch, 1990;Molsted, 1999). Cleft palate surgery's main problem is still to find the ideal balance with basic rehabilitation, which on the one hand should occur as early as possible for functional reasons, especially speech (Witzel et al, 1984), and on the other hand should not adversely affect facial growth and development.…”

Candidate Genes for Cleft Lip and Palate: Review

“…Yüz deformiteleri içerisinde en sık görülen konjenital anomalilerden biri olduğu belirtilirken, toplumların genelinde her 750-1000 canlı doğumda bir rastlandığı bildirilmektedir. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Dudak-damak yarıkları ırklara göre değişik oranlarda görülmektedir (Tablo 1). Siyah ırkta nadir görülürken, Doğulu sarı ırkta çok daha sık ortaya çıktığı belirtilmektedir.…”

“…Epidermal büyüme faktörü ile yaklaşık %40 diziliş benzerliği gösterirken, epidermal büyüme faktörü reseptörlerini bağlamak, fosforilasyonu uyarmak ve mitojenik yanıt oluşturmak için epidermal büyüme faktörü ile yarışmaktadır. 9 Kraniyofayal gelişim süresince TGF-α, birleşen palatal uzantıların medial sınır epitellerini oluşturmada görev alarak ekstraselüler matriks sentezini ve mezenkimal hücre göçünü hızlandır-maktadır. 12,58 TGF-α'nın diş eksikliği ve dudak-damak yarıklarının oluşumunda %20 oranında etkin olduğu bildirilmekle birlikte; kutanöz malign melanomaya, göğüs kanserlerine ve oral kanserlere de neden olabildiği bildirilmektedir.…”

Studies on the Craniofacial Morphology of Adult Cleft Patients Using Euclidean Distance Matrix Analysis (EDMA)

“…However, this contrasts with its proven (and less desirable) effect on speech development [22,36]. Friede [11] addressed the controversy of early vs. delayed hard palate closure in a detailed review.…”