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Update on outcomes research for cleft lip and palate

Shaye, David

Current Opinion in Otolaryngology & Head & Neck Surgery:
doi: 10.1097/MOO.0000000000000064
FACIAL PLASTIC SURGERY: Edited by Travis T. Tollefson
Editor's Choice

Purpose of review: The purpose of this review is to summarize the recent evidence-based literature focusing on cleft lip and palate outcomes research.

Recent findings: The findings of recently published literature focus on cleft lip and palate outcomes research, patient-based outcomes measurement tools, nasoalveolar molding, and how speech outcomes relate to palatoplasty timing, technique, and intravelar veloplasty. Studies have investigated the relationship between palatoplasty timing and facial development.

Summary: The literature lacks any evidence-based consensus to support a superior method of cleft lip repair. A majority of North American surgeons, however, utilize a rotation-advancement technique and perform cleft rhinoplasty at the time of primary lip repair, with the idea that this could decrease the number of revision surgeries needed over the long term. Most cleft surgeons perform a single-stage palatoplasty at 9–12 months of age for improved early speech outcomes. There is insufficient evidence to support a two-stage palatoplasty with the intention of improved maxillary growth. Controversy persists on the relationship between early palatal surgery and its deleterious effects on facial development. A shift toward patient-reported outcomes is called for; however, this remains difficult, as there are few validated, cleft-specific outcome measurement tools.

Author Information

Division of Facial Plastic & Reconstructive Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to David Shaye, MD, Division of Facial Plastic & Reconstructive Surgery, Massachusetts Eye & Ear Infirmary, 243 Charles Street, Boston, Massachusetts, 02114, USA. Tel: +1 617 573 4105; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins