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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31821e6f92
Pediatric/Craniofacial: Original Articles

From Birth to Maturity: A Group of Patients Who Have Completed Their Protocol Management. Part III. Bilateral Cleft Lip-Cleft Palate

David, David John F.R.C.S.E., F.R.C.S., F.R.A.C.S.; Smith, Ian M.Sc., F.D.S.R.C.S., F.R.C.S.(Plast.); Nugent, Michael M.S., F.R.A.C.D.S.; Richards, Christina B.App.Sci.; Anderson, Peter John F.D.S.R.C.S., F.R.C.S.

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Abstract

Background: The optimal management of cleft lip-cleft palate patients presents a formidable challenge to the cleft surgeon. This is especially so in the case of bilateral cleft lip-cleft palate, and the long-term management in a multidisciplinary setting is essential. This study presents the results of the specific management protocol at the Australian Craniofacial Unit for patients with bilateral cleft lip-cleft palate who have completed their protocol treatment under the care of a single surgeon (D.J.D.) during the period 1974 to 2006.

Methods: A retrospective study of the outcomes in relation to facial growth, speech, hearing, and occlusion is presented of patients with bilateral cleft lip-cleft palate.

Results: Nineteen cases were identified from the departmental database, 12 male patients and seven female patients. Six patients with severe craniofacial deformities who had bilateral cleft lip-cleft palate were excluded. Cephalometric analysis at skeletal maturity identified that a majority of cases had midface hypoplasia requiring midface advancement in 14 cases. Speech and hearing outcomes were worse when compared with other clefting types.

Conclusion: Overall, these results demonstrate that facial growth is more affected in bilateral cleft lip-cleft palate patients than in either unilateral cleft lip-cleft palate or isolated cleft palate patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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