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Evaluation of a Sample of Patients With Unilateral Cleft Lip and Palate Treated With a Two-Stage Protocol

Brusati, Roberto, MD*; Meazzini, Maria Costanza, DMD, MMSC; Rezzonico, Angela, ST; Biglioli, Federico, MD; Garattini, Giovanna, DDS; Battista, Valeria Marinella Augusta, MD§; Autelitano, Luca, MD

doi: 10.1097/SCS.0000000000004789
Original Articles

The aim of this paper was to assess growth, speech, and aesthetic results at the completion of growth in patients with unilateral cleft lip and palate treated with the 2 stages Milan surgical protocol.

Craniofacial growth was evaluated with cephalometric analysis and a theoretical need for orthognathic surgery.

Nasolabial appearance was qualitatively assessed using the Asher McDade Aesthetic Index.

Speech was assessed using the Gos.Sp.Ass ’98 modified for Italian language scoring system.

Burden of care was recorded in terms of number of secondary surgical procedures. All of the patients were treated and evaluated at San Paolo Hospital, Smile House, Milan.

Fifty-two consecutive patients treated by the same surgeon were recalled, 12 patients did not come for assessment.

The first surgical step (average age of 6 months) was cheilorhinoplasty (Millard modified Delaire technique) and soft palate rapair (Pigott). The second step (average age of 35 months) was hard palate and alveolar repair performed simultaneously with an early secondary gengivo alveolo plasty. Fifty-six percent of the patients did not need further surgery after the 2-stage surgery protocol.

The 2-stage surgical protocol of Milano, Smile House, seems to be effective for treatment of unilateral cleft lip and palate, with good results in terms of speech, labial appearance, and alveolar cleft management. Nevertheless, maxillary growth was moderately impaired by the protocol.

*Regional Center for Cleft Lip and Palate, Smile House-CLP Center, San Paolo University Hospital, Università degli Studi di Milano

Regional Center for Cleft Lip and Palate, Smile House-CLP Center, Department of Maxillo-Facial Surgery

Department of Orthodontics, San Paolo Hospital, University of Milan

§Maxillo-Facial Surgery Department, San Paolo University Hospital, Università degli Studi di Milano, Milan, Italy.

Address correspondence and reprint requests to Valeria Marinella Augusta Battista, MD, via De Predis 2, 20100 Milano, Italy; E-mail:

Received 14 January, 2018

Accepted 31 May, 2018

A case series of 20 patients, part of this paper, was presented during the 10th European Craniofacial Congress in Göteborg, Sweden, in 2015.

No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

The authors report no conflicts of interest.

© 2018 by Mutaz B. Habal, MD.