Ralph Millard's book Cleft Craft1 outlines the tremendous advances that have been made in the surgery of the cleft palate in recent decades. Nevertheless, the surgical technique and timing of procedures remains highly variable from institution to institution.
This reflects the absence of randomized studies to evaluate the function of the palate after repair. After palatoplasty, the ultimate outcome measure is speech. A speech evaluation is, by its nature, subjective. Therefore, making comparisons from institution to institution or even within the same institution over time are difficult. Consequently, palatoplasty remains an art. The techniques and minor modifications are passed from teacher to student and modified throughout one's career.
This article will not deal with the controversies regarding the timing of repair or staging of repair. It will focus on two types of repair that have gained popularity in the last two decades. Both the intravelar veloplasty and the double-reversing
Senders CW, Sykes JM. Advances in Palatoplasty. Arch Otolaryngol Head Neck Surg. 1993;119(4):375–377. doi:10.1001/archotol.1993.01880160019003
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