The Ideal Cleft Lip and Palate Treatment Protocol – A World Of Diversity

The treatment for cleft lip and palate (CLP) requires a multidisciplinary team approach with multiple interventions going from birth to adulthood. With several milestones of cleft care, there are multiple surgical and therapeutic options all with advantages and disadvantages. The timing, methods, and stages of surgical interventions as well as non-surgical treatments remain controversial in terms of the ideal treatment outcome.

In order to better appreciate the potential effects surgical and therapeutic interventions have on facial development, a chronological, stepwise review of the different treatments for CLP repair is needed: What is the importance of Nasoalveolar Molding treatment in the pre-surgical phase? When to use gingivoperioplasy? Should a primary septoplasty be done together with primary lip repair? What is the best line of treatment for a child older than one year? When should we do secondary alveolar bone grafting? What is the best way to treat the midface deficiency (Orthognathic surgery/ distraction)? How should we treat palatal fistulas? When and how to treat secondary deformations of the cleft lip and palate (Redo lip/palate)? How to address rhinoplasty for the cleft patient?

All are questions to be answered when treating a cleft child, with many ways to address each part of the treatment. The review is done, with the purpose to provide a better appreciation and evaluation when formulating a treatment plan.