Maxillary growth controversies after two-stage palatal repair with delayed hard palate closure in unilateral cleft lip and palate patients: perspectives from literature and personal experience.

OBJECTIVE: To analyze published papers dealing with delayed hard palate repair within a two-stage palatal surgery protocol in treatment of cleft lip and palate. Timing of the procedures, methods used, as well as growth results were considered.
METHOD: By utilizing this information in relation to knowledge about normal maxillary development, efforts were made to explain differences in growth outcome between different investigations. Particularly, follow-up reports of unilateral cleft lip and palate patients with records up to at least 10 years of age were studied.
RESULTS: Most papers reported an excellent or very good maxillary growth outcome after their delayed hard palate closure protocols. Where unsatisfactory results were published, reasonable explanations were found accounting for why the method had failed the expectation of good maxillary growth.
CONCLUSION: Based on the published reports and the experience from a cleft team where the studied protocol has been practiced since 1975, recommendation for method as well as timing for the two-stage protocol is laid out in some detail.