The case of early bone grafting in cleft lip and cleft palate.

To date there are conflicting reports in the literature as to the efficacy of early maxillary orthopedic procedures and primary osteoplasty in newborns with complete clefts of the lip, alveolus, and palate. Ross accounts for the disagreement by stating that the critical variable may be the surgical procedure utilized in closing the palate, not necessarily the placement of the graft. Friede has also postulated that perhaps it is principally a difference in the graft techniques. Cephalometric evaluation of our sample at 13 years 11 months of age compared with a like sample wherein the primary osteoplasty had not been done showed the two samples to be clinically the same. We feel that in utilizing our sequence of procedures and carefully monitoring facial growth of these children we do not adversely influence facial growth and, in fact, present a more favorable maxillary segment alignment and teeth in better overall occlusion than if we had not done these procedures. From our results, we conclude that there should be no condemnation of the principle of this treatment because of individual failings and failures. Although differences in techniques can and do influence results, the concept of maxillary orthopedics and primary osteoplasty need not be thrust aside even if some techniques are found wanting.