I am often asked about staged palate repairs and why they are not part of our team’s treatment plan. Staged palate repairs were implemented in an effort to reduce stunting the growth of the upper jaw and to eliminate the need to have the jaw surgically advanced later in life. The hope was a staged repair would also allow normal speech to develop.
We know from several studies that the growth of the upper jaw can be stunted by operating too early on the hard palate. We also know that waiting too long to fix the palate can inhibit normal speech development. The thought of fixing the soft palate early (the speech part of the palate) and delaying the repair of the hard palate (the growth part of the upper jaw) by anchoring a piece of plastic over the cleft was an experiment to see if the number of kids needing upper jaw surgery could be reduced. This sounds like a great idea, and has been tried by many doctors in the past; however, there has not been any reproducible evidence to show that it is effective. As a result, most centers around the country have abandoned the practice of staged palate repairs.
An additional reason staged palate repairs are not recommended is because of the many problems that arise when this method is employed. A few of note are:
- Staged repairs increase the number of surgeries a child has to undergo which also increases stress, trauma, and unnecessary medical bills for patients and their families.
- Speech problems can also develop because the child’s tongue interacts with plastic instead of normal tissue.
- Complications can arise when the plastic coverings come loose or fall out.
For the reasons mentioned above, the physicians at the Cleft and Craniofacial Institute of Utah strongly believe the best strategy for cleft palate repair is to fix the entire palate between 9-12 months of age. This is the method and the timeline practiced by the majority of centers in the United States and the developed world. It is the preferred method because it produces the best results for patients. Substantial studies prove closure of the entire palate between the ages of 9-12 months is the best window to develop normal speech and limit the need for upper jaw surgery later in life.
–Devan Griner, MD