University dissertation from Dept of Clinical Sciences in Malmö, Lund University

Abstract: Cleft lip and palate (CLP), the most common of all craniofacial anomalies, has an incidence about 2 per 1000 births in the Scandinavian countries. The Department of Plastic and Reconstructive Surgery in Malmö has been a regional centre in southern Sweden for the treatment of patients with CLP since 1954 with about 40 new cases of clefts each year. Speech and facial growth are important objectives in the treatment for CLP and these are thought to depend on the primary surgery during infancy. Between 1954 and 1976 we operated on the lip using Millard´s technique and the palate was repaired early according to von Langenbeck’s technique (L-group). From 1976 to 1996, the lip was repaired by a two-stage procedure – the Johansson-Randall concept. Palate repair was postponed to about 18 months of age and performed using Wardill’s technique (W-group). Hence, there was a unique opportunity to study two long periods during which different strategies of primary repair were used according to standardized protocols. Altogether 97 adult patients were investigated for this long term follow-up. The first two studies describe the outcome in patients with unilateral CLP (UCLP) regarding speech (I) and facial growth (II). Only slight speech quality differences were observed between the two groups. The findings possibly favour the L-groups, though at the expense of an increased need for a complementary speech improving operation. The L- and W-groups showed similar results regarding facial growth. Studies III and IV describe similarly the long-term outcome in patients with bilateral CLP (BCLP), respectively. Also in patients with BCLP, only minor differences were noted between groups L and W. However, as in UCLP, the outcome regarding speech possibly favoured the L-group. Concerning facial growth, the results were again compatible. UCLP is generally associated with the better results regarding speech and facial growth, in the long-term perspective. BCLP is associated with the more marked deviation of facial morphology, and the rate of complementary operations, including those intended to improve speech, is more frequent.

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