Management of Cleft Deformities

Comprehensive care of the child with a congenital cleft malformation is a complex process that requires a multidisciplinary, team approach. Successful treatment requires a dedicated effort, including lifelong evaluation and treatment of dental, psychological, speech, otologic, and aesthetic needs of the cleft patient.

The ultimate goal of the cleft surgeon is to maximize the form and function of the child with a cleft deformity. Achievement of this goal is more art than science. Careful analysis of surgical outcomes of cleft surgery requires lifelong study. Criteria for success include three-dimensional final facial growth and appearance, normal speech development, and functional dental occlusion. Developing a successful treatment philosophy for the large range of cleft deformities involves many years of experience with careful evaluation of results.

This issue of Facial Plastic Surgery focuses on many contemporary aspects of the cleft team and the importance of a comprehensive approach to cleft care. Other articles on improving techniques on unilateral and bilateral cleft lip repair and on the diagnosis and treatment of velopharyngeal dysfunction are contained. Last, the importance of newer surgical techniques to improve skeletal proportion and balance is stressed. These include articles on nasoalveolar molding and craniofacial distractions osteogenesis.

The need to critically evaluate results of operative techniques requires years to follow the growth of the cleft patient. During this period, each cleft surgeon will likely change surgical techniques many times. This fact both stimulates and haunts every cleft surgeon. This volume on the evaluation and treatment of cleft deformities is designed to aid the cleft surgeon in the pursuit of the unattainable goal of perfection.