long term results: do and don’t in cleft comprehensive care
Treating cleft lip an palate patients is always a real challenge because of the great anatomic variability of the defects, the great number of technique proposed and the timing of the different protocols.
The priority is always to avoid complications.
Complications can be infective, related to mistakes of treatment choice, related to mistakes in the technique execution and related to the planning and timing the multidisciplinary treatments.
In our experience, to achieve excellent long term results in treating cleft patient the surgical protocol must be divided in three steps:
• primary surgery to close the lip, the alveolus, and the palate.
• secondary surgery for bone grafting to allow the canine eruption (if necessary) or interceptive (to correct any primary sequels).
• tertiary surgery at the end of growth.
Never forget to repair gingivo-alveolar structures at time of lip closure; alveolar and sulcus surgery must always be performed simultaneously with lip surgery to avoid anterior fistulas.
Moreover, it’s important always understand the causes of the possible fails: this allow to avoid surgical technique with major risk of relapse or complications. That’s why we agree with Millard’s philosophy that said: “never make the same mistake twice and when in doubt , don’t “.