Cleft Lip and Palate in Norway: III. Surgical Treatment of CLP Patients in Oslo 1954-75

Abstract

During a period of 22 years, from 1954-75, 1555 patients with cleft lip and/or palate were admitted to the Department of Plastic Surgery, Rikshospitalet, Oslo. The surgical methods used for the primary repair and for secondary corrections in these patients are reviewed, and advantages and shortcomings of various operations are commented upon. During this period, certain alterations have been made in the surgical methods used and in the timing of the operations, but no major changes have been made in the total treatment program. The experience gained from this large patient material has given ample evidence of the value of team work, experience and continuity in the treatment of cleft patients. Careful planning and timing of the operations, conservative and atraumatic primary surgery, and good cooperation with the patients and their families are important factors contributing to a good final result. Based on this experience a comprehensive plan for the surgical treatment of CLP patients is outlined: Unilateral clefts of the lip are closed at the age of 3 months by a Millard's technique. Bilateral complete clefts are closed in two stages with an interval of 4-6 weeks between the operations. The anterior part of the palate is closed simultaneously with the lip by means of a single layer vomer plasty. Clefts of the secondary palate are closed at the age of 15-18 months with a von Langen-beck procedure and reconstruction of the levator muscle sling. The patients are reviewed at the age of 3-4 years when plans are made for further treatment. Functional and cosmetic imperfections are corrected as far as possible before school age. Most patients with bilateral clefts require a lengthening of the columella and a reconstruction of the labial sulcus. Cleft palate patients with persistent velopharyngeal incompetence are treated with a superiorly based pharyngeal flap. When necessary, a final nose correction is done in the teen age period. Experience over the last 3 year with secondary bone grafting to the bony cleft of the primary palate has been so promising that this operation is now offered to the patients as a standard procedure. A detailed report on this subject is being prepared.