Maxillary growth of adult patients with unoperated cleft: answers to the debates.

Maxillary growth of adult patients with unoperated cleft has long been studied, but results varied between different studies. The objectives of this study were to determine the growth potential of adult patients with unoperated clefts compared to the normal population and to differentiate the growth potential among types of clefts. METHODS: Subjects were from the same ethnic group, were more than 16 years of age with non-syndromic cleft and no associated anomalies. The types of cleft included unilateral complete cleft lip and palate (UCLP), bilateral complete cleft lip and palate (BCLP), unilateral cleft lip (UCL) and isolated cleft palate (CP). The sella-nasion-A point (SNA) angle from the cephalometry was measured, and a dental cast study using a three-dimensional imaging system was performed. RESULTS: SNA measurements showed significant differences among different groups, the BCLP group having larger values and the CP group having smaller values when compared with normal values. Dental cast analysis measuring palatal surface area showed a significantly smaller area in patients with cleft as compared to normal controls, but no difference among the different types of cleft. From the linear measurement it was found that the interdental distance was significantly more narrow in the anterior part up to the first premolar region as compared to the control group, especially in the complete cleft groups (UCLP and BCLP). Dentoalveolar arch was also deeper and longer in these complete cleft groups. CONCLUSION: There is an intrinsic tissue deficiency in all groups of patients with cleft; however, the sagittal development is still comparable to that of a normal population. Tissue deficiency mostly occurs in the anterior part. There is no difference in terms of the deficiencies among the different groups of cleft.     

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate

BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.     

婴儿期单侧完全性唇腭裂术前正畸治疗的临床研究

目的探讨上颌-鼻软骨整形矫治器在婴儿期单侧完全性唇腭裂术前正畸中的应用与疗效。方法2003年1月~2004年3月,对100例出生后10 d~3个月内单侧完全性唇腭裂婴儿进行上颌-鼻软骨整形矫治器矫治。其中男60例,女40例,健康状况良好。根据矫治起始时间的不同分为观察组(10 d~1个月内)及对照组(1~3个月)各50例,对比两组婴儿正畸治疗前后上唇裂隙、上前牙槽突裂隙关闭程度及唇腭裂联合整复术后3个月鼻翼外观满意度,评价疗效。结果婴儿正畸前后上唇裂隙、上前牙槽突裂隙宽度观察组为5.0±1.6 mm、4.1±2.7 mm,6.9±2.6 mm、6.4±2.9 mm;与对照组7.5±3.1 mm、8.3±3.0 mm,12.5±4.0 mm、10.8±2.6 mm比较,差异均有统计学意义(P<0.05)。两组婴儿正畸前后上唇裂隙、上前牙槽突裂隙宽度自身比较,差异无统计学意义。两组患儿术后鼻翼外观满意度观察组86.3%与对照组62.4%比较,差异有统计学意义(P<0.05)。结论尽早对单侧完全性唇腭裂患儿实施上颌-鼻软骨整形矫治器矫治,可明显改善上颌形态及鼻畸形程度,减小牙槽突裂隙,并有效减小上唇张力,为婴儿期唇腭裂联合手术创造有利条件。     

Palatal surface area measurement: comparisons among different cleft types

The purpose of this study was to use three-dimensional imaging methods to measure the palatal surface of unrepaired cleft patients. The surface area of the palate was defined and measured on three-dimensional computed tomography images of dental plaster models in four different groups of cleft patients at 3 months of age. There were 30 unilateral complete cleft lips and palates (UCLP), 27 bilateral complete cleft lips and palates (BCLP), 23 isolated cleft palates of incomplete form (CP), and 19 unilateral cleft lips without cleft palates (UCL). These patients were nonsyndromic, unoperated, and without other major deformities. The dental casts were scanned, and the computed tomography data were transferred to an imaging laboratory for processing and reconstruction of three-dimensional images. Surface area of the palate was delineated, which was defined as within the alveolar crest and the line connecting both tuberosities. In UCLP and BCLP, the edge of cleft formed the medial boundary of the area for each palatal shelf, and the palatal surface area was the combination of both palatal shelves and the premaxillary area in BCLP group. The surface area was measured. Repeated definition and measurement tasks were performed for calculation of errors. The imaging data management and measurement were performed using the Analyze program (Biomedical Imaging Resource, Mayo Foundation, MN). In addition, linear distances were measured between the canine points on the alveolar crest (line C) and the tuberosity points (line T). The measurements were compared among the different groups. Analysis of variance and multiple comparisons were used for statistical analyses. The results showed that the mean error between repeated area definitions and measurements in this study was 1.86%. The bilateral complete cleft lip and palate (BCLP) and unilateral complete cleft lip and palate (UCLP) groups had significantly smaller palatal surface area than the unilateral cleft lip without cleft palate (UCL) and isolated cleft palate of incomplete form (CP) groups. There was no significant difference between the BCLP and UCLP groups. Line C and line T distances were significantly longer in BCLP and UCLP groups than in UCL and CP groups. The findings suggest that compared with UCL and CP patients, there is an intrinsic tissue deficiency in the palate/maxilla of BCLP and UCLP patients.     

Ambulatory surgery for cleft lip repair

Standard of care for cleft lip repair has included preadmission testing, surgical correction, and postoperative hospital care. Driven not by managed care economics but to speed the safe home care of infants by parents, the authors have gained experience in ambulatory cleft lip repair. In this retrospective study the authors evaluated the outcome of patients who underwent ambulatory cleft lip repair compared with those patients who were hospitalized after surgery. From 1989 to 1998, 24 cleft lip repairs in 24 patients performed by the senior author were evaluated. Two groups were treated. Group 1 (N = 11) consisted of ambulatory unilateral cleft lip repairs and group 2 (N = 13) consisted of inpatient unilateral cleft lip repairs. Important surgical factors considered were technique of cleft lip repair, performance of ancillary procedures, type of local anesthetic administered, and intravenous steroid administration. Time to first postoperative feeding and complications, including bleeding, spontaneous or traumatic wound dehiscence, and infection, were considered important outcome parameters. There were no differences in surgical technique or use of antibiotics and postoperative analgesics between the two groups. None of the patients in group 1 underwent ancillary procedures. Four patients underwent soft palate repair and 3 patients underwent insertion of myringotomy tubes among group 2 patients. The use of a 1:1 mixture of 1% lidocaine and 0.5% bupivacaine with epinephrine vs. 1% lidocaine with epinephrine as a local anesthetic and intravenous steroid administration was greater in group 1 (92%) than in group 2 (33%) patients. The average time to the first postoperative feeding was more than 1 hour sooner in the ambulatory group (p < 0.05) compared with the hospitalized group (excluding the 4 patients who underwent soft palate repair). There were no complications among patients with ambulatory cleft lip repair, and there were two cases of minor wound separation in patients who received postoperative hospital care. Although many variables factor into the outcome after cleft lip repair, these data support the safety and continued practice of ambulatory cleft lip repair.     

异氟醚与氯胺酮麻醉诱导对婴儿唇腭裂修复术后苏醒的比较

目的比较异氟醚与氯胺酮麻醉诱导对婴儿唇腭裂术后苏醒的影响.方法对208例1～12月婴儿全麻下行唇腭裂修复术的病例进行分析,按照不同的麻醉诱导方法分为氯胺酮组(K组)和异氟醚组(Ⅰ组),比较两组术后自主呼吸恢复时间、拔管时间、清醒时间、送入恢复室的例数、恢复室停留时间以及苏醒期躁动发生率.结果Ⅰ组自主呼吸恢复时间、拔管时间、清醒时间、送入恢复室的例数以及恢复室停留时间均少于K组,而Ⅰ组苏醒期躁动的发生率高于K组.结论和氯胺酮诱导相比,异氟醚吸入诱导用于婴儿唇腭裂修复术有利于患儿术后的快速苏醒,但同时苏醒期躁动的发生率增加.     

Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate.

OBJECTIVE: The objective of this study was to investigate the relationship between halitosis parameters in patients with and without cleft lip and/or palate. STUDY DESIGN: Forty-two subjects were examined. They were divided into group I, postgraduate students of Bauru Dental School (FOB); and group II, individuals with repaired cleft lip and/or palate. The concentration of volatile sulfur compounds (VSC) was assessed with a portable sulfide monitor and the values were correlated to the salivary flow rate and weight of tongue coating. RESULTS: There was a relationship between the presence of tongue coating and VSC levels, as well as between salivary flow rate and VSC levels in group II. The same group also revealed a significant correlation between weight of tongue coating and salivary flow rate. There were no significant differences between groups as regards the Halimeter oral measurement. CONCLUSIONS: Individuals with repaired cleft lip and/or palate can have the same VSC levels as subjects without clefts.     

Clinical and epidemiologic studies of nonsyndromic cleft lip and palate in china: analysis of 4268 cases

The aim of our study was to review clinical and epidemiologic characteristic of the nonsyndromic cleft lip and cleft palate over a period of 10 years at West China Stomatological Hospital, Sichuan University. Four thousand two hundred sixty-eight nonsyndromic cleft lip and cleft palate cases were retrospectively analyzed according to the following variables: general information, cleft type, maternal age, familial history, as well as associated malformations, et al. In these cases, 1075 of which were cleft lip, 1985 were cleft lip with cleft palate; 1208 were isolated cleft palate. There were more men than women in the cleft lip and cleft lip with cleft palate group, while there were more women than men in the isolated cleft palate group. There were significantly more unilateral cleft lip cases than cleft lip on both sides; the cases of cleft lip on the left side were more than that of cleft lip on the right side. The cases with inherited history accounted for 6.68% of all the cases. Most infection cases occurred among the deleterious factors and the complications experienced during the first 3 months after the pregnancy. In all of the 14 twin cases, only 1 of the babies was affected. There were totally 152 cases with other associated malformations. Patients with cleft lip born in November to January were less than those born in the other three quarters of the year. Patients of A blood group composed a higher proportion than the control group. Our data may provide references for appropriate resource use, cleft lip and cleft palate prevention programs, and counseling programs with China-specific data.     

心理干预对青少年唇腭裂正畸患者的影响

目的:探讨心理干预对青少年唇腭裂正畸治疗患者心理状态的影响。方法:对48例青少年唇腭裂正畸治疗患者按随机分组原则分为对照组和干预组。对照组在正畸治疗期间在常规护理下进行正畸治疗,干预组在接受常规护理与正畸治疗的同时进行心理干预。正畸治疗前后分别对两组患者进行测评,以评价心理干预对青少年唇腭裂正畸患者心理状态的影响。测量工具是症状自评量表(SCL-90)。结果:对照组和干预组患者治疗前所有指标没有明显差异。干预组治疗后SCL-90量表得分与对照组比较有明显差异(P<0.05)。结论:正畸治疗期间心理干预能在一定程度上改善青少年唇腭裂患者的心理健康水平。     

Two sisters with unoperated bilateral cleft lip and palate, age 6 and 4 years.

Two sisters with unoperated bilateral cleft lip and palate, aged 5 years 8 months and 3 years II months, are described. The degree of premaxillary protrusion in both was similar to that in unoperated infants. On the other hand, children operated in infancy showed less midfacial protrusion than the sisters following repair of their lips at a later age suggesting that the repaired lip has a long-acting effect in restricting growth of the premaxillary-vomerine complex. Later, forwards growth of the mandible and elongation of the face also serve to minimise the convexity due to the projecting premaxilla.     

Social adjustment in French adults from who had undergone standardised treatment of complete unilateral cleft lip and palate

France has a population of about 60 million peoples and each ten years data about the standard of living are collected by the central bureau of statistics, we considered the collection of data on 5000 households in 1999 in our geographical area would afford a unique opportunity to compare the equivalent status of French adults with repaired cleft of the lip and palate (CLP). Aspects of social adjustment were investigated in a sample of 82 French adults 18-35 years old with repaired complete unilateral cleft of the lip and palate (CLP). All subjects received a standardized regimen of care from the Burgundy cleft palate team of Dijon. The investigation, based on response to a questionnaire, partly replicated a national survey of social and economic life in the population (Standard of living survey Burgundy, INSEE France 1999), so that adults with complete clefts could be compared with a large control sample of the same age. The control group was constituted by subjects between 18 and 35 years in the standard of living survey Burgundy 1999, INSEE France, they were taken from a regional probability sample of households. This report covers education, employment, and marriage. The significant difference between groups was assessed by: Student's t-test or analysis of variance for continuous variables and chi2 test for categorical variables. The results demonstrated that there are significant differences in educational attainment and employment between adults with cleft of the lip and palate and other people. Fewer with cleft of the lip and palate marry, and when they marry they do so later in life, scholarship history showed significant delay in the cleft of the lip and palate group, independence regarding housing was lower in the cleft of the lip and palate group. If cleft of the lip and palate adults functioned within normal limits with regard to employment. However, levels of income were substantively lower than control groups. It would appear that cleft subjects experience some limitation in their ability to secure vocational and economic rewards from society. As a conclusion we can say regarding our results that the cleft of the lip and palate group, even with the smallest degree of malformation (unilateral without associated malformation), showed a significant delay in the independence process.     

A comparative study of maxillary growth following rotation-advancement and triangular flap unilateral cleft lip repairs: an experimental study in rabbits

The present study was designed to investigate 2 features of maxillary growth following Millard rotation-advancement and Tennison triangular flap cleft lip repairs in rabbits with surgically created defects simulating unilateral cleft lip and cleft alveolus. Sixty purebred New Zealand rabbits were used in this experiment. The animals were divided into 4 groups: 2 control groups (unoperated and unrepaired) and 2 experimental groups (lip repair with rotation-advancement and lip repair with triangular flap). Nineteen metric cranial variables were measured directly from the cleaned skulls. Direct cephalometric measurements were taken in the following dimensions: maxillary length, width and height, posterior facial width, and nasal deflection. Significant differences were noted between Millard rotation-advancement group and Tennison triangular flap group in 2 of 6 measurements of maxillary length. Analysis of variance revealed significantly statistical differences between Millard rotation-advancement group and Tennison triangular flap group in 3 of 6 measures of maxillary width. Analysis of variance revealed no significantly statistical differences between Millard rotation-advancement group and Tennison triangular flap group in maxillary height. Statistical differences were noted between Millard rotation-advancement group and Tennison triangular flap group in posterior facial width. There was no significantly statistical difference between Millard rotation-advancement group and Tennison triangular flap group for the nasal deflection measurements. The results of this study indicated that the features of maxillary growth were different between the 2 lip-repair techniques in rabbits with surgically created defects simulating unilateral cleft lip and alveolus.     

Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate

BACKGROUND: A retrospective survey of 339 infants who had undergone primary plastic surgery for cleft lip and palate was performed to evaluate the concomitant preoperative assessment based on severity grading of the common cold and the correlation of cleft type with the incidence of perioperative respiratory complications. METHODS: We assessed the severity of common cold symptoms in the preoperative period using the Common Cold Score, which comprises 10 symptoms and findings. We then determined the association of the incidence of perioperative respiratory complications with the increasing severity of common cold symptoms and also compared the complication incidence in the three cleft types in healthy infants without a common cold. RESULTS: The incidence of perioperative respiratory complications was greater in the group with a suspected presence of a common cold. Infants with severer cleft, who had bilateral cleft lip and palate, even without common cold symptoms, had a significantly higher incidence of perioperative respiratory complications (8.9%) than infants with simple cleft lip (1.7%, P < 0.05). CONCLUSIONS: Clinicians should consider postponing primary plastic surgery for cleft lip and palate in infants with a suspected presence of a common cold. Our results also suggest that the presence of a wide cleft is a risk factor for causing perioperative respiratory complications in infants with cleft lip and palate. We believe that a careful preoperative assessment of common cold symptoms in these infants can decrease the incidence of perioperative respiratory complications.     

Cleft lip and palate patients prior to delayed closure of the hard palate: evaluation of maxillary morphology and the effect of early stimulation on pre-school speech

Speech and maxillary development were analysed in two groups of patients with unilateral cleft lip and palate; both groups had early jaw orthopaedic treatment and a surgical regimen that included two-stage lip surgery (mean ages of 2 and 19 months) and soft palate repair (8 months). Closure of the hard palate was postponed until the children were 8 to 10 years of age. The first group comprised 10 consecutive patients who were analysed at 5 and 7 years of age, and the second group seven patients who were studied at the age of 5. Both groups were thus investigated before the repair of the cleft in the hard palate. In addition to surgical and jaw orthopaedic treatment, the second group of patients received early stimulation of lip and tongue tip movements. Our results indicated that hypernasality was less a problem than was retracted palatal or velar articulation of dental consonants. These deviations tended to be reduced, however, after early stimulation. There seemed to be no clear association between the size of the residual cleft in the hard palate and the extent of speech development. The average size of the residual cleft in our patients was comparatively small, and decreased further during follow up. We conclude that preschool children with unilateral cleft lip and palate may develop good speech, in spite of the residual cleft, if they use an intraoral plate and are given extra lip and tongue tip stimulation, together with early speech therapy if necessary.     

Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip).

OBJECTIVE: The objective of this study was to examine nasal airflow and olfactory functions in patients with repaired cleft palate compared with matching normal controls. STUDY DESIGN: The all-cleft group consisted of 25 patients with hard palate cleft comprising 15 patients with unilateral cleft palate and lip (UCLP); 2 with CP but no cleft lip (UCLP subgroup) and 8 patients with bilateral cleft lip and palate (BCLP subgroup). All had had surgical correction of the palate in infancy. The control group consisted of 20 nonaffected orthodontic patients. The median age of both groups was 14 years. The tests included the following: (1) nasal airflow measured by anterior rhinomanometry, (2) smell threshold for isoamyl-acetate determined using a 3-way forced choice method, (3) a self-administered questionnaire regarding the subjective perception of smell sense function, and (4) orthonasal and retronasal smell identification (correct/incorrect) and hedonics using visual analog scale (VAS). RESULTS: The respective test results follow. (1) When compared with the control group, the total airflow in the UCLP subgroup was significantly lower especially on the affected side; while in the BCLP subgroup it was lower than in the control group bilaterally. No significant difference was found between the cleft side of UCLP and BCLP subgroups. (2) The smell threshold of the UCLP subgroup was significantly higher than that of the control group and BCLP subgroup. No significant differences were found between right and left nostrils within the BCLP patients and between them and the control group. (3) No difference was found between the groups regarding the subjective perception of smell. (4) No significant differences were found between the UCLP and BCLP subgroups and between the all-cleft group and the control group, except for one item, regarding orthonasal and retronasal smell identification and hedonics. CONCLUSION: Although nasal airflow is significantly lower and the smell threshold higher on the cleft side, the day-to-day function of the sense of smell of cleft patients is similar to that of normal controls.     

双侧唇腭裂婴幼儿正畸与外科治疗新技术——术前鼻-牙槽骨塑形和早期同期唇-鼻-牙槽整复术

目的：探索双侧唇腭裂婴幼儿术前鼻-牙槽骨塑形及同期唇-鼻-牙槽整复术的时机、方法、特点,并进行其疗效的初步观察。方法：对21例双侧唇腭裂婴幼儿进行了术前鼻-牙槽骨塑形和同期唇-鼻-牙槽整复术。术前鼻-牙槽骨塑形主要包括前颌后退、牙槽骨间隙的关闭、唇的牵张及鼻的矫形;同期唇-鼻-牙槽整复术包括牙龈-牙周膜-牙槽骨整形术及改良长庚式双侧唇裂唇鼻同期整复术。结果：21例行术前鼻-牙槽骨塑形的患者前唇后退充分;唇裂隙宽度变窄,裂隙两侧唇组织适度牵张;鼻小柱延长及鼻塌陷畸形明显改善;牙槽裂隙变窄为1～2mm。19例术后患者经1～5年随访,结果表明：唇鼻形态良好;前庭沟连续;口-鼻腔瘘封闭;16例上牙槽连续、稳定,但部分病例牙槽高度、宽度稍嫌不足,其中13例患者在原牙槽裂隙处长出乳齿。结论：双侧唇裂患者为了获得理想的唇鼻形态及完整稳定的牙槽骨,术前进行正畸鼻-牙槽突塑形和早期同期唇-鼻-牙槽整复术是一种实用、无创、安全、可行、经济、值得借鉴的序列治疗方法。     

先天性唇、腭裂对患儿呼吸系统顺应性的影响

目的 探讨先天性辰、腭裂对患儿呼吸系统顺应性（ＣＴ）的影响。方法 唇裂或腭裂病儿２４０例（观察组）,非唇腭裂病儿６０例（对照组）均为择期手术患,按年龄段：１～１２月、１～３岁、４～７岁、８～１２岁,各分为５个亚组。全麻诱导气管内插管后,行机械通气,保持ＰＥＴＣＯ２４～４．６ｋＰａ,用Ｄａｔｅｘ Ｕｌｔｉｍａ监测仪测定ＣＴ。结果 与非唇裂同一年龄组ＣＴ值相比,唇裂各年龄组、腭裂１～１２月及１～３岁组     

腭骨外侧缝牵张成骨关闭硬腭裂的长期效果和对颌面发育 …

目的 了解腭骨外侧缝牵张的长期效果和对颌面发育的影响。方法 采用头颅测量方法对经过腭骨外侧缝牵张的６只和正常对照８只Ｂｅａｇｌｅ犬进行观察和分析。结果 所有实验组犬两侧腭骨水平板均在中线形成骨性愈合。两组动物面长度和高度变量无明显差异，实验组面宽度，腭骨水平板宽度和垂反间距均小于对照组，差异具有显著性意义。结论 采用腭骨外侧缝牵张成骨的方法，能够使缺裂的腭骨板形成永久而完善的骨性修复；对在长度和高     

Malnutrition in cleft lip and palate children in Uganda

The objective of this study is to investigate the nutritional status of patients with cleft lip and/or palate when compared to non-cleft lip or palate patients. A retrospective analysis was carried out of all patients aged less than 1 year who were operated on in the Comprehensive Rehabilitation Services in Uganda hospital since opening in April 2009 to November 2010. The data was divided into three groups: cleft lip patients; cleft lip and palate patients and non-cleft patients. The WHO anthropometric calculator was used to calculate weight-for-age Z scores on each patient for the initial outpatient appointment and the operation. The demographic data and Z scores were compared using independent T tests. Three hundred and twenty-one patients were identified, 131 patients had cleft lip alone, 112 patients had cleft lip and palate and 78 patients had no cleft. The cleft lip and palate group had significantly lower Z scores for both the outpatient appointment and operation (i.e. were more malnourished) than either the cleft lip group or the non-cleft group. Malnutrition is a well-documented problem associated with cleft lip and palate. Our research confirms this malnutrition but also highlights the severity of the malnutrition. The patients with cleft lip and palate are unable to feed adequately and therefore need intervention. We operate on these patients once they reach a target weight of 3 kg and repair both lip and palate in one operation to enable patients to feed and improve their nutritional status.     

Facial morphology and occlusion at the stage of early mixed dentition in cleft lip and palate patients treated with delayed closure of the hard palate

Cephalometric radiographs and dental study casts were analyzed in a group of 23 seven-year-old cleft lip and palate patients, 16 with unilateral and 7 with bilateral cleft. The patients' primary surgical procedures had been completed except for closure of the cleft in the hard palate. For comparison, similar records from another group of patients, 18 with unilateral and 8 with bilateral cleft lip and palate, were studied. In these cases the cleft of the hard palate had been repaired in infancy, using a vomer flap procedure. The results indicated that midfacial growth and dental occlusion of the unilateral cleft sample was significantly better in patients whose closure of the hard palatal cleft had been delayed to the stage of mixed dentition than where repair had been performed with a vomer flap in infancy. No differences were found, however, between similar subgroups with bilateral cleft lip and palate.