Paediatric Facial Cleft Treatment - Lessons Learned

Abstract

The title of this publication includes the words “Lessons Learned” in order to emphasise the knowledge and experience gained in more than 4 decades in treating 5000+ patients with facial-oral cleft anomalies. The choice, timing and optimization of the most appropriate paediatric surgical and paediatric orthodontic treatments are reflected in the extremely satisfactory treatment outcomes. This paper delineates hierarchically the conceptual framework of treatment for the most profound to the least severe cleft anomaly. Over the years multiple treatment techniques, options and protocols have been published internationally and yet the young professionals often use the procedures and timing of interventions they have learned from their ‘masters’ or seniors, irrespective of whether these have been chosen based on the best long-term treatment outcomes. This paper advocates specific treatment protocols and techniques, based on the results of research, on observation, clinical evaluation, judgement of outcome and the ideal treatment of a specific type of cleft anomaly, in order to optimize long-term outcomes. The initial short-term result, as well as the long-term facial growth, functional and aesthetic influence or their combined influence, have been recorded until the onset of the adolescence age. The application of technique(s) appropriate for treatment of a particular type of cleft anomaly are described and motivated for use, without mention the so-called original or first person who applied or described or used a particular technique or procedure for the first time. Conversely, those treatment technique(s) utilized during the very important developmental phases of the neonate, the infant and the child and which have had a profoundly negative effect on function and/or facial growth and/or facial aesthetic in the long-term, are also described, without mention the name of the person(s) who advocated their use. Paediatric patients who have been treated by means of these latter surgical techniques or interventions which may lead to undesirable or insufficiently positive outcomes, may require extensive drawn-out surgical restructuring and orthodontic treatment during their adolescent’s years.