[Summary] (New trends in the complex treatment in the Cleft Centre in Bratislava. Kokavec R, Hedera J, Fedeles J, Janovic J, Kratka E, Klimova. Bratisl Lek Listy 2001; 102 (6): 290-293. Complete text: http://www.bmj.sk/VL102-06.htm (verified 22 March 2007))
Practice at the National Cleft Centre, Bratislava:
Surgeons at the National Cleft Centre, Bratislava, prefer a 2-stage closure of the cleft lip and palate. The first stage (3–6 months) involves lip closure, while the second stage (after 6 months) involves palate closure. About 46.4% of all cases of clefts of the primary palate require a bone graft to fill the gap in the dentoalveolar arch, timed with eruption of the definitive canine.
Secondary corrections analysis indicated: lip correction in 18.2% of patients, corrective rhinoplasty in 22.3%, septorhinoplasty in 9%, pharyngeal flap in 10.1%, and vestibulonasal/oronasal communications in 23.2% of patients. Average age for bone grafting was 14 years. Intensive therapy for speech and hearing is prioritized between ages 3–6 to maximize articulation development.
Claims in Relation to Worldwide Treatment and Trends:
Numerous concepts exist for comprehensive treatment of cleft anomalies, making comparisons difficult. Globally, care is increasingly concentrated in cleft centers with interdisciplinary teams including plastic surgery, anesthesiology, maxillofacial surgery, orthodontics, speech therapy, pediatrics, genetics, and teratology.
Primary cleft operations are increasingly performed as early as possible after birth, ideally before age 1. There is also a trend toward one-stage closure of the cleft lip and palate. Advantages include fewer anesthesias and hospitalizations, reduced stress for children and parents, lower costs, and improved outcomes for speech, hearing, and maxillary development.