Introduction

Cleft lip and palate is a complex congenital anomaly affecting the development of the face, oro-pharynx and nose, resulting in a disturbance of appearance and function. Often multiple treatment outcomes need to be considered for an individual patient due to the wide range of severity of clefts and the nature of the special structures involved. In general, long-term outcomes from cleft lip and palate surgery include an assessment of facial appearance, speech, facial growth, dental development, hearing and psychological well-being. Consequently, final outcomes may need to be assessed many years after the original surgery, usually during early adult life.

It is well recognized that different surgical protocols for primary cleft repair can have a major influence on long-term outcomes. Protocols may differ with regard to technique used, timing of surgery, the sequence of repair, or the possible use of presurgical orthopedic alignment of the maxillary segments. Whilst the severity of the cleft and the effectiveness of the surgery undoubtedly have a major influence on outcomes, other important factors may complicate the picture further, such as general developmental variations, syndromal associations, and socio-economic factors. Non-surgical interventions such as speech and language therapy, orthodontics and audiologic input also influence the final “surgical” outcomes. The technical skill of the surgeon is a further compounding influence – a skilled surgeon can partially compensate for a mediocre technique of repair achieving good results, whereas a poor surgeon may produce unacceptable results despite the application of an otherwise sound reconstructive technique.