Mid-facial contour in patients with cleft lip and cleft palate.

T HE PEDIATRICIANwith the responsibility for directing the care of a child with a cleft lip and cleft palate is confronted by conflicting points of view in the literature, especially in regard to the effects of palatal surgery on facial growth and contour. For many years the majority of plastic surgeons have recommended repair of the cleft lip in the first few months of life for both func tional and cosmetic reasons. The repair of the palate is usually carried out during the latter part of the second year of life to obtain optimal speech and to prevent reflux of food into the nasal fossae and internal auditory meati. In recent years a sharp attack has been made on the results of cleft palate surgery in regard to the ensuing high incidence of facial disfigurement. These criticisms arise, for the most part, from a group in the Chi cago area trained in cephalometric tech niques.1-― Their work has been character ized by the presentation of studies of pa tients with cleft palate exhibiting postopera tive deformities and whose facial and den tal defects they attributed to “¿ early and traumatic― surgery of the palate. This dis figurement is said to result either directly from operative interference with the maxil lary growth centers, or indirectly from post operative cicatricial contracture.1' Examples of this point of view are seen in the follow ing quotations from Craber: