14

LATER

EARLY

SOFT

AATE AND
CLOSURE

ARD

AATE

AND

LZJP

ADHESION

IF

WAS INEVITABLE
WIRES

THAT

THOSE

SEEING TOO

THE

LONGTERM
AND TOO
AGAINST

RESULTS

OF

CONSTRICTING

AND SURGERY

RADICAL

EARLY

WOULD

NOTE THE

DAMAGE BEING

DONE AND SPEAK OUT

IT

SLAUGHTER PRUZANSKY
THIS
OF
LOT

AND BRODIE
TO

THEN
BIODIE OF

FINALL

FELL

WAYNE
CHIEF

13

SLAUGHTCR AND ALLAN SURGEON

LJNIVERSITN TO

CHICAGO SLAUGHTER
IVIEDICAL

PLASTIC

THE

LJNIVERSIT

XISCONSIN HICAGO

SCHOOL TON OLA

SULGERN

MEDICAL
NOT

SCHOOL AND

OLLEGE OF DENTAL

INHERITED

ONLN

BROPHYS
NF
FOR

INSTRUMENTS AND RECORDS BUT HIS ACTUAL CASES

THE

BRODIE

CHAIRM
AND

DEPARTMENT OF ORTHODONTIA
YEARS DEAN
IN

UNIVERSITY

OF ILLINOIS

OVER 10
SCIENCE

OF THE COLLEGE OF DENTISTRY

COMBINED
CLINICAL

BASIC

ANATOMY PHYSIOLOGY AND GROWTH WITH

TEACHING REFLECTED THESE INTEIESTS

PRACTICE

HIS

RESEARCH AND NATIONAL

BRINGING

HIM
TO

MANY
RCFLECT

AND INTERNATIONAL
SUCCESSFULLY
IN

HONORS HE
IN
HIS

ALSO

TOOK TIME
AT

MOST

AUGUST

CABIN CASTING

BCAR LAKE
RUYAL

MICHIGAN

WHERE HE WADED TROUT STTEAMS

STYLE

CUACH

MAN WESTERN
THESE

WHILE

HUMMING

POMP AND
JOINED THE OPPOSITE

CIRCUMSTANCE
TOGETHER DIRECTION ASSOCIATION

TV

THEN SLAUGHTER AND BRODIE

IN

AND WITH OF OF

STARTED THE
THEIR PLASLIC

PENDULUM SWINGING
PRESEN IATLON
IN SCT

1948

BOSTON TO THE
THE STAGC

MERICAN
ATTACK

SURGEONS THEY

FOR THCIT

RC

ICU

1AN

THE

NORMAL THEY NOTED

ALL

THAT

IN

THE
ALL

FACE THERE

IS

GENERALIZED

GROWTH ON ALMOST
YEAR
ACTIVE
AFTER SITES

SURFACES OF SURFACE

BONES UNTIL

ABOUT THE

FIFTH

WHICH

THE

GROWTH TENDS

TO DISAPPEAR

CERTAIN

OF GROWTH REMAIN AND CONTINUE TO GROW AT

THE COMPLETION

HIGH RATE STUD

ALMOST UNTIL
IES

OF GROWTH THEIR

LONGITUDINAL

OF CHILDREN

WITH CLEFTING DEFECTS REVEALED THE SAME PATTERN AND

THAT CLEFTS REPRESENTED

THEY

HYPOTHESIZED

TEMPORARY ABERRATION DURING

EARLY

OF GROWTH PROBABLY OF SHORT DURATION

LIFE

INTRAUTERINE

ONCE

RECOVERY

OCCURRED HOWEVER THE VARIOUS AND

RATES

PARTS PURSUED ORIGINAL

SPECIFIC

NOW

RELATIVELY

NORMAL PATHS BUT

IT

OF GROWTH THE
UNLESS

DISTORTION

REMAINED

BECAME NO WORSE
HAD BEEN

GROWTH OR ADJUSTMENT

SITE

PERMANENTLY

AFFECTED AGAINST THE

THE

TUBEROSITY

OF THE MAXILLA
FIXED

GROWING BACKWARD
IS

PTERYGOID PROCESS FORWARD DEVELOPMENT

BASE

THE

AGENT RESPONSIBLE
FACE

FOR THE

OF THE

MIDDLE
AT

AN

EQUAL

AMOUNT OF
IT

GROWTH OCCURS
TO

IN

THE PALATE

THE

TRANSVERSE SUTURE
IN

OCCURRED AND
IF
IT

SLAUGHTER AND
BY

BRODIE
IN

THAT

REDUCTION

BLOOD

SUPPLY

CONSTRICTION

SCARS

THESE

AREAS
TO

MAY
SOFT

JEOPARDIZE
TISSUE

GROWTH

DOES WITH

THEN BLOOD

UNWARRANTED TRAUMA
SUPPLY

AND AND
TO

INTERFERENCE STRIPPING

AND

FRACTURING

OF

BONE

OF

MUCOPERIOSTEUM MAY
FOR FI
CLEFTS AXIAL

CAUSE

PERMANENT DAMAGE
THIS

GROWTH SITES

YEARS SLAUGHTER

OPERATED WITH

IDEA

IN

MIND ON XRAYS

3I
THE

MEASUIEMENTS WERE TAKEN WITH CEPHALOMETRIC

RAY

PASSING

THROUGH THE EXTERNAL

AUDITORN

MEATUSES

HEAD

PLATES PLANE

PLASTER

MOLDS AND PHOTOGRAPHS THE

TO RELATE

FRANKLORT

HORI7ONTAL

WA

USED
THEIR

CRANIAL ARE

AND

FACIAL

STRUCTUIES

THREE
OLD 19

EXAMPLES MALE

OF

TRACINGS

SHOWN
WHOSE
CLEFT LIP

NORMAL

12YEAR
AT

19YEAROLD MALE
PALATE
AT

WAS CLOSED

MONTHS AND
UNILATERAL
FIRST

12

YEARS
RECEIVED

23YEAROLD FEMALE WHOSE

SURGERY

LIP

AND PALATE

CLEFT

ONCE

YEAR FOR HER

14

YEARS ATRAUMARIC
BILATERAL

SIMPLE

SURGERY DEFECT

WAS
IN

ADVISED

WITH CLOSURE OF THE

LIP

PORTION OF
USED
FOR

TWO

STAGES
CLEFT

AN OBTURATOR BEING

THE

ALVEOLAR

AND
THEIR

HARD PALATE STAND

THEY SUMMARIZED

SURGERY CAN AND DOES INHIBIT

PIRRS UNLESS

NORMAL GROWTH

ONGENITALLN

DEFOIMED
SU

PERMANENTLY

DAMAGED GROW AT NORMAL

RATES THUS

GERY POOILV

EXECUTED OR POORH TIMED CAN DO MORE LAMAGE THAN GOOD IN THE

LONG

232

FIVE

YEARS LATER

SLAUGHTER WAS JOINED

RESEARCH FELLOW

BY SAMUEL PRUZANSKY
THE

ORTHODONTIST

AND

FROM

NATIONAL

INSTITUTES

OF HEALTH THEY PRESENTED

AS THE
FIRST

THE RATIONALE

FOR CLOSURE

OF THE VELUM

PALATE

THE MEETING SURGERY AT

OF THE AMERICAN SOCIETY

HELD
AT

OF PLASTIC

AND

RECONSTRUCTIVE

SURGEONS

CORONADO

IN

1953

KIRKHAM

WARDILL
THAT

AND
LATERAL

PSAUM HAD ALREADY SHOWN

DIMENSIONS OF THE
THE

BY HAMULAR
ARE

MEASUREMENTS
GREATER IN
CLEFT

NASOPHARYNX

PALATE

INDIVIDUALS

THAN IN

NORMAL SUBTELNY LAMINOGRA

BUT ACTUAL

HAD STUDIED

PTERYGOID

PLATES BY FRONTAL CEPHALOMETRIC

REVEALED NOT ONLY PHY WHICH DISTORTION IN CLEFT

BREAK IN

THE STRUCTURES

WITHOUT

THE

MUSCLE BAND OF RESTRAINT

THE

TONGUE

PUSHES THE MAXILLARY

DENTAL ARCH

ELEMENTS OUT OF MANDIBULAR

PROCESSES ARE NORMALLY

ALIGNMENT THE MOLDED AROUND

LIP

AND ALVEOLAR

THE TONGUE BY THE ACTION

OF THE BUCCINATOR AND

MUSCLES

THE

SAME
TENSION

DISTORTION

IS

BEING

PROMOTED BY
TENSORS

THE

LATERAL

UNOPPOSED
PALATAL

OF THE
IF

LEVATORS

AND
LIP

PULLING

ON
THE

THE

ELE ARCH

MENTS

CLOSURE

OF THE

MUSCLE

MOLDS

ANTERIOR

THOUGHT SLAUGHTER
THE

AND PRUZANSKY
SINGLE
ACT

WHY

NOT CLOSE THE MUSCLES OF

THE

VELUM

THIS

WOULD MOLD
ENI

MAXILLA
INTO

REDUCE AND

UNOPPOSED MUSCLE ACTION

ACTUALLY

PI

TONGUE THEN

ENTRY

THE CLEFT

DIMINISH

THE

CLEFT

ITSELF

PROPOSED MEIELY

TO PARE

EDGES AND APPROXIMATE NORMAL PHX SIOLOGY

IN
SERIES

MESODERM

ACROSS THE CLEFT TO PRESENT

MORE

FOR GROW TH AND

DEVELOPMENT
IN

OF 200

SIMPLE VELAR CLOSURES THE OUTCOMES VARIED

CLEFT

ONE

COMPLETE

UNILATERAL
CLEFT

THE

LIP

WAS CLOSED

AT

WEEKS
PROCESSES

NARROWING THE

WITH SOME OVERLAP

TO STRAIGHTEN

OF THE ALVEOLAR

THE SEPTUM TENDED

OTHER AND

AND
11

VELAR ELEMENTS NEARED THE PALATAL PARTS

EACH COULD

BECAME

LARGER

AT AGE

MONTHS

BE APPROXIMATED

AND

DECREASE IN

THE HARD PALATE THE MAXILLARY

CLEFT

RESULTED

THE
CLEFT

ALVEOLAR
SIDE

OVERLAP

IMPROVED
IN

AS

SEGMENT
FACIAL

ON

THE

INCREASED IN

ANTEROPOSTERIOR THERE WAS NOSE WITH

IS

LENGTH

GROWTH
FORWARD

CONTINUED MIGRATION
TION

NORMAL FASHION
FLOOR

DOWNWARD AND
UPRIGHTING

OF THE

OF THE

AND ELONGA WERE AGAINST

OF THE NASAL SEPTUM

OF THE IN

THIS
IN

ONE REASON THEY

USE OF PORTIONS

SEPTUM

PALATE

CLOSURE

RANDOM STUDY

OF OTHER

CASES

THE SERIES

OF 200

SHOWED ONE

CASE WITH REDUCTION

233

OF THE
PALATE

WIDTH
PARTS TO

OF THE

CLEFT

AND

INCREASE

IN

THE
AT

BULK

OF THE

SOFT

MAKE

VELAR CLOSURE POSSIBLE

22

MONTHS
NOT UNTIL

ANOTHER YEARS
START

WAS NOT READY UNTIL

YEARS OF AGE AND ANOTHER

THUS
CLEFT

DID

SLAUGHTER WITH BRODIE

AND
IN

LATER

PRUZANSKY

THE

SURGICAL

PENDULUM SWINGING
THE FACE OF

THE

CONSERVATIVE

DIRECTION OF

SLAUGHTER

HAVING

FIGHTER INTO VALLEY

HIS

AND QUALITIES
SPORTS

CHAM

PION

PROMPTED ME
HELD
AT

TO INQUIRE

ACHIEVEMENTS

FOUND HE HAD
IN

THE MISSOURI

CROSSCOUNTRY RECORD

AND

1931

WHILE
RELAY

NEBRASKA HAD BEEN

MEMBER OF
TO

WORLD RECORD

HALFMILE

TEAM

HE

HAD ANOTHER CLAIM

FAME WHICH NO
IS

DOUBT HAD BEEN BY

SOURCE OF

AMUSEMENT
OTHERS

TO

HIM BUT

APPRECIATED TIGER IN

SOME

SURGEONS MORE THAN

HE

TRAINED

PRUZANSKY AND TURNED HIM LOOSE IN OUR MIDST WHERE HIS ROARS AND
THE
RIP

OF

HIS

CLAWS

HAVE BEEN HEARD AND REVIEWED

ET AL IN THEIR

FELT

FROM TIME

TO

TIME
CLO

SLAUGHTER AND BRODIE

SURE 20 YEARS LATER FOR
LIP

FEELINGS

ABOUT VELAR

GRABB

1971 THEY LOOKED

TO ADEQUATE

CLOSURE FOR

ITS

MOLDING

EFFECT

AND EXPRESSED

NO GREAT CONCERN FOR

CAN BE
CLEFT

CO1LAPSE OVERCOME

OF THE ALVEOLAR ARCH BECAUSE WITH GROWTH THIS

THE

HAD

NO

INTEREST

IN

PUTTING

BONE

IN

THE
FELT

WHERE GROWTH HAS MERELY BEGUN UNDUE

ACT

TO EXPRESS

ITSELF

THEY

THAT

SURGICAL INTERFERENCE THE

COULD

ALTER

GIOWTH AND

APPLIANCES

COULD
THE

TO CONSTRICT
SHELI

RNAXILIIRV TO 24

SEGMENTS
ELAR
IT

OR IMPINGE CLOSURE WAS

UPON DONE

PALATAL IN IF

ES
AFTER

MONTHS

SIMPLY STAGES

THTEE LAYERS NECESSARY

CLEFT

EDGC PALING

CAN BE

LONE

IN

THEY EMPHASIZED
FEATUIC OF THIS VELAR PIOCEDURE SURGICAL
IS

THE

PRINCIPAL

TO ESTABLISH OF THE

NORMAL BALANCE OF ELUM DOES MORE

MUSCLE TENSIONS THAN LEPAIL

LOGICAL

ACIOSS

DEFECT

CLOSURE
IT

COMPLETE CONGENITAL
IN

DEFECT

PROVIDES

MORC NORMAL PHYSIO MAY

TAKE

ENVIRONMENT

WHICH

GROWTH AND DEVELOPMENT

PLACE

LIP

AND VELAR CLOSURE WAS FOLLOWED BY

CLEFT
IF
IT

REDUCTION

IN

THE WIDTH

OF THE HARD PALATE

WAS NARROW ENOUGH FOR MINIMAL

UNDERMINING OF EDGES AND

IF BY YEARS OF AGE THE CLEFT

DIRECT CLOSURE THEN THIS

WAS JUSTIFIED
OBTURATOR

WAS STILL TOO WIDE

FOR TEMPORARY

PLASTIC

WAS
IN

SNAPPED
1961
LUIZ

INTO

POSITION

AID PAULO
STATED
HIS

NI

MADEIRA

OF

ENDOISEMENT

OF THE SLAUGHTER
AT

PLAN
OF THE BARD PALATE AFTCR YEAIS

CLOSURE OF THE SOFT PALATE

18

MONTHS AND

OF

AGE

234

WALKER
IN

1966

IN

THE JOURNAL

OF THE

SOUTH

AFRICAN

LOGOPEDIC

SOCIETY
LIP

DENNIS
SOFT

WALKER ADVOCATED THE SLAUGHTER PRINCIPLE

CLOSURE
AFTER

OF

AND
FIRST

PALATE

WALKER BECAME JAMES

CUTHBERT MIGRATED FROM
16

CUTHBERTS

REGISTRAR IN

SOON

ROOKSDOWNHOUSE
YEARS

ENGLAND

AND

WORKED WITH
BEING
AT

HIM

ALL

OF

HIS

LIFE

IN AS

JOHANNESBURG

EVENTUALLY

APPOINTED
UNIVERSITY

TO FOLLOW HIS OF

CHIEF

HEAD OF PLASTIC

SURGERY
GILLIES

THE

WITWATERSRAND
TODAY

ADHERING

TO

THE

PRINCIPLE

NEVER DO

WHAT CAN
RESPECT FOR THE

HONOURABLY

BE PUT OFF UNTIL BUT ANXIOUS

RING

TOMORROWAND
TO

WITH

IN2I

WAKC

GROWTH MOUTH

CENTERS

HARNESS

MOLDING

FORCES OF

MUSCLE AND

AND

PALATOPHARYNGEAL

MUSCLE

RING
FLAP

HE WAS

CLOSED THE LIP FEASIBLE

SOFT PALATE

ONLY EXCEPT WHEN

CHANGE IN
REPLACING THE

VOMER

HE

NOTED THE GRADUAL

ELLIPSE TO

RESIDUAL

CLEFT

THE

FORM OF HIS WITH

LONG NARROW

THE SHORTER QUITE

WIDER

OVAL
SPEECH THE

ORTHODONTIST

WAS ABLE

PROMOTE

SATISFACTORY THIS

AN OBTURATOR ALTERED HARD PALATE

CLEFT

FREQUENTLY
LEFT

UNDER
12

REGIMEN

RESIDUAL THE

WAS

UNTIL

OR 14 YEARS OF

AGE WHEN

CLOSURE

WAS

RELATIVELY

EASY

III

SC
IT

HWECKE ND EK
IS

OF

INTEREST

THAT

10

YEARS

BEFOIE

SLAUGHTER

PROPOSED VELAR OF

CLOSURE IVLARBURG
SOFT

HERMANN SCHWECKENDIEK LAHN GERMANY

THROUGH
SMALL
IN

AN OTOT HINOLARYNGOLOGIST PROPOSED

EARLY

1944

CLOSURE

OF THE

PALATE

INCISIONS

WHICH

DID

NOT NECESSITATE OF THC BUT

MUCOPERIOSTEAL

DISSECTIONS
LEFT

OR OSTEOTOMY PALATE
AS

OR

OSTECTOMY

HAMULUS HE
OCCLUDED
ITH

THE

HAID

OPEN AND
RS 12

UNDISTURBED
YEARS

SPCCCH PLATE

LU

OR 15

GRRDUAL

IHMAN

2W

CLOSURE

OF THE BONY BY
HIS

CLEFT

WAS NOTED FROM

15

MM TO

OR

MM
IN TO

AND ACCOMPANIED
THE EARLY

MINIMUM

OF ORTHOPEDIC DISTURBANCES

1960S
THIS

SON WOLFRAM SCHWECKENDIEK CONTINUED

PROMOTE
FREE

PRINCIPLE

DEVELOPMENT

OF THE JAW AND PALATE CAN BE ATTAINED BY PRIMARY VELOPLASRY

LEAVING

IF

THE SOFT PALATE

CLEFT

IS

CLOSED DURING

INFANCY
CLEFT

RESIDUAL

IN

THE

HARD PALATE
OF THE

THE

NARROWS SPONTANEOUSLY DUE TO THE GROWTH OF THE SIDES

CAUSING

PALATE

WITHOUT

ANY COMPRESSION OF THE

JAW

THE

EDGES OF THE

SOFT PALATE

CLEFT

WERE PARED AND SIDE POUCHES

SPECIAL

DISSECTED

RUBBER BAND WAS PASSED WITH

NEEDLE THROUGH
IN

THE POUCHES AND

TAMPONADED BY

LITTLE

FOAM RUBBER SPONGES

THE

POUCHES THE
THE TENSION

SOFT PALATE

WAS UNITED

WITH THREELAYER

SUTURING

AND

OF THE

RUBBER BAND ADJUSTED

AND SUTURED

AT
STATED
THIS

THE

1964

HAMBURG SYMPOSIUM

THE

YOUNG SCHWECKENDIEK

PROCEDURE USUALLY

RESULTS IN

PRIMARY

UNION

OF THE SOFT PALATE

THE THE
SMALL THE
AS

MUSCLE LAYER DEVELOPS

MAJORITY
CLEFT

WELL AND THE ACQUIRE

PALATE GIOWS LONG AND MOBILE

OF THE CHILDREN

PERFECTLY NORMAL SPEECH

EVEN THOUGH
CLEFT FOI

REMAINS

OTHER REQUIRE

TEMPORARY PLATE TO COXER THE

SO THAT
AS

SPONTANEOUS GROWTH OF THE UPPER JAW MAY REMAIN UNDISTURBED

POSSIBLE IN CASE OF TOTAL CLEFT
IS

LONG

CORRECTION

OF THE POSITION
TIPS

OF THE TEETH IN THE

THE RESIDUAL
CLEFT
IS

AREA OF THE CLEFT WOLFRAM SCHWWKNDZCK

OFTEN

NESSARY DURING

TICATMENT

COVERED BY

PLATE

THE

SCHWECKENDIEKS
IN

PREFER TO OPERATE CLEFT

ON
THE

THE SOFT PALATE

SOFT AT

AT

TO

MONTHS OF AGE
FIRST

THE COMPLETE
LATER

PALATE

IS

CLOSED

AND THREE WEEKS OF SHORTNESS

THE LIP

IS

CLOSED
THEY

ALL

ABOUT

MONTHS
BASED

IN

CASES

OF THE

VELUM

USE

SUPERIORLY

236

PHARYNGEAL FLAP OF THE HARD PALATE

THE IN

PLATE
IS

IS

FITTED

AND CLOSURE OF THE RESIDUAL

TO 14 YEARS

CLEFT

POSTPONED TO THE AGE OF 12

IS

WHEN

NORMAL GROWTH OF THE JAW 1977

AT THE

VIRTUALLY

COMPLETE
IN

THIRD

INTERNATIONAL

CONGRESS ON CLEFT PALATE

REPORTED

TORONTO WOLFRAM
NORMAL MAXILLARY
THE

SCHWECKENDIEK
CRANIAL

25YEAR 60
TO 70

RESULTS

OF

AND
CLEFTS

GROWTH WITH
AND 95

PERCENT

OF

HARD PALATE

NARROWING

PERCENT

OF THE

ALVEOLAR

EDGES

APPROXIMATING WITH
SPEECH

SCHWECKENDIEK DEVELOPMENT

ADMITTED

TO HAVING

SOME
OF

DIFFICULTY

BETWEEN
AFTER

AND

YEARS

AGE
IN

BUT REPORTED CONTINUED IMPROVEMENT NORMAL SPEECH

PERCENT IN
PALATAL IN

SCHOOL AGE RESULTING

IN

57

PERCENT REQUIRED

AND MINOR PROBLEMS

POSTERIOR IN

37

PERCENT

OF HIS

CASES

PHARYNGEAL FLAPS
BRIEFLY

1964

PROFESSOR

BURIAN

HAMBURG

REVIEWED

HIS

RETROPOSITIONING

AND PHARYNGOFIXARION
FOR 40 YEARS

CARRIED OUT AT AGE

YEARS

WHICH HE HAD USED

HE

THEN INFORMED

THE

SYMPOSIUM
IN THE

THAT HE HAD CHANGED TO THE THIRD GILLIES HIS

SCHWECKENDIEK
LECTURE

METHOD
IN

MORE FORMAL
ELABORATED
PALATE

MEMORIAL
PLAN

1964
AT

BURIAN

RECALLING
AT

EARLIER

OF

LIP

CLOSURE

MONTHS AND

YEARS

THE

PATICNT

HAS TO BE REHABILITATED OF THE

FROM THE TIME OF THE

LASTED

LIP

OPERATION

TILL

THE

OPERATION

PALATE

THE TIEARMENR

LONG RIME AND WAS ALSO AND THE DISTRESS OF THEIR

HICH

EXPENSIVE
FAMILIES CONSISTS ALNNE LATER

TO

TEDUCE

THE SUFFERINGS

OF THE PATIENTS

THE METHOD OF SCHSEEKENDIEK ADOPTED SOME NEARS AGO OF THE ICCONSTRUCOON AT THE
CLEFT

AGE OF ON
IS

TO
AT

MONTHS OF
TIME

RHC SOFT PALATE OR

THE TO

LIP

IN

TOTAL

IS

OPERATED

THE SAME

SOME WEEKS

THE HARD PALATE PALATE

AN OCCLUSIVE
CONSIDERABLY

PLATE THE

APPLIED

THE

EARLY CONSTRUCTION EAR INFLARN QUITE

OF THE

SOFT

REDUCES

FREQUENCY OF MIDDLE
ACQUIRES

MARIONS

BOTH

ACUTE

AND CHRONIC

THE

CHILD

GOOD

SPEECH

QUICKLY THE
OPERATION TREATMENT

CLEFT

IN THE HARD PALATE NARROWS VISIBLY

AT

AND MAY BE CLOSED BY AN

AFFAIR

LATER
IS

ON

ANY TIME

THIS

IS

THEN

MINOR

THE ORTHODONTIC
TO

VERY

EASY

THE SCHWECKENDIEK
UNNECESSARY

METHOD SEEMS
HOPE THAT
IT

ME

TO

MAKE

THE PRIMARY
RLIC

BONE GRAFTING

AND

WILL

REDUCE

UIMRDCNRBLY

IIR

FUR

CUNDARY

BONE GRAFTING

CUPAR
SUGGESTED

OF YUGOSLAVIA BY SLAUGHTER
SOFT

APPROVED AND

OF THE

TWOSTAGED
AS

OPERATIONS RATIONAL
BASIS

SCHWECKENDIEK
CLOSURE CREATES ALSO AVOIDS
IS

REALLY

PROCEDURE EARLY
FOR

PALATE

MORE
MAXILLARY OBJECTIVE

FAVORABLE

SPEECH
LIP

DEVELOPMENT AND
SOFT

AND

DEFORMITIES
EVIDENCE THAT

AFTER

PALATE

CLOSURE

THERE

237

THE CLEFT PALATE

IN

THE
LESS

HARD PALATE

IS

REDUCED

LATER

CLOSURE

OF THE HARD

OFFERS

CHANCE OF ARCH DISTORTION

PRIORITY
REGIONAL
ASSOCIATED CREDIT
LOYALTIES

AND LANGUAGE
AN

BARRIERS

OFTEN

DICTATE

THE

NAME
GETS
IS

WITH
IN

OPERATION UNITED

IN

EUROPE SCHWECKENDIEK

BUT

THE

STATES

WAYNE

SLAUGHTERS

NAME

SYNONYMOUS WITH
INTERNATIONAL

THE PRIMARY VELAR CLOSURE PRINCIPLE LIP

AT
IN

THE 1969

CLEFT

AND

PALATE

SYMPOSIUM

CHICAGO

SLAUGHTER WAS CHALLENGED

HE

CLEARED THE AIR WITH

ONE THRUST AND

NO PARRY
THAT PROCEDURE WAS DOCUMENTED IN 1840 AND 1914
IT

HAS

BEEN

REFERRED

TO

REPEATEDLY

THE

LAST

WRITTEN

REPORTS

WERE IN

BY THE LATE JOHN STAIGE

THESE PROCE

DAVIS
DURES

AND
BEFORE

HAD THE PRIVILEGE HE DIED

OF SEEING

HIM PERFORM SOME OF

THERE HAD BEEN SPORADIC

TO

EXPRESSIONS IN

OF CONSERVATISM FROM TIME

RIME
SAFEST

EVEN DORRANCE
AGE TO OPERATE OPERATIONS
LESS

1933

WROTE
IS

THE

FOR CLEFT

PALATE
AFTER

ABOUT THE
YEAI

FIFTH

YEAR OF LIFE

IN

OUR AND

EXPERIENCE FAILURES ATE

PEIFORMED

THE FIFTH

ARE FREE OF MORRALIT

FRECUENT

IN

1972
AND

GUSTAVE

AUFRICHT

WROTE
EAIL CLOSURE OF THE

AM

ALSO AGAINST ONLY

FULLY SOFT

THE

HARD PALATE
FOR THE

ALREAD
PALATE

ESSET UNTIL

AD

OCARED

PALATE

JOSURE

AND UBRUTATNI

HARD

PATIENT

WAS

DEELOPED AND SLAUGHTER HEEDING

FACING THE DENTAL

THE SCHWECKENDIEKS
GROANING OF THE DENTISTS
EARLY

THE

MOANING AND
FOLLOWING THE

DISASTERS

TRAUMATIC

PALARAL

SURGERY LED

CONSERVATIVE

REVOLUTION THIS

NEW STAND

STIMULATED TYPES

RESEARCH TO RR TO DETERMINE OF CLEFT PALATE SURGERY

WHAT EFFECTS

IF

ANY MODERN GROWING

WOULD HAVE ON YOUNG

MAXILLARY

BONE

IN

1958

HERFERT FOLLOWING
AFTER

HIS

ON RETARDATION
DISSECTION
HIS SO EGERN

OF MAXILLARY
LIGATION
IN

GROWTH
PUPPIES

MUCOPERIOSTEAL AND TIMED

AND
IN

VESSEL

DESIGNED

MPATHY WITH

HIS

RESEARCH FINDINGS

AND ACCORDING TO THE PRINCIPLES 1963 HE REPORTED

SET

BY SCHWECK 1955 HE HAD HE SAID

PALATE THE

ENDIEK AND SLAUGHTER IN BEEN USING

THAT

THAT SINCE

SCHWECKENDIEK5 METHOD
STIMULATION PLATES

HE

DID

NOT FEEL

MCNEIL

WERE NECESSARY IN

CLEFT

CHILDREN
INFANT

BUT HE DID

RECOGNIZE THE IMPORTANCC

OF PROVIDING

WITH AN INTACT VELUM WITH WHICH TO ACQUIRE

CLOSED THE
SOFT

NORMAL SPEECH 16

AND

THUS

PALATE

ONLY

AT

14

TO

MONTHS HE

NOTED
CLOSURE OF THE
SOFT

AFTER

PALATE

CONTRACTION

OF ITS

MUSCLE

FIBERS

STIMULATES

GROWTH OF BONY PALATAL PLATES ESPECIALLY

FUNCTIONAL STIMULATION
ALL

TO THE PERIOSTEUM NEAR THE LEADS TO TRUE

RIM THIS
OF BONE

OF THE

PERIOSREUM

GROG

TH

WHICH WAS NOTED IN

OUR CASES

TWO THREE

OT FOUR YEARS AFTER CLOSURE OF THE IRHOUR

CLEFT

VELUM

THE CLEFT

OF THE HAID

PALATE WAS TEDUCED

ANY DIRECT OPETARIVE

PALATE

PROCEDURE
CANT ADVANTAGES THE SOFT PALATE THE HARD PALATE PALATE

BY
AIE

THE

TWOSTAGE OPERATION NORMAL SPEECH

IS

OF THE

TWO

SIGNIFI

GAINED

ENCOUIAGED

BY

EARLX
IS

CLOSURE OF

AND IESRRICTION

OF GROWTH OF THE UPPET JAW

OIDED
IN

AS

REMAINS UNTOUCHED THE SECOND STAGE OPERATION

YEARS TEN OF AGE

THE HARD
IS

AROUND
IN

BECOMES MINUTES

RELATIVELY

SMALL

PROCEDURE AND

PERFUIIIICD

TO FIFTEEN

CONFLICTING
YET SARNAT
ALSO IN

FINDINGS
1958

IN

ANIMALS
EXCISED IN RHC

WORKING ON MONKEYS
THE GREATER PALATINE

MUCOPERIOSTEAL

FLAP

AND LIGATED

ARTERY

ONE

HE WENT GROUP OF ANIMALS

SHELF AND NASAL GROSS DIFFERENCES

APE

AND ALSO EXCISED

THE

BONY

PALATAL

LINING
IN

THESE

EXPERIMENTS

SHOWED NO

SIGNIFICANT

GROWTH AND DEVELOPMENT

OF THE HARD PALATE

RELATIONSHIP

MAXILLARY OR TOTAL

ARCH MANDIBULAR
FACE

ARCH MAXILLOMANDIBULAR
IS

THE

IMPLICATION

THAT NEITHER

THE SURGICAL
IS

TRAUMA
CAUSE OF

OF RAISING

FLAPS

NOR DEPRIVATION
LACK OF
IN

OF BLOOD SUPPLY
FINDING
IN

THE

MAXILLAR
FOSTERS IN

AND 1962

FACIAL

GROWTH

ACCORDANCE WITH
ALVEOLAR THAT
JUST CLEFTS

WORK

HUMANS WITH COMPLETE

ER

1967
OF

KREMENAK

AL
STRIP

SHOWED

IN

PUPPIES

UNILATERAL

EXCISION

MMWIDE
TEETH CAUSED

OF MUCOPERIOSTEUM
DEFINITE

MEDIAL

TO

THE POSTERIOR

VERY THAT
FLAP

DECREASE IN

OF PALARAL

WIDTH
OF ARTERY

27

PERCENT

NARROWER ON

SIDE

CONTRAST ELEVATION OF THE

PALATE PALATINE

UNILATERAL CAUSED

MUENPERIOSTEAL
PERCENT

OR LIGATION

ONLY

NAN OWING OF THE

LATHAM
MAISELS

AND BURSTON
THAT THESE RESEARCH CONTRADICTIONS

NOTED

WOULD HAVE
CLOSURE OF

THROWN
THE

CONFUSING CLOUD OVER THE DECISION EXCEPT FOR THE 1966

FOR TIMING

HARD PALATE
IN THE

FINDINGS

OF LATHAM
ACTIVITY

AND
IN

BURSTON
THE

HUMAN
SUTURE

THEY

SHOWED THAT

THE LATERAL

MIDPALATINE
FOR PRACTICAL TO

IS

GREATLY DIMINISHED

BY 18

MONTHS AND
AFTER

HAS

PURPOSES CEASED BY
LATERAL

YEARS OF AGE THE HARD PALATE

THUS

18
AS

MONTHS
RESULT

YEARS

GROWTHOF

TAKES PLACE

OF ALVEOLAR APPOSITIONAL
PARTS ALONG THE

GROWTH ONLY AND NOT BY SEPARA

SUTURE CONSEQUENTLY HARD PALATE
AT THIS

TION

OF THE

MIDPALATINE

MAISELS

REASONED THAT OPERATIONS

ON

THE

TIME

COULD NOT BE EXPECTED TO INHIBIT

SIDES

GROWTH BY
OF SCAR

TETHERING

THE

TWO

TO EACH OTHER

BY

SHEET

MAISELS FINDINGS

BREATHED
BRITISH

SIGH

OF

RELIEF

AT

THE
FELT

CONVENIENCE
THAT THE

OF THESE OF

SURGEONS HAVE

LONG

TIMING

CLOSURE OF THE SECONDARY PALATE SHOULD BE DICTATED ACQUIRING

BY THE NEED FOR WITH

NORMAL

SPEECH RATHER THAN BY

FEAR

OF INTERFERING

SUBSEQUENT GROWTH

DELAYING
JACK

PALATE

SURGERY
OF CINCINNATI
SUTURE THE

LONGACRE OF THE UNIVERSITY

NOTED
CLOSES AT THE END OF

GROWTH SRUDIE HAVE SHOWN THAT

THE
FIRST EAI

THE PRERNAXIL1AI SEPALATING

HUT THE

SAGITRAL

SUTURE

MAXILLAE

AND THE

TWO

HORIZONTAL
FIXE

PLATES OF THE PALATINE

HONE ONLY CLOSES HETWEEN THE AGE OF FOUR TO

DIAMERCI OF THE

THIS

MEANS
AT

THAT THE HIS TIME

RRANS
TO

HON

PALATE AND THE ARCH

IS

COIN PLETED SURFACE

THIS MUST

HE ADDED THE APPOISTIONAL

GROWTH ON

THE

OF THE

HONE
THAT PRIOR TO CLOSURE

HE

CITED

LOGAN LEVEN WHO HAD SHOWN GROWTH OF

AFTER

OF

THE DEFECT THE

JACK LONGACRE

THE MAXILLA

IN

THE CLEFT PALATE DEFECT THERE

GROUP WAS

NEARLY NORMAL BUT RETARDATION

CLOSURE OF THE

WAS MARKED

OF GROWTH WAITING

LONGACRE THEREFORE BEGAN PLAYING

IN

GAME AND
OF
HIS

IN

1964

HAMBURG

HE REPORTED

LONGITUDINAL

RESULTS

DELAYING

POLICY

WE FOUND

THAT THE

GIOUP

WHERE THE PALATE WAS REPAIRED

TO

AT

OR NEAR THE

TIME
FACIAL

OF THE CLOSURE OF THE SAGITTAL SUTURE DEVELOPMENT AND

LESS

YEARS SHOWED MOIC NORMAL

THAN THE OTHER

DENTAL

CRIPPLING

GLOUP

240

HE

ALSO NOTED THAT EVEN IN THERE

THE OLDER

GROUP WHEN THE

LESSER

DEFECT

WAS

LARGE

WAS SOME
HIS

CROSSBITE
SPLIT RIB

ALTHOUGH TO
GRAFTS BE

DEGREE THUS BETWEEN EVEN

THE
THIS

HE PROPOSED THAT
PALATAL SHELVES

INTERPOSED TO

AND

THE

ALVEOLAR FILMS

PROCESS TAKEN IN

PREVENT

AMOUNT OF DEFORMITY
DEFECT

XRAY

THE AREA OF THE ALVEOLAR THE

SHOWED TOOTH BUDS GROWING DOWN INTO

ALLOWING FOR MORE NORMAL ERUPTION
IN
HIS

NEWLY GRAFTED TEETH LONGACRE HAD

THE

BONE

OF THE

FINALLY PRESENTED

HIS

1970

BOOK
AFTER

CLEFT

PALATE

DEFORMATION

IMPRESSION BY

22

YEARS

WITH 500
HIS

CASES THESE

BEEN

CORRECTED

HIMSELF
LIP

WITH

MODIFICATION

OF
CLOSURE

LEMESURIERHAGEDORN

TECHNIQUE

AT

MONTHS AND

OF

TH
THE

CLEFT

PALATE

BY THE
IN

VY
THE

PROCEDURE OF KILNER
SERIES

WARDILL

VEAN II
PALATE

ONLY

VARIABLE

WAS THE

TIMING

OF THE

SURGERY LONGACRE
TIENTS
RESULTS

PRESENTED
EARLY

HIS

FINDINGS REPAIR

WITH

PHOTOGRAPHS
TO

OF 24 WITH

PA
POOR

11

WITH

PALATE REPAIR

112

YEARS

AND 13 WITH

LATE

TO 414
FACIAL

YEARS WITH GOOD RESULTS

LESS RETRUSION

SHOWING

LESS INTERFERENCE

WITH

GROWTH

OF THE

PREMAXILLA
NEARLY CLUSION

MINIMAL

COLLAPSE

OF THE
LESS

MAXILLARY
SEPTAL

SEGRRICTITS

MURT

NORMAL MAXILLARY

ARCHES
CARIES

DEVIATION

BETTER

OC

AND FEWER

DENTAL

LONGACRE SAID
UPON

IT

WOULD APPEAR
DIFFERENT
SX

TRORN THIS

TUDV

THAT THESE SCI JES HAD BEEN OPERATED CORRECTLY THE THE DIFFERENCE OF THE
IN

TWO

SURGCONS MORE
ITH

RESULTS MAXILLATY

MAY BE
ARCH
IS

COSRELATED ESSENTIALLY

THE

TACT

THAT

DE EIOPMENT

COMPLETED

85CC

BY FOUR YEARS OF AGE

IN

FACT JACK

LONGACRE OFTEN

EMPHASIZED
PATIENT

COMPARING

RESULTS IN

YOUNG ADULTS BETWEEN

AT

WITH EARLY PALATE REPAIR

AND ONE WITH PALATE REPAIRED AND

FOUR YEAIS

IS

ALMOST LIKE COMPARING

DR JEKYLL

MR

HYDE

THE

GREATEST YEARS

CRITICISM
IS

OF WAITING

TO CLOSE THE PALATE FOR FIVE

EFFECT

AND

ONEHALF

THE IN
HIS

PROBABLE DELETERIOUS

ON

THE

DEVELOP

MENT

OF SPEECH
HIS

DEFENSE LONGACRE SUMMARIZED THE FINDINGS

OF DREXLER THERE

SPEECH PATHOLOGIST
DIFFERENCE DIFFERENT IN IN NASALITY NASAL EMISSION

IS

NO SIGNIFICANT BETWEEN THE

AND SPEECH SRUD

LOSS

PROFICIENCY
FAILED

GROUPS

SIMILAR
ITH

AUDIOMETRIC
IEGARD TO HEARING

TO

SHOW AN

DIFFERENCE

THE

TWO GROUPS

24

RITTER
PROFESSOR

REINHOLD

RITTER

OF HEIDELBERG

GERMANY ARGUED
IS

IF THE TOTAL CLEFT

PALATE

IS

OPERATED

ON BEFORE THERE
THE RESULT
IS

GOOD OCCLUSION
BIHRERIL

IN

THE

BABY MOLAR REGION

AGE

YEARS

ALWAYS

MOSTLY
CROSS BITE IN EAILY

ASYMMETRICAL OR UNILATERAL
IN THE SIDE PARTS AND THE THERE

COMPRESSION OF THE UPPER JAW

IS

WE SEE

PROGNARHISM

OR

OPISROGNATBIA

OPERATION
TBE TEETH

UPPER JAW AND THE CAVUM OF THE NOSE ARE OFTEN DEPRIVED BECAUSE THEY HAVE NO NORMAL FUNCTION

AND

CARIOUS

HE
REINHOLD

ALSO

NOTED

THAT

THE

CHILDREN THE

DO NOT

RETN

SPEAK

AS

WELL

AS

THOSE

WITHOUT
CUSSED SION

DEFORMITY
PATIENTS

AT

1964
AT

HAMBURG SYMPOSIUM
YEARS OF AGE WITH

HE DIS

OPERATED ON

NORMAL OCCLU

WHO REQUIRED
HIS

ONLY ORTHONDONRICS FOR OBLIQUE FRONT TEETH

HE

EXPLAINED

REASONING

AR

AGE

THE

BONE OF THE UPPER JAW

IS

HARDER

AND

SCAI

HAS LESS

CHANCE OF

CAUSING

DEFORMITIES

IN

1971

RITTER

WROTE TO

ME

TO AFFIRM

HIS

STAND

HAVE BEEN INTERESTED

IN

THE TREATMENT

OF CLEFT

LIP

AND PALATE
BELIEVE

PA
AS

SINCE

1928
DOUNI

BOTH
XS

OI

RHODONRIC AND SURGICAL

XS

RIEARMCNR
OF

RHA

RHC FUSI OF

HO

IRNED

AT

CALL

OPELARION

THE AGE
AT

CLEFT

PAL

HECAU
OF THE

DISTURBANCE PALATE
IS

OF UPPER JAV
YEARS

GROWS RH
IS

TUE

BEST

FOR OPERATION
THIS

CLEFT

THE BONE

HARD

ENOUGH

TIME

GABKA
THE
RESONANT

JOACHIM

GABKA OF
PRINCIPLE
AT

BERLIN

ACKNOWLEDGED
CLOSING

HIS

USE
AT

OF THE SCHWECKENDIEK
TO TO
EARLY

HE
18

REPORTED

THE LIP

MONTHS
YEARS

THE SOFT PALATE IN

HIS

MONTHS AND
OF

THE HARD
AT

PALATE AT
RELATIVELY

VIEW

CONSTRUCTION

TELUM ON
THE

AGE WITHOUT
IS

DELETERIOUS

INFLUENCE STUDIES
IN

GROWTH OF

THE

UPPER JAW

IMPORTANT NARROWING PRIMARY

GABKAS
OF THE

1964

REVEALED THE
AS

THAT THE
FIRST

MOST

RAPID

CLEFT

OCCURRED WITHIN AND NOT LATER

SIX

MONTHS

AFTER

VELAR CLOSURE

CLAIMED

BY

SCHWECKENDIEK

242

LIMBERG
MOST
CONSERVATIVE TIMES

SURGEON

AS

TO

AGE FOR PALATE OF RUSSIA

YEAR

SURGERY

IN

MODERN

WAS THE GRAND OLD GENTLEMAN

ALEXANDER

LIMBERG OF LENINGRAD
THE PALATE CLEFT WITH

HE

CLOSED

HIS

LIPS

AT

AND OCCLUDED OLD WHEN

PLATE UNTIL

THE CHILD

WAS 10
BY

YEARS

HE

FINALLY

LENGTHENED AND CLOSED

THE PALATE

HIS

VY

METHOD

DINGMAN
RCED DINGMAN OF
DENTIST THE UNIVERSITY

OF MICHIGAN
IN

TRAINED CLEFTS

AS

BOTH

AND SURGEON AND WITH

THE

VAST EXPERIENCE CLEFT PALATE HIS

AT

HAS USED

MANY METHODS AT GEN

TIVE

CONGRESS IN CHANGE TO
TO
AT

COPENHA
CONSERVA

WITH APPROACH
LIP

OCONNOR
USING
LIP

HE REPORTED ADHESION

MONTHS AND
15 TO 18

DEFINITIVE

CLOSURE AT
SOFT

TO 12

MONTHS THEN

MONTHS
OVER

HE

CLOSES

THE

PALATE

WITHOUT AND

UNDERMINING
AT

OR INCISIONS

BONY PORTIONS
TION

OF THE PALATE

YEARS

AFTER

COMPLETE ERUP
TO CLOSE

OF THE PRIMARY
FISTULA

MOLARS HE AT
TO

INSERTS

DENTAL

SPLINT

THE

HARD PALATE
ANTERIOR

YEARS

VOMER

FLAP IS

USED TO CLOSE THE

CLEFT

HE

REPORTED
AND DEX CINJAMENT
IN THESE CASES APPEAR

RE411T
FAX

IN

PCCCH

AND GIOWTH

C1

ORABLE

14

RALPH BLOCKSMA OF GIAND

RAPIDS

MICHIGAN
AND

PLASTIC

SURGEON OF

DUTCH DESCENT
INTEGRITY BEFORE

DEDICATED TO

MISSIONARY THE

MAN
IDEAL

OF IMPECCABLE

PERSONIFIES

ME

IMAGE OF THE
OF PLASTIC LEUZ AND

DOCTOR IN 1974
IN

THE

AMERICAN ASSOCIATION
CHRISTOPHER

SURGEONS

SEATTLE

WITH JOHN BURNINK

PRESENTED ELIMINATE
VSIS FOR HIS

KENT MELLERSTIG

HE

CONSERVATIVE

PROGRAM FOR MANAGING

FLAP

THE ORAL CLEFT TO

RADICAL CLEFT

MUCNPERINSREAL
SURGERY

PROCEDURES
AT

10YEAR

ANAL

OF

ALL

PALATE

PERFORMED

BUTTERWORTH HOSPITAL

19631973
PATIENTS
AT

REVEALED

MLANX

HO HAD HAD AGE OF

CAIS

AN

EARH

MUCOPERIOSTEAL
EX

FLAP

ELOSUIC

LOOKED

EXCELLENT

THE

BUT EXHIBITED

IDENCE

OF

SERIOTIS

NAAXIHAL

2A

GROWTH ARREST MOST OF THE

AT

THE

AGE OF 15 YEARS
SEEN IN IN PATIENTS

MEMBERS OF OUR
WITH
REPAIRED

CLINIC
CLEFT

AGREED PALATES

THAT

DEFORMITIES IATROGENIC

WERE

FUNDAMENTALLY

ORIGIN

AND

WE INCLUDED
OF THE SUPERIOR MAXILLA

THE

FLAT

FACE SYNDROME

HYPOPLASIA

AND

SHORT

NOSE THE HAD THE

TEETH

SYNDROME

IRREGULAR

DENTITION

AND DENTAL

CARIES SUPERIOR

DISTORTED

ARCH SYNDROME MALOCCLUSION

WITH

CONTRACTED

DENTAL

ARCH EXHAUSTION SYNDROME EXPENSES

FOR THE HOSPITAL

THE

FINANCIAL

PEDO

DONTIST

ORTHODONTIST

PROSTHODONTIST PLASTIC

SURGEON

ENT

SURGEON

PSYCHOLOGIST AND SPEECH THERAPIST

BLOCKSMA FORMULATED
GERY

THE

FOLLOWING LAWS OF GOOD PALATE

SUR

DO NOT
DEPRIVE VIOLATE THE THE PALATE

BONE

OF ANY PART
IT

OF ITS

BLOOD SUPPLY
OF ITS

VOMER
THE

OR DEPRIVE
01

OF ANY PART

BLOOD SUPPLY

AMPUTATE DENUDE

PREMAXILLA

PROLABIUM

THE

ENTIRE

HARD PALATE TO GAIN

TEMPORAL

LENGTH

FOT

THE

SOFT

SIMULTANEOUSLY DEPRIVE
SACRIFICE

THE PALATE HONE OF BOTH ORAL AND NASAL FOR IMMEDIATE SURGICAL

MUCOSA

LONGREIM GROWTH

EXPEDIENCC

FO
OBC
THE OF GOOD INCISIONS

OUND
SMALL

HEALING

KEEP IELAXING
ELELAV

SURGCRV

MX OH ING

BONE

AT

ICAST

UNTIL

AFRET

THE

6TH YEAR

THIS
ALL

CONSERVATIVE CLEFTS

APPROACH STARTED
THE
LIP AT

IN

1964

AND

NOW USED

WITH

ORAL

CLOSES

TO

MONTHS WITH
OF THE

MINIMAL
WITH

UNDERMINING
MODIFIED AROUND THE
DIVISION THE

AR

18

TO 24

MONTHS CLOSURE

SOFT PALATE

VON LANGENBECK TECHNIQUE

MAXILLARY TUBEROSITIES PALATINE

INVOLVES

SMALL

INCISION

WITH

FRACTURE OF THE

HAMULUS
OF

OF THE POSTERIOR

APONEUROSIS FROM THE MARGIN

ORAL

HARD PALATE

AND NASAL

AND

MUCOSA SUTURING

BLOCKSMA NOTED
IN

MOST CASES

VIRTUALLY

OMPLERE ABUTMENT

OF THE

CLEFT

OF THE HARD PALATE

OCCURS SPONTANEOUSLY WITH OF TO YEARS

GROWTH THIS

IS

NOR ALWAYS
GILL

TRUE

AR THE AGE NARROW

SIMPLE

TURNOVER VOMER

FLAP

SUFFICE TO CLOSE THE

HARD PALATE FISRULA AFTER MOST OF THE PALATAL GROWTH HAS BEEN ACHIEVED

WE THEN
THERAPY
IS

DETERMINE WHETHER

PHAIVNGEAL
TEFLON

FLAP

IS

INDIEARED INTO

HETHER THE

SPEECH

NEEDED
BE

OR

WHERHEI

ILNLALANTATION

POSTERIOR

PHARVNX

REE

244

IN

1977

JEAN

PSAUM
BEFORE

AND RENT MALEK OF PARIS OF THE

LIP

ADVOCATED

SOFT

PALATE

CLOSURE

CLOSURE OCCURS

AND HARD PALATE

LACK

BECAUSE
SOFT

TONGUE RETROPOSITION
PALATE PREDICT

ON ACCOUNT OF
BETWEEN
CLOSURE

OF NORMAL
PROCESSES

AND

ABNORMAL
EARLY

WIDTH

PTERYGOID
WILL

THEY

THAT

SOFT

PALATE

CORRECT

PREOPERATIVE

TONGUE RETROPOSITION

BY IMPROVING

MUSCLE BALANCE

OPPOSITION
IN

1966

FRIEDRICH

SCHRBDER
PALATE

OF WIIRZBURG
BRIDGE
FLAP

FAVORED

THE

VON
THE

LANGENBECKIERNSTVEAU SCHWECKENDIEK

METHOD

OVER

METHOD BECAUSE
OF THE
IN

DEFORMATION AVOIDED

MAXILLAE

AFTER SCHWECKENDIEKS

OPERATION

CAN

BE

ONI

NAILOW
OF THE

CLEFTS

GOOD FUNCTION
CASES SINCE

SOFT PALATE

CAN BE ACHIEVED

ONLY

IN

FAVOURABLE

COIIECTION

OF AN INSUFHCIENT

SOFT PALATE

AFRET

SCH ECKEN
EARLIER

DIEKS

ELOPLASTY

PHAR

NGOPLASTY

IS

IECORNRNENDED NOR
PERIOD

THAN
DEX EL

THE SECOND

DECENNIUM
THUS

THE

MOST FAVOURABLE

FOR SPEECH

OPMENR
IN

IS

MISSED

1977

IEN
FOR

L37OCH

OF THE LINIVERSITY

OF FLORIDA

WARNED
FOLLOW

THE
LATEI

ATIONAIC BX HAI

TXX

ST

SUIGICAL
XX

CLOSUL

SOFT

PALATE

FII

ST

CR1

JD
APPLICATION

LOSURC

ITH

OBTURATION ESENUS

OF THE HAI

CLOSUIC SPEECH
ITS

IPPEAIS

LOYLLAL
IS

BUT
USUALLX
OF

MANY

HA
SEAL

PALARC BEFORE ACHIEX ING

FINAL

TO

UNI MAL
CI

DEXASTING

TO SPCCCH SUIGICAL

DEVELOPMENT
CLOSUIC HARD
IS

WHENEX
FOLIOSS

PROLONGED

POSTP
MOVES
TOSS

HAID AN

PALATE

ED

OBTURATORS GENERALLX
SOFT PALATE

ESULT IN

INADC
MY
PALATE

OF THE

PALATE THIS

AS THE

ARD CLOSURE

ONGEST EXPERIENCE
CLOSUIE UHIEE

WITH

METHOD MONTHS

OF APPROACH INVOLVED
FOLLOWED HARD

PRIMAN

SOFT

POSTPONED

TO 18

PALATE

CLOSUIC PREPARED

BETWEEN

AND FOUR YEARS OF AGE

HARD PALATE OBRURATORS IN

AN
THE

EXCELLENT PIOSTHODONTIST

AND MODIFIED
THIS

INTERIM

THE

POPULATION

RECEIVING

APPROACH PTESENRED
PAIRICNLAILV
AS

WITH

LAIGE SUBSTI THIS IN

NUMBER
TUTIONS

OF IHNNIMAL

HABITS
EAILY

OF ARTICULATION
SPEECH

GLOTTAL STOP TO MODIFY

ALTHOUGH
EASES THEX
CLEFTS
XX

DITEER
AS

THERAPY
AS

ABLE

MANS

CRC NOT

SUCCESSFUL

EARL

COMPLETE CLOSURE

LTIC
OR

WITH SIMILAI
TESEAREB OF LIP
XX

TODAY

MIGHT

ADD

CAN SEE NO REASON

AS

FROM EXPERIENCE
EAIL
AS

HX SOFT PILATE
FOI

CLOSURE COULD NOR BE INSTITUTED ADS ANTAGE OF THIS

IHE

TIMING TUBE

CLOSUIC

THE

ON

FACIAL

GROSS

TH

EUSRACHIAN

FUNCTION THEN

AND FOR MUSCLE HYPCRTIOPHX

BCTSX

OMPLETE

HARD PALATE CLOSURE MIGHT

FOLIOS

CEO ONE AND

THREE

EARS OF AGE

AT

THE

1978 AND

AMERICAN
ARLENE

CLEFT

PALATE

ASSOCIATION

MEETING BARD
MEDICAL

COSMAN
CENTER

FALK REPORTED

OF COLUMBIA

PRESBYTERIAN
RESULTS

NEW YORK
CLOSURE

ON

THE

SPEECH

OF APPROXI AND

MATELY 35 PATIENTS
DELAYED

TREATED WITH

EARLY

CLOSURE OF THE SOFT PALATE

AT

OF THE

HARD PALATE

OR

YEARS

SCHWECKEN
PERCENT

DIEK

AT

AGE

YEARS 66 PERCENT

HAD POOR SPEECH AND 32

IT

HAD HAD SECONDARY PHARYNGEAL FLAPS 60

PERCENT

WAS PREDICTED

THAT NEARLY

WOULD

EVENTUALLY

REQUIRE

SECONDARY PHARYNGEAL FLAP

LIP
THE
LIP

ADHESION
ADHESION PRINCIPLE DEVELOPED BY MEIJER AND NI AND II
IT

JOHANSON
COLLITO
IS

MILLARD BEEN

RANDALL
SCRIBED
IN

WALKER
DETAIL IN

HAS

DE

VOLUMES

SIMPLE
IS

SURGICAL

PROCEDURE AVAILABLE
TO

WHEN PRESURGICAL
SEGMENTS INTO
IN

ORTHODONTICS

UNAVAILABLE

MOXE MAXILLARY
BETTER

MORE CONVENIENT
FOR DEFINITIVE
LIP

AND POSSIBLY
CLOSURE

ALIGNMENT

PREPARATION

AND

EVENTUAL
EARLY

CLOSURE OF THE ALVEOLAR

AND HARD PALATE CLEFT BY AVUIDING

FLAPS
IT

ELEVATION

OF MUCOPERIOSTEAL
OF

FOLLOWS

THE

SAME CON
SOFT

SELVATIVE CLOSUIC PALATE VEIY

PRINCIPLE

MOLDING

ANTERIORLY
RXX

WHAT
LIP

EARLY

PALATE
SOFT AT

ACHIEX ES POSTERIORLY CLOSURE

OFTEN THE

ADHESION AND

CAN BE CARRIED OUT TOGETHER ADVANTAGEOUSL

YOUNG AGE VOLUMES

AND
II

SINCE

OF CEFT

CRAFT

HAVE BEEN PUBLISHED

CLEFT

MODIFICATION

OF THE ADHESION
FLAP
IS STILL

PROCEDURE HAS BEEN DEVELOPED

IT IS

EDGE MUCOSAL
THE

USED BUT RATHER

SELDOM INSERTED
RELEASE

ALONG
LATERAL

INRERCARTILAGINOUS

LINE

THE

OF SHORT
STRAIGHT
FLAP
IS

VESRIBULAR

MUCOSA
THE

IS

MADE BY AN

INCISION

RUNNING

BACK
THIS

WARD ALONG

PYRIFORM

APERTURE BY LETTING

INTO

ANREROPOSRERIOR

CUT

THE

VESRIBULAR BASE

MUCOSAL SHORTNESS

RELIEVED

WITHOUT
INCISION

EVERTING THE NASAL

THE ALAR SKIN

AND RIM

THROUGH
FROM THE

THIS ALAR

VESTIBULAR CARTILAGE THE ALAR

CAN BE DISSECTED
LIFTING STITCHES

THEN THROUGH ANDTHROUGH

CARTILAGE
LIP
IS

CAN HELP
BETTER

SLIDE

AND

ITS

ATTACHED

MUCOSA UP

INTO

POSITION

THE

JOINED

AS

TEMPOLARN ADHESION USING MEDIAL

LATERAL

MUCOSA TURNED
FLAP

OVER TO MAKE UP FOR ANY

DEFECT

LEFT

246

RICHARD EXTENDED
THE

GREMINGER
DESIGN

OF

THE
FLAP

ALBANY
TO

MEDICAL

COLLEGE

HAS BASE

OF

INCLUDE

PERIOSTEAL
FLAP

WHICH WHEN APPROXIMATED

TO

MUCOPERIOSTEAL
LINING OF AN

ELEVATED

FROM THE ALVEOLUS CREATES THE INSIDE

ALVEOLAR RIDGE

247