Comparative study on cleft palate morphology after passive presurgical plate therapy in unilateral cleft lip and palate

Background Presurgical plate therapy has been a widely accepted treatment prior to palatal cleft closure. The effects of passive presurgical plate therapy on cleft morphology prior to single-stage unilateral cleft lip and palate (UCLP) repair was quantified. Patients and methods We compared the dimensions of cleft width and cleft area (true cleft and palatal cleft) measured pre-operatively at two European cleft centers. Center A performed single-stage UCLP repair at the infants’ age of 8 months without any presurgical orthopedic treatment. Center B initiated passive presurgical plate therapy immediately after birth of the neonates, followed by single-stage UCLP repair at 8 months of age. Results We included 28 patients with complete UCLP from Center A and 12 patients from Center B. The average anterior width of the true cleft before surgery was significantly smaller in infants at Center B than Center A (p=0.001) with 95% confidence interval of (1.8, 5.7) mm, but average posterior width was similar in the two groups. Mean presurgical true cleft area amounted to 106.8 mm2 (sd=42.4 mm2) at Center A and 71.9 mm2 (sd=32.2 mm2) at Center B, with a confidence interval for the difference being (9.8, 60.1) mm2. This corresponded to a 32.7% reduction of the true cleft area (TCA) if passive presurgical plate therapy was used for the first 8 months of the infants’ life. Conclusion Passive presurgical plate therapy in UCLP significantly reduced the cleft area. Implication for the subsequent surgical outcome might depend on the surgical technique used.