Cleft Lip and Palate Repair: One-Stage versus Two-Stage Palatoplasty

Abstract

Introduction: Timing and technique of palatoplasty affect speech outcomes and facial growth. This review compares one-stage (complete palate repair in infancy) versus two-stage (delayed hard palate closure) palatoplasty.

Methods: A systematic review of studies reporting speech outcomes and craniofacial growth. Inclusion: non-syndromic cleft palate patients followed to at least five years of age. Outcomes: velopharyngeal insufficiency, need for secondary speech surgery, and maxillary retrusion.

Results: Twenty studies (n=1,452 patients) were included. One-stage palatoplasty at 9-12 months resulted in normal speech in 70% versus 55% for two-stage. Need for pharyngeal flap was lower with one-stage (15% versus 25%). Maxillary retrusion requiring orthognathic surgery occurred in 20% of one-stage versus 10% of two-stage patients. Two-stage allowed better midfacial growth but at the cost of worse speech.

Discussion: The trade-off between speech and growth is clear. One-stage prioritizes speech, two-stage prioritizes growth. Current consensus favors one-stage for isolated cleft palate but modified approaches for bilateral clefts.

Conclusions: One-stage palatoplasty is preferred for optimal speech outcomes. Two-stage may be considered when growth is the primary concern. Parent counseling should address this trade-off.