Optimal timing of cleft palate closure. Speech, facial growth, and hearing considerations.

We have presented an updated overview of the controversy surrounding the timing of cleft palate closure based upon the goals of cleft palate surgery: attainment of normal speech, maxillofacial growth, and hearing. From a critical analysis of the conflicting literature in these areas, we have developed our own philosophy of the cleft palate closure over the past decade that incorporates these three primary goals in the multidisciplinary care of the cleft palate patient. We feel that only through an objective, long-term, goal-oriented, prospective study of our patients will we be able to obtain realistic data in this controversial area. To date, there are no long-term, prospective, double-blind studies available in the area of cleft palate surgery. In the interim, we must objectively assess our results and, above all, adhere to the primary principle of medicine of doing no harm in the multidisciplinary management of the cleft palate patient.