The correction of cleft palate with primary veloplasty and delayed repair of the hard palate.

Optimal repair of the cleft palate requires meticulous balance of the effects of the procedure on craniofacial growth, dentition, and speech. Aggressive, early closure of the entire palate was practiced by the senior author many years ago. Successful closure with reasonable speech was produced at the price of severe facial and dental disturbance. Patients were adversely affected for many years before the "antisurgery war-cry" of dentists and orthodontists tempered our enthusiasm. In the past 5 or 6 years, the din of speech therapists again advocating early closures has arisen. Besieged on both sides, the plastic surgeon must temper the demands of both camps, seeking the overall benefit of the patient. We believe that primary veloplasty and delayed hard-palate closure as demonstrated in this series provide superior speech with minimal deleterious side effects. The results of intravelar veloplasty, when combined with two-step closure, are especially gratifying. It is hoped that the further refinement of this technique in the past several years will improve results even further.