Delayed hard palate closure: the philosophy revisited.

Delaying surgical closure of the hard palate in children with cleft lip and palate has become increasingly popular. This essay is a review of the rationale and supporting evidence for this procedure, with emphasis on its effect on speech, particularly articulation and velopharyngeal function. We have concluded that the assumptions on which this method is based have never been proven, and that the deleterious effects on speech often noted have not received appropriate attention.