Anyone who has treated CLP knows the problems associated with skeletal growth occurring during treatment. There were numerous attempts to find out the source of these problems to improve treatment. It was assumed that a growth deficit results from the malformation, which causes the skeletal changes. Deficient growth of the jaws in patients with CLP was often regarded as genetic disorder. A host of treatments such as complicated surgical techniques combined with extensive orthodontic treatment were designed to improve the outcomes in cases of cleft lip, alveolus, and palate, many of which ended in an osteotomy to correct skeletal harmony after growth had stopped. Doubts about this inevitable development were expressed by Schilli (1963), who was the first to point out that reconstruction of the orbicularis oris muscle could be important in the development of the facial skeleton. Delaire (1977) recognized that to attain normal skeletal growth of the midface in cases of cleft lip, alveolus, and palate, not only have the perioral muscles to be reconstructed, but also the perinasal and midfacial muscles. It finally became evident that the underdevelopment of the midface in cases of CLP was the result not of genetic factors, but mainly of malfunction. The goal of our surgical measures must therefore be the timely reconstruction of the functional units interrupted by the cleft formation to encourage normal development as early as possible.
Long-term outcomes in management of UCLP and BCLP taking into consideration anatomy and growth will be presented with over 30-year experience.