Cleft lip and palate are congenital deformities, which, because of their frequency and localization to the orofacial region, are of great significance to the oral and maxillofacial surgeon. Although confined to a fairly small anatomic region, the typical cleft deformity requires significant specialized care by many disciplines. Nearly 15 years ago, the American Cleft Palate – Craniofacial Association (ACPCA) proposed parameters of care designed to help standardize the management of cleft patients. The goals of these cleft teams are to carry out periodic assessments and make suggestions regarding timing and sequencing of care. Although mainly a North American phenomenon, the ACPCA guidelines have been taken on a global front and interpreted differently by many countries. The result has been a vast array of management protocols without universal standardization.
Because it is neither practical nor desirable to expect all surgeons worldwide to conform to a single surgical technique, I have elected to divide the lip and palate into the 2 most popular techniques for repair. For the primary unilateral cleft lip-nose repair utilizing modified Millard technique, Drs. Costello and Ruiz provide a very detailed and thorough breakdown of this popular technique. Dr. David Precious provides an interesting and eloquent description of the primary unilateral cleft lip-nose repair as well as the bilateral primary cleft lip-nose repair, both utilizing the Delaire technique. The primary bilateral cleft lip-nose repair utilizing the modified Millard technique is also described by the editor. Relative to primary palatal repair, this is divided into the modified Von Langenback technique described by Dr. Kevin Smith and the primary palatoplasty utilizing a Furlow technique described by Dr. Bruce Horswell. The alveolar cleft repair is described in detail by Dr. Bruce Epker. I am indebted to these experienced surgeons for providing their time and efforts to this Atlas. I am hopeful that an overview of these techniques, as provided in this Atlas, will be of value to those practicing oral and maxillofacial surgeons and residents interested in the field of cleft surgery.