Early Management of Bilateral Total Cleft Lip and Palate

Coordination of maxillary orthopedics with surgical interventions for cleft lip and palate repair is described. The objective is to obtain optimal form and function during the whole course of development, performing every step at the most propitious moment and refraining from measures that could make later management more difficult. For this purpose the Čelešnik approach to bilateral lip repair and a two-step closure of the palate have been used in Zurich for the past six years, yielding to-date positive results: regular intermaxillary relationship, no need for expansion in deciduous dentition, cephalometric values within the range of normal variations, very satisfactory speech results.