Repair of cleft palate by Philibert Roux in 1819

Cleft Palate Repair: A History of Techniques and Variations

Orofacial clefting is a common reconstructive surgical condition that often involves the palate. Cleft palate repair has evolved over three centuries from merely achieving anatomical closure to prioritizing speech development and avoiding midface hypoplasia. Despite centuries of advancements, there is still substantial controversy and variable consensus on technique, timing, and sequence of cleft palate repair procedures. Furthermore, evaluating the success of various techniques is hindered by a lack of universal outcome metrics and difficulty maintaining long-term follow-up. This article presents the current controversies of cleft palate repair and details how the history of cleft palate repair has influenced current techniques commonly used worldwide. Our review highlights the need for a global consortium on cleft care to gather expert opinions on current practices and outcomes and to standardize technique classifications. An understanding of global protocols is crucial in an attempt to standardize technique and timing to achieve anatomical closure with optimal velopharyngeal competence, while also minimizing the occurrence of maxillary hypoplasia and palatal fistulae.

Requirement for frzb and fzd7a in cranial neural crest convergence and extension mechanisms during zebrafish palate and jaw morphogenesis

Regulation of convergence and extension by wnt-frizzled signaling is a common theme in embryogenesis. This study examines the functional requirements of frzb and fzd7a in convergence and extension mechanisms during craniofacial development. Using a morpholino knockdown approach, we found that frzb and fzd7a are dispensable for directed migration of the bilateral trabeculae, but necessary for the convergence and extension of the palatal elements, where the extension process is mediated by chondrocyte proliferation, morphologic change and intercalation. In contrast, frzb and fzd7a are required for convergence of the mandibular prominences, where knockdown of either frzb or fzd7a resulted in complete loss of lower jaw structures. Further, we found that bapx1 was specifically downregulated in the wnt9a/frzb/fzd7a morphants, while general neural crest markers were unaffected. In addition, expression of wnt9a and frzb was also absent in the edn-/- mutant. Notably, over-expression of bapx1 was sufficient to partially rescue mandibular elements in the wnt9a/frzb/fzd7a morphants, demonstrating genetic epistasis of bapx1 acting downstream of edn1 and wnt9a/frzb/fzd7a in lower jaw development. This study underscores the important role of wnt-frizzled signaling in convergence and extension in palate and craniofacial morphogenesis, distinct regulation of upper vs. lower jaw structures, and integration of wnt-frizzled with endothelin signaling to coordinate shaping of the facial form.

John Stephenson's Cleft Palate

An account of the history surrounding the first successful surgical repair of a cleft palate, with excerpts from the patient's narrative.

Cleft lip-cleft palate closure: the unknown contributions of Harvey Cushing

BACKGROUND

The development of surgical repair of cleft lip-cleft palate closure has been well documented in the literature. However, the contributions of an unlikely pioneer, Harvey Cushing, in the development of cleft lip-cleft palate closure have been to date unknown.

METHODS

Patient surgical records from 1896 to 1912 at The Johns Hopkins Hospital documenting Harvey Cushing's cases were reviewed.

RESULTS

Three cases of Cushing's surgical closure of cleft lip-cleft palate, using a variety of techniques, are described and placed into historical context in the development of cleft lip-cleft palate surgery.

CONCLUSIONS

Harvey Cushing's contributions to the field of plastic and reconstructive surgery have largely remained unknown. The cases reported here illustrate the early work of this pioneering surgeon in the area of cleft lip-cleft palate surgery.