Adverse Effects of Early Palatoplasty on Maxillary Growth in Patients with Cleft Palate: A Contemporary Systematic Review
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Abstract
Background:
The optimal timing of palatoplasty in cleft palate repair remains a persistent clinical controversy despite advances in cleft care protocols and surgical techniques. Evidence continues to suggest that early palate closure (before 18 months of age), although beneficial for speech development, may adversely affect maxillary growth because of fibrosis, scar contracture, and tension across craniofacial growth centers. With evolving treatment philosophies and modern multidisciplinary cleft care, an updated synthesis of recent evidence is necessary to clarify the current understanding of the long-term dentofacial consequences of early palatoplasty.
Objective:
To systematically evaluate and synthesize contemporary evidence published between 2020 and 2025 on the adverse effects of early palatoplasty on maxillary growth and craniofacial skeletal development compared with late or staged repair in patients with cleft palate.
Methods:
This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A focused search of recent literature published from January 2020 to October 2025 was performed using PubMed, Cochrane CENTRAL, and ClinicalTrials.gov to identify studies comparing maxillary growth outcomes between early (<18 months) and late (≥18 months) palatoplasty. Eligible studies included randomized controlled trials and comparative observational studies involving non-syndromic cleft palate patients. Extracted outcomes included contemporary cephalometric indices (SNA, ANB, Co-A), dental arch dimensions, and occlusal classifications. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle–Ottawa Scale.
Results:
Seven eligible studies (n = 865) were included. Across studies, early palatoplasty was consistently associated with reduced SNA and Co–A values, narrower maxillary arch widths, and higher GOSLON Yardstick scores, which indicate more arch constriction and maxillary retrusion. These effects were lessened but not completely eliminated by muscle-preserving and two-stage palatoplasty procedures.
Conclusion:
Measurable adverse effects on maxillary growth are linked to early palatoplasty. The timing of surgery should be patient oriented, weighing the advantages of early speech against the long-term results of craniofacial growth.
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