Cleft palate: modern technology and neuroscience merge.

This is a report of a cleft palate-craniofacial team's experience with 768 patients that have had clefting over 22 years, with a primary focus on function and prevention of communication disorders associated traditionally with cleft palate. The treatment philosophy is based on tenets of child development and the dependency of neuropsychobiological development on the child's inherent competency, and early environmental stimulation and support. The applied treatments include ensuring early and adequate hearing, psychosocial adaptation of the parent and child through training for applications of indirect therapies, and early fistula-free surgical closure of the cleft that produces minimal scarring and a mobile velum. Team members have extensive backgrounds in child development that seem to have helped the majority of families in their complex efforts of daily care and sensory stimulation, and their children have developed early the ability to adapt modified structures to normal functions. Only one of these patients has needed or received secondary palatal surgery for correction of velopalatal insufficiency. Fifty-six children who did not achieve acceptable 2 to 3-year old communication criteria were referred for speech and language evaluation and therapy. These patients were reported to exhibit oral motor deficits described as developmental verbal dyspraxia.