The management of the cleft lip and palate patient.

We believe that early closure of the hard palate defect with a palatal appliance and surgical closure of the lip and soft palate according to the rule of tens are very important. Delaying the hard palate closure allows for maximal growth of the palatal shelves. We also feel that pressure equalizing tubes placed in the ears at the initial surgical procedure allows for more normal function of the middle ear, less middle ear infections, better hearing, and ultimately better speech. We feel that early closure of the soft palate may decrease velopharyngeal incompetence by normalizing the position of the pterygoid plates. It may also help to reduce serous otitis media by improving eustachian tube function.