Objectives for cleft palate repair.

Improved anesthesia and nutrition are permitting earlier safe cleft palate repair, with higher success rates. Three factors that are considered necessary to obtain satisfactory function of the soft palate for speech are (1) adequate length, (2) adequate mobility, which should include consideration of resting tension and elasticity of the levator and depressor muscles, and (3) the need for conformity of the dorsal surface to the pharyngeal wall, which this paper seeks to emphasize. These concepts are examined with reference to the literature and observations made by the author from endoscopic and x-ray studies and from electrical stimulation of the palate muscles prior to palate repair. A technique for relocating the musculus uvulae is described. It is concluded that at least 9 out of 10 palates are long enough at birth and have sufficient mobility, provided that this is not impaired iatrogenically, to obtain satisfactory speech. Emphasis needs to be placed on providing a normal dorsal convexity and, where levator activity appears to be inadequate, means need to be found whereby inappropriate activity or tension of the palate depressors can be diagnosed and effective treatment devised.