Cleft Opinion

One baby out of every 800 is born with a cleft palate. Uncorrected, the condition makes normal speech impossible. Rival schools in medicine and dentistry have long argued over the best time and the best way to perform surgery to help these handicapped children. Most orthodox surgeons favor operating at about 18 months--to prevent the development of bad speech habits and to ward off nose and throat diseases.

In the current Journal of Pediatrics, an outspoken young (33) Chicago dentist, Dr. Touro M. Graber, charges that early surgery often does more harm than good. Dr. Graber's basic argument: physicians generally have tended to ignore the fact that the upper and lower jaws do not grow at the same rate.

At Northwestern University's Cleft Lip and Palate Institute, Orthodontist Graber and other researchers emphasize that five-sixths of the upper jaw's growth is completed in the first five years of life, while the lower keeps on growing for another dozen years or more. When surgery is performed to close a cleft palate in an infant only one or two years old, Dr. Graber says, the growth of the upper jaw may be stunted, tooth buds are often destroyed, and normal growth of the lower jaw eventually produces a grotesque appearance.

The solution favored by Dr. Graber is to put off surgery* until the child is four or five years old. This need not mean that the child cannot learn to talk, or must learn wrong ways of talking. Dr. Graber holds: a plastic false palate can be fitted to close the cleft, and worn until the age when surgery becomes desirable.

Although there were M.D.s (including surgeons) on Northwestern's team, first comments by other surgeons on Dr. Graber's paper were sharply critical. Bad results from early operations, they argued, were uncommon, and happened because the surgeon was not as skillful as he should have been. Apparently it would take years--until many more children treated by Northwestern's method have reached jaw-growth maturity--for the results of the two systems to be compared, and the argument settled.

* Except for harelip (a condition usually found with cleft palate), for which operations may begin when the baby is only a few days old.

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