Managing labio-maxillarypalatal clefts: the Nancy protocol

Labio-maxillary-palatal clefts, which are caused by fetal nasal buds failing to fuse with the maxillary bud, disrupt the ensemble of the structures that support and interact with the nose and upper jaw creating a rupture of balance that becomes an increasingly exacerbating vicious circle. In correcting these defects practitioners must effect a compromise between the need to re-unite separated parts – under as little tension as possible – and the need to preserve the interrupted potential for growth in the affected facial region. They must carry out this compromise in the double sense of topography and chronology. Adhering to this therapeutic philosophy, the Nancy protocol closely associates orthopedic preparation and surgical treatment of patients to obtain: – high quality morphology, – an unblocked, sufficiently broad maxilla, – correct nasal breathing, – velo-pharyngeal competence. We use a tibial periosteal graft to repair the oral cleft as an important element of our procedures.