Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice. 1. Introduction Orofacial clefts are the most prevalent craniofacial birth defects and the second most common birth anomaly, second only to clubfoot [1]. In the United States of America, it is estimated that $100,000 are spent to rehabilitate a child born with oral cleft [2]. The approach of the patient with cleft lip and palate is multidisciplinary, and the cleft team should be ideally composed by craniofacial surgeons, otolaryngologists, geneticists, anesthesiologists, speech-language pathologists, nutritionists, orthodontists, prosthodontists, and psychologists, and to be capable of treating even rare facial clefts with excellence, neurosurgeons, and ophthalmologists. In this manner, it is possible to provide long-term followup through the entire child’s development and achieve all of the following treatment goals: normalized facial aesthetic, integrity of the primary and secondary palate, normal speech and hearing, airway patency, class I occlusion with normal masticatory function, good dental and periodontal health, and normal psychosocial development [3]. The most broadcast treatment modalities in the management of unilateral cleft lip and palate are listed in Table 1 (chronologic age) and Table 2 (dentofacial development). Table 1: Treatment modalities in the management of unilateral cleft lip and palate which are often based on chronologic age. Table 2: Treatment modalities in the management of unilateral cleft lip and palate which are often based on dentofacial development. The presented management of cleft lip and palate
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