Primary Surgical Protocol and Early Maxillary Growth in Unilateral Cleft Lip and Palate: Talmant Versus Malek-A Retrospective Comparative Study
In brief
Talmant cleft protocol linked to positive overjet in 82% vs 33%
Among 54 children assessed at age 4, positive overjet was more common after the Talmant protocol than after the Malek protocol, and dental arch relationship scores were also better. The retrospective comparison cannot separate the protocol from changes over time or the surgeon, and a single unblinded examiner scored the primary outcome, so the findings show an association, not cause and effect.
- Journal
- The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association (Q1)
- Published
- 3 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Clara Chauvet-Jauseau, Guillaume Captier, Caroline Baumler, François Boutin, Stéphane Barthélemi, Ayoub Chaouati
- PMID
- 42974742
- DOI
- 10.1177/10556656261503760
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 6 November 2026): Comparative cleft palate protocols and early maxillary growth outcomes
Abstract
ObjectiveTo compare early maxillary growth at age 4 in non-syndromic complete unilateral cleft lip and palate (UCLP) between 2 sequential primary surgical protocols.DesignRetrospective before-after comparative cohort study of 2 successive treatment periods.SettingSingle tertiary cleft center, 1990 to 2019.PatientsFifty-four patients with non-syndromic complete UCLP (21 Malek, 33 Talmant).InterventionsMalek protocol (veloplasty at 3 months, cheilo-palatoplasty at 6 months) versus Talmant protocol (cheilo-veloplasty at 6 months, delayed palatoplasty at 18 months).Main Outcome MeasuresGOSLON (Great Ormond Street, London, and Oslo) Yardstick score (primary); overjet and intercanine distance (secondary), assessed on dental casts at age 4.ResultsGroups did not differ in sex, cleft side, or lateral incisor status. GOSLON scores were better in the Talmant group (median 2 [interquartile range (IQR), 1-3] versus 3[3-4]; Mann-Whitney P < .001). Positive overjet was more frequent with Talmant (82% vs 33%; Fisher P < .001; adjusted odds ratio (OR) = 9.10; 95% confidence interval (CI): 2.53-38.7). Intercanine distance did not differ (adjusted β = 1.7 mm; 95% CI: -0.01-3.3; P = .051, inconclusive).ConclusionsDelayed hard-palate closure was associated with better dental arch relationships and more frequent positive overjet at age 4. Because the protocols were used in successive periods and because the Talmant protocol was performed by a single surgeon, neither a period effect nor a surgeon effect can be separated from a protocol effect. The primary outcome was scored by a single non-blinded examiner without reliability testing; these findings are therefore hypothesis-generating and represent an association, not evidence of causation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.