Hard palate closure performed in a separate operation

In patients with isolated palatal clefts, the soft palate is operated at four to six months of age. In those patients who have a cleft that also involves the hard palate, a residual cleft will persist in the hard palate after soft palate repair. As the patient grows, the cleft in the hard palate will decrease in size. At around one-and-a-half and two years, the size of the hard palate cleft is often very small and can be closed by a less extensive operation.  

If a complete cleft in the hard and soft palate is closed in the first stage (early), several studies have shown that growth of the maxilla may be affected. This may result in the crowding of the teeth, malocclusion and possibly restricted midfacial growth.