Article révisé par les pairs
Résumé : The priority in the treatment of facial clefts is to avoid the iatrogenic sequellae by restoring a normal anatomy of the face. The difficulty of this treatment is that the majority of the sequellae are only observed 15 years after the primary treatment. After having treated out children during more than 20 years by a primary closure of the lip at 6 months and closure of the palate by push back according to Veau Wardill at 18 months, we adopted the technique of René Malek since 1981 with early closure of the palate at 3 months then, without undermining of the palatal mucosa, closure of the bony palate with a vomer flap at the age of 6 months. Since 1988, in unilateral complete cleft, we perform a complete closure of the lip and palate at 3 months according to the same surgical principles. The study of the dental casts according to the Golson Yardstick at the age of 10 and the cephalometric study by lateral Xrays at the age of 15 show an excellent facial growth in the majority of the cases with only 6 % needing a osteotomy at the end of growth. Moreover the phonation of these children was very good in the majority of the cases, 15 % only needing a secondary surgery. The only remaining sequellae are in the auditory field with an abnormal frequency of sero mucous otitis. These could not be improved until now despite the early use of tympanic drains. © 2002 Éditions scientifiques et médicales Elsevier SAS.