Functional matrix cleft repair: principles and techniques

The concept of functional matrix surgery arose from analysis of observable biologic behavior in patients with a cleft (ie, the almost inevitable pattern of relapse after conventional repair). The deterioration seen over time after initially excellent surgery is not technical but conceptual in origin. Physicians' understanding of the cleft problem continues to be based on a model of facial "processes" developed from the light-microscopic observations of Wilhelm His, almost 150 years ago. For all practical purposes, traditional embryology is about as relevant to cleft surgeons as Sanskrit. The "molecular revolution" has melded together developmental anatomy and genetics to create a new and clinically relevant model of facial development [1 - 10]. This article outlines the scientific rationale for cleft repair based on this model.