A review of cleft lip and palate management: Experience of a Nigerian Teaching Hospital

Efunkoya, Akinwale A; Omeje, Kelvin Uchenna; Amole, Ibiyinka; Osunde, OD; Akpasa, Izegboya Olohitae

doi:10.4103/0189-6725.172566

Cited by 13 publications

(8 citation statements)

References 11 publications

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“…Longer hospital stays are associated with increased risk of complications and resource utilization, with the additional newfound risk of potential exposure to COVID-19. Efunkoya et al 35 reported that patients remain in the hospital for 7 days after cleft lip and palate repair for monitoring in a Nigerian teaching hospital. Hush et al 29 found that the length of hospital stay after cleft palate repair has reduced from 1.83 to 1.16 days following implementation of ERAS protocol.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings

Melhem

Ramly

Abyad

et al. 2022

The Cleft Palate Craniofacial Journal

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Introduction Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. Methods A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. Results Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. Conclusion The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings

Melhem

Ramly

Abyad

et al. 2022

The Cleft Palate Craniofacial Journal

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“…[ 10 11 12 13 14 15 ] CLA was the most common diagnosis made which concur with previous local studies which also showed a similar trend. [ 15 16 ] Other authors have however reported CL and palate to be more prevalent in their centers. [ 17 18 19 20 ] Furthermore, similar to previous studies, we found unilateral clefts occurring more often on the left than the right side.…”

Section: Discussionmentioning

confidence: 99%

Management of orofacial cleft in Nigeria - A retrospective study

James

Adekunle

Adamson

et al. 2020

Ann Maxillofac Surg

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Introduction: Orofacial clefts (OFCs) are among the most common craniofacial developmental abnormalities worldwide and a significant cause of childhood morbidity and mortality. This study aimed to identify patterns of patient presentation, treatment approaches, and changes in our overall cleft care service between 2007 and 2019. Methods and Methodology: A retrospective review of patients managed at a tertiary health facility in Nigeria of all OFC cases operated between 2007 and 2019 was done using the postintervention data retrieved from the Smile Train database. Data of all OFC cases operated within the period were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed using the Statistical Package for the Social Sciences version 20.0. Results: A total number of 740 OFC surgeries were performed in 565 patients, consisting of 269 females (48.2%) and 289 males (51.8%). The majority (63%) of the patients presented before the age of 2 years. Thirty-seven percent presented with cleft lip and alveolus, 27.1% with cleft palate only, and 36.7% with cleft lip, alveolus, and palate. Primary cleft lip repair was the most performed surgery (n = 320, 43.2%), the mean age at repair was 2.1 years. Since 2017, additional services such as speech therapy, mixed dentition orthodontics, and nutritional support were added to services provided to our cleft patients. Fifteen patients have undergone speech assessment and three have completed speech treatment. Eight patients have undergone mixed dentition stage orthodontic treatment. Discussion: Our services have evolved from simply providing surgical care to comprehensive care with a multidisciplinary team approach and provision of a wide range of services including nutritional counseling, pediatric care, orthodontic services, and speech therapy. We believe these will improve the overall well-being of our patients while we continue to improve on services based on clinical research outcomes.

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“…Many surgical techniques have been advocated to improve the result of cleft surgery. 7 It is obvious that every surgeon attempts to prevent complications following these surgical procedures. However, the surgeon may be trapped unwittingly into some pitfalls.…”

Section: Discussionmentioning

confidence: 99%

“…Collected data included age, sex, type of cleft, and types of complication associated were analyzed using Statistical Package for Social Sciences (SPSS) for windows student version 13.0 (SPSS Inc., Chicago, IL, USA). 7 Statistical significance was inferred at P < 0.05.…”

Section: Methodsmentioning

confidence: 99%

Postoperative complications from primary repair of cleft lip and palate in a semi-urban Nigerian teaching hospital

et al. 2016

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Background:This paper seeks to investigate the incidence of short-term postoperative complications in children and adult patients undergoing primary surgery of cleft lip and palate.Patients and Methods:One hundred and fifteen patients consisting of children (below 12 years) and adult (12 years and above) who were operated for both cleft lip and palate within a 2-year period at the University of Maiduguri Teaching Hospital were reviewed postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year intervals, respectively. The complications encountered within the periods of the review were recorded.Results:One hundred and twenty surgeries were performed on 115 patients (85 children 30 Adults). A total of 43 complications (31 in children and 12 in adults) were recorded over the study period. Eighteen (41.9%) of these complications were noticed in unilateral cleft lip repair, while 12 (27.9%) and 13 (30.2%) complications were observed in bilateral cleft lip and cleft palate surgeries, respectively. A higher complication rate (72.0%) was recorded in children compared with adults. Major complications (13.9%) were, however, observed more in adults than children.Conclusion:Although every surgeon attempts to prevent complications during surgery, they may still occur. The high complication rate observed in our study may be due to a small sample size. General complications observed among children are due to cross infection during a hospital stay, contributing immensely to the higher rate of complications in children. Moreover, this may be reduced by short hospital stay following surgery. We also advocate early contact with children with cleft, and early surgical intervention in other to prevent some of the major complications encountered in adult patients.

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A review of cleft lip and palate management: Experience of a Nigerian Teaching Hospital

Cited by 13 publications

References 11 publications

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings

Management of orofacial cleft in Nigeria - A retrospective study

Postoperative complications from primary repair of cleft lip and palate in a semi-urban Nigerian teaching hospital

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