Adopted children with cleft lip or palate, or both, require special needs cleft surgery

Abstract

In recent years adoption of children with cleft lip, with or without cleft palate (CLP), and other birth defects has become more common. The aim of the present study was to describe the characteristics and initial care and treatment of adopted children with CLP. A total of 25 children were referred to our department between 2008 and 2010, 7 (28%) of whom had bilateral CLP and 16 (64%) had unilateral CLP. Two children had atypical clefts. Twenty of the patients (80%) had been operated on with a lip plasty in China before adoption. Most patients (n = 14) was seen by the cleft team within two months of arrival, and 13 were operated on within a month of the first visit at our department. In total, 22 primary palatoplasties, 6 lip plasties, and 1 lip adhesion were done. There were 5 fistulas (14%) three months after the palatoplasty. On arrival, 11 (44%) of the children were carriers of methicillin-resistant Staphylococcus aureus (MRSA). Adoption of children with CLP creates new challenges for the cleft teams, as we no longer have control over the overall treatment plan as regards preoperative and surgical treatment and timing of the operations. The patients are also often carriers of resistant bacteria, which create nursing challenges. In cases where the child is older than a year and has not been operated on, we advocate that the palatoplasty, or combined lip plasty and palatoplasty, is always given priority so that speech development is not compromised.

Children with orofacial clefts : dental caries and health-related quality of life

“…Most of them had primary lip surgery performed before arrival to Sweden and most part of the adoptees had complete clefts (25 children UCLP and 13 BCLP), which is in accordance with Hansson et al (2012) reporting that 80% of the adoptees from China with CL/P are operated when arriving to Sweden and have more often BCLP then the native population. Only two children in the non-cleft group were adopted, one from China and one from Russia.…”

Velopharyngeal Insufficiency Rates After Delayed Cleft Palate Repair

“…1,2 Whereas patients in the United States typically undergo palatoplasty between 9 and 12 months of age, 3 or at the latest before 18 months of age, 4 social circumstances often result in delayed repair for internationally adopted patients. In addition, adopted patients and their families undergo additional challenges in that they are forming new relationships within the family and that patients must adapt to a new language and culture.…”

“…In addition, adopted patients and their families undergo additional challenges in that they are forming new relationships within the family and that patients must adapt to a new language and culture. 1,2 Outcomes studies for internationally adopted patients with cleft palate are extremely rare. In our literature search, we have not found any studies from the United States.…”

Long term speech outcomes following late cleft palate repair using the modified Furlow technique

“…In this group, timely palate repair may aid the new parent-child interactions, as parents are better able to use face-to-face play and respond to social cues from their child [26][27][28]. When comparing the adopted population to the nonadopted population undergoing late repair, hypernasality scores were significantly less severe in the adopted population during the first time point (p = 0.04).…”