Cleft Lip and Palate Surgery during COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic has caused a negative impact in every sector of life, especially in the health sector. Patients with different medical conditions are suffering delays in their surgical treatments. Cleft lip and palate is a common congenital disease that requires early interdisciplinary attention, and there is uncertainty about the safety of performing its surgical treatment during the COVID-19 pandemic. The objective of this study was to evaluate the safety of a surgical cleft protocol for cleft lip and palate used during the COVID-19 pandemic at a high volume cleft center in Lima, Peru. Methods: This is a comparative study between two groups of patients with nonsyndromic cleft lip and palate who were operated on before and during the COVID-19 pandemic. Data collection was done by evaluation of presurgical condition, and surgical and nonsurgical postoperative outcomes and complications. Results: Significant differences were observed regarding both the age of the patients at the time of the primary surgeries, and surgical times between the two groups. Nonstatistical significant differences were observed between the two groups regarding the presurgical conditions, postoperative outcomes, and complications. Rate of COVID-19 infection was 1.25%. Conclusions: The surgical protocol used for cleft lip and palate repair during the COVID-19 pandemic is a safe method based on the observed postoperative outcomes. However, the COVID-19 pandemic caused delays of the time of the primary cleft lip and palate repair, and its long-term impact should be well evaluated.

Adapting Elements of Cleft Care Protocols in Low- and Middle-income Countries During and After COVID-19: A Process-driven Review With Recommendations

“…There is a need for prioritization within the cleft protocol despite each element of comprehensive cleft care having equal importance, because some elements are time-sensitive and linked to functional outcomes, therefore their delay would lead to irreversible harm ( Rossell-Perry and Gavino-Gutierrez, 2021 ). Prioritization of care according to clinical urgency has been widely encouraged as a vital part of reestablishing elective services amidst the backlog of untreated cases ( Royal College of Paediatrics and Child Health, 2020 ).…”

“…The working group looked at safety protocols in common use before the pandemic and made recommendations on adaptations to consider specifically for COVID-19. Some of these adaptations, such as COVID-19 testing, will come at an increased monetary cost, and this is likely to be problematic in LMICs, where resources were already limited ( Rossell-Perry and Gavino-Gutierrez, 2021 ). On the other hand, some COVID-19 adaptations represent innovations and the advances in telemedicine in particular, which has proven to be successful for preoperative COVID-19 screening and speech therapy delivery, may be well suited to LMICs ( Ramanathan et al, 2021 ).…”

“…Projections using data from 67 LMICs estimated 25,000 fewer cleft operations performed during 2020 compared to 2019 ( Vander Burg et al, 2021 ). In Peru, children born with CL/P were having primary reconstructions at a significantly older age during the pandemic when compared to a prepandemic cohort, with delays most marked in primary cleft lip and nose reconstruction ( Rossell-Perry and Gavino-Gutierrez, 2021 ). Prioritizing cleft care in an overcrowded healthcare system when the pandemic ends will be challenging, even in high resource settings ( Breugem et al, 2020 ).…”

A Pandemic in Review: The Impact on Surgical Volume of Cleft Lip and Palate

“…8 However, given the lasting impairment linked to the delay of treatment of cleft lip and cleft palate, it may be regarded as essential by definition. 9 While surgical repair of cleft lip or cleft palate is not regarded as fully elective, healthcare policy changes amidst the pandemic may have led to a delay in care for these conditions. ACPA modified guidelines, instructing providers to delay treatment to ensure patient safety during.…”

Application of postoperative analgesia with different doses of nalbuphine in children with cleft palate

“…During our study continuing, the COVID-19 pandemic occurred. But The surgical protocol used for cleft lip and palate repair was a safe method based on the observed postoperative outcomes [23].…”