Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Abstract

Background:The optimal timing for cleft lip repair has yet to be established. Advances in neonatal anesthesia, along with a growing body of literature, suggesting benefits of earlier cleft lip and nasal repair, have set the stage for a reexamination of current practices.Methods:In this prospective study, cleft lip and nasal repair occurred on average at 34.8 days (13–69 days). Nasal correction was achieved primarily through molding the nasal cartilage without the placement of nasal sutures at the time of repair. A standardized anesthetic protocol aimed at limiting neurotoxicity was utilized in all cases. Anesthetic and postoperative complications were assessed. A 3-dimensional nasal analysis compared pre- and postoperative nasal symmetry for unilateral clefts. Surveys assessed familial response to repair.Results:Thirty-two patients were included (27 unilateral and 5 bilateral clefts). In this study, the overall complication rate was 3.1%. Anthropometric measurements taken from 3-dimensional-image models showed statistically significant improvement in ratios of nostril height (preoperative mean, 0.59; postoperative mean, 0.80), nasal base width (preoperative mean, 1.96; postoperative mean, 1.12), columella length (preoperative mean, 0.62; postoperative mean, 0.89; and columella angle (preoperative mean, 30.73; postoperative mean, 9.1). Survey data indicated that families uniformly preferred earlier repair.Conclusions:We present evidence that early cleft lip and nasal repair can be performed safely and is effective at improving nasal symmetry without the placement of any nasal sutures. Utilization of this protocol has the potential to be a paradigm shift in the treatment of cleft lip and nasal deformity.

Sustainable Cleft Care Through Education: The First Simulation-Based Comprehensive Workshop in the Middle East and North Africa Region

“…With these issues in mind, we sought to organize the first simulation-based comprehensive educational cleft care workshop in the Middle East and North Africa in an attempt to promote regional cleft care sustainability through capacity building and education. The benefits of a standardized multidisciplinary approach in cleft care are well recognized (Allori et al, 2017;Hammoudeh et al, 2017;Perillo et al, 2018). Surgeons, speech pathologists, orthodontists, and nurses must be involved in the longitudinal care of patients with cleft lip and/or palate for optimal preoperative assessment, presurgical optimization, surgical repair, and postoperative follow-up from birth to adulthood.…”

Impact of COVID-19 on Cleft Surgical Care

“…Surgeries conducted after 4 months of age, 12 months of age, and 108 months of age (9 years) were classified as late procedures for primary CL repair, primary CP repair, and ABG, respectively. [3][4][5]7,9 ABG augmentations (ABG subgroup), revisional surgeries, and secondary repairs were excluded from this analysis as they do not follow explicit timelines. Untimely surgeries were classified based on their causality and included acute illnesses, difficulties with coordinating patient care, complex pre-existing conditions, COVID-19, dental immaturity (ABG subgroup only), and unspecified.…”

“…1 Philosophies regarding the optimal timing of cleft surgeries vary across craniofacial centers. [2][3][4][5] Surgeons at our institution generally repair cleft lip (CL) deformities by 4 months of age and cleft palates (CP) by 12 months of age. These timings, in accordance with guidelines issued by the American Cleft-Palate Craniofacial Association (ACPA), have served our patients well in regard to aesthetic and speech outcomes, respectively.…”

Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair

“…Cleft lip (CL) and cleft lip and palate (CLP) result from inappropriate facial fusion during the fetal period of development. The most appropriate timing of CL repair is still the subject of expert discussions (Hammoudeh et al, 2017). The operation can be divided according to its timing into early repair (neonatal), which is carried out in the first 2 weeks after birth, most often several days after birth and the late repair (around the age of 3 months of life).…”

“…The advantages of early CL repair are faster healing, better acceptance of surgery by parents and better nasal and cleft repair (Calteux et al, 2013, Hammoudeh et al, 2017. There are, however, some variations in timing depending on the specialized center.…”