Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: The Cleft Care UK study

Abstract

Objects To describe the range of surgery used to repair the lip and palate in the UK with specific interest in the sequence/timing used in complete unilateral cleft lip and palate (cUCLP). Setting and Sample Population The Cleft Care UK study, a cross‐sectional study of 268 5‐year‐olds, born from 2005 to 2007, with complete unilateral cleft lip and palate. Materials & Methods Information on surgery was extracted from medical notes by surgeons during research clinics and transcribed onto a standardized questionnaire. Results Surgical data were available for 251 (94%) children from all cleft centres in the UK (n = 18). Over a two‐year period, 32 surgeons used 10 different surgical sequences in primary repair of the cleft lip and palate. The most frequently used sequence was repair of cleft lip and anterior hard palate followed by repair of posterior hard palate and soft palate (70%). Four surgical sequences were used only once. Most surgeons had a preferred sequence, but 38% (11/29) used more than one sequence during the study period. The timing of repair of the lip, the hard palate and the soft palate varied with surgical sequence, and also between surgeons, even adjusting for the different sequences used. Conclusion Despite centralization of cleft services in the UK, there remains considerable variation in both the sequence and timing of surgical repair of cleft lip and palate in infancy. Further work is required to understand whether these factors are associated with differences in outcome.

Early Assessment of Speech: Useful Clinical Indicators of Later Outcomes

“…Children born with cleft palate in the developed world typically undergo surgery to repair the palate between six and eighteen months [14]. Timing of the surgery is an area under investigation as an unrepaired cleft of the palate during the period of development described above, can inevitably cause disruption to the typical trajectory.…”

Innovative Molecular and Cellular Therapeutics in Cleft Palate Tissue Engineering

“…35,36 As midfacial growth and speech development do not occur in unison, disagreement exists as to the timing of palatoplasty most compatible with normal speech development and that does not restrict maxillary growth. [37][38][39][40][41][42] Some fear that a cleft in the soft palate that persists past 1 year of age may impair normal development of speech mechanisms, therefore, favoring earlier palatoplasty. Conversely, others are concerned that early palatoplasty may impair midface growth, thus arguing for delaying intervention until midface growth is nearing completion.…”

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

“…Many causes of variation in outcomes have been proposed, including individual patient factors (eg, cleft type, cleft width), population differences, and treatment factors. Treatment factors include timing of surgery, differences in surgical technique, differences in surgical experience (learning curve), and innate surgical ability (Rautio et al, 2017;Slator et al, 2020). The main interest of this article is to examine the different ways individual surgeons perform the same palate operation; subsequently, this assessment could form a foundation to explore whether small differences in surgical technique are a factor influencing variation in outcomes.…”