The role of primary surgery in the management of orofacial clefting

Cleft lip and/or palate includes a spectrum of congenital disorders affecting union on the lip, alveolus, hard and/or soft palate. The management of children born with an orofacial cleft requires a complex process from a multidisciplinary team (MDT) to restore form and function. Since the Clinical Standards Advisory Group (CSAG) report in 1998, the UK has reformed and restructured cleft services to improve the outcomes for children born with a cleft.The spectrum of cleft conditions, the members of the MDT and a chronological description of the stages of cleft management from diagnosis to adulthood are described using a clinical example. This paper forms the introduction to a series of more detailed papers which span all major aspects of cleft management. The papers will cover the following topics: dental anomalies; associated medical conditions among children; orthodontic management of patients; speech assessment and intervention; role of the clinical psychologist; challenges for the paediatric dentist; genetics and orofacial clefts; surgery - primary and secondary; restorative dentistry; and global perspectives.

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An introduction to the UK care pathway for children born with a cleft of the lip and/or palate

Dudding

Martin

Popat

2023

Br Dent J

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Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for Alveolar Bone Grafting

Balumuka,

Daly,

Krakauer

et al. 2024

The Cleft Palate Craniofacial Journal

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Objective This study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP). Design/Setting Retrospective university hospital single center study. Patients Children with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded. Interventions Included patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher's exact tests were utilized for statistical analysis. Main Outcome Measure The need for ABG. Results Of the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age ( P = .004) and at the time of initial cleft lip repair ( P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only ( P = .015). The operating surgeon impacted the likelihood of ABG ( P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG. Conclusion GPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.

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A GDP's Guide to Cleft Lip and Palate

Bilkhoo,

Rivers,

Devlin

2024

Dent Update

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General dental practitioners form a vital part of the multidisciplinary team for cleft lip and palate management and their role in treatment and prevention is key to ensuring successful outcomes. This article highlights key dental aspects to be aware of when treating this cohort of patients and summarizes the input of other medical specialties involved in care from birth to adulthood. CPD/Clinical Relevance: Knowledge of the pathway for patients born with cleft lip and palate is fundamental for GDPs.

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The role of primary surgery in the management of orofacial clefting

Cited by 3 publications

References 37 publications

An introduction to the UK care pathway for children born with a cleft of the lip and/or palate

An introduction to the UK care pathway for children born with a cleft of the lip and/or palate

Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for Alveolar Bone Grafting

A GDP's Guide to Cleft Lip and Palate

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