The Rule Of “10’s” in the Management of Unilateral Cleft Lip Children: The Komfo Anokye Teaching Hospital Experience

Abstract

Background: Despite significant advances in cleft lip and palate (CLP) care, the often quoted "rule of 10 s" has not been objectively investigated concerning its practicality since its inception, especially, in low-resourced country like Ghana. Aim of the Study: This was to evaluate the unilateral cleft lip weight, haemoglobin and surgical repair outcome by considering the "Rule of 10's". Materials and Methods: A retrospective study of all consecutive patients who presented with unilateral cleft lip and were operated on during the period 2011 to 2015. The information retrieved from the patient's records included the following at the time of surgery: Age (weeks), weight (pounds), hemoglobin level (g/dl), type of cleft and surgical outcome. Results: A total of 120 patients were seen during the study period (2011 to 2015) that had unilateral cleft lip. Female to male ratio was 3:2. (74) 62% had in addition, cleft palate (UCLp) and (46) 38% were only unilateral cleft lip without a palate (UCLo). Unilateral cleft lip was also divided into complete(UCLc) and incomplete unilateral cleft lip(UCLi). Out of the total number 120 patients seen during the study period, (80) 67% had complete unilateral cleft lip while (40) 33% had incomplete unilateral cleft lip. At week 10, the average weight were 11.2, 8.5, 8.2, 11.8 pounds for the various types of cleft at the time of surgery of the lip (UCLo, UCLp, UCLc and UCLi respectively). ≥10 weeks, the level of Haemoglobin at the time of surgery were 10.5, 8.6, 8.6 and 10.8 gm/dl (UCLo, UCLp, UCLc and UCLi respectively. Most of the patients, 28.4% with an associated cleft palate had their unilateral cleft repairs done by week 15. Conclusion: Children with unilateral cleft lip with an associated palate and unilateral complete cleft lip turned to have lower haemoglobin and weight at week ten after birth compared to unilateral incomplete cleft lip without cleft palate patients. This means that, the rule of 10s is still applicable in our centre especially for those with incomplete unilateral cleft lip without an associated cleft palate. There were more post-operative wound infections in children who had unilateral cleft lip with an associated cleft palate.

The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review

“…In a retrospective study in Ghana, it was found that children with unilateral CL/P and unilateral complete cleft lip had lower hemoglobin and weight compared to unilateral incomplete cleft lip patients (Acheampong et al, 2019). Additionally, when repairs were performed in anemic and malnourished children, there were higher infection rates (Acheampong et al, 2019). The results highlight the need for improved studies of the outcome of preoperative screening factors when providing cleft care in SSA.…”

“…Furthermore, this rule has not been properly studied in low resource settings within SSA. In a retrospective study in Ghana, it was found that children with unilateral CL/P and unilateral complete cleft lip had lower hemoglobin and weight compared to unilateral incomplete cleft lip patients (Acheampong et al, 2019). Additionally, when repairs were performed in anemic and malnourished children, there were higher infection rates (Acheampong et al, 2019).…”

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: a retrospective cohort study

“…The hospital commenced partnership with the Smile Train in 2007 and has been providing free cleft care to patients with clefts. The rule of 10 as proposed by Wilhelmsen and Musgrave [4] and modified by Millard [8] is used for guiding scheduling of our patients for primary lip repair. The data of patients who received cleft care are entered into the Smile Train Express (STX).…”

“…One of the common guidelines for the timing of surgical cleft lip repair is the rule of ten (4). Although its validity is questioned, the “rule of ten” guideline is still widely used(6–8). By this rule, children who are ten weeks old, attained the weight of five kilograms and have a haemoglobin of 10g/dl can commence primary lip repair if there are no other mitigating medical conditions (9).…”

“…(3) One of the common guidelines for the timing of surgical cleft lip repair is the rule of ten. (4) Although its validity is being put to question, it is still widely used (6)(7)(8). This rule is also employed in our institution.…”