[Bilateral labio-maxillo-palatal clefts. Therapeutic evaluation].

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Context:

• Bilateral facial clefts present complex surgical challenges, especially regarding long-term outcomes.
• Assessing surgical success in cleft lip and palate (CLP) patients is difficult due to anatomical variations.
• Current protocols require evaluation to optimize treatment strategies for CLP.

Purpose:

• To analyze the effectiveness of a 3-step surgical protocol for bilateral facial clefts at Grenoble University Hospital.
• To identify factors influencing long-term surgical outcomes in cleft repair.
• To propose modifications to the existing surgical protocol based on outcome analysis.

Summary:

• A 3-step protocol involving Skoog's cheilo-rhino-uranoplasty and periosteal tibial grafts showed high revision rates for certain procedures (43% for labial vestibule/tubercule, 32% for osteotomy).
• While palatine closure (82%) and premaxillary stability (86%) favored periosteal grafts, graft osteogenic capacity decreased with repeated harvesting.
• A revised protocol emphasizes early total bony palate closure and periosteal tibial grafts, with initial results showing improved scars and maxillary arch form.

Impact:

• The revised protocol demonstrates potential for better aesthetic and functional results in cleft lip and palate surgery.
• Optimized surgical timing and techniques, including early bony palate closure, enhance maxillary arch development.
• Continued use of periosteal tibial grafts maintains positive outcomes, contributing to more harmonious facial reconstruction.