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Primary bilateral cleft lip repair with management of premaxilla without preoperative orthopedics
1Department of Plastic Surgery, Cleft & Craniofacial Center, Sri Ramachandra University, Porur, Chennai, India. srmc.chennai@smiletrainasia.org
Insights
Primary repair of bilateral complete cleft lip and palate (BCLP) without preoperative orthopedics in infants can lead to dental occlusion issues. Protocol modifications are needed for older children with BCLP.
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Cleft Lip and Palate Treatment
Background:
- Children with cleft lip and palate often face delays in primary repair in developing countries.
- Logistic and financial constraints frequently preclude necessary preoperative orthopedic treatment for bilateral complete cleft lip and palate (BCLP).
Purpose of the Study:
- To present a protocol for primary repair of BCLP without preoperative orthopedics across different age groups.
- To evaluate the outcomes of this approach, focusing on dental occlusion and premaxillary position.
Main Methods:
- Surgical repair of 240 children with BCLP between 2001 and 2003.
- Grouped patients by age: <1 year, 2-10 years, and >10 years.
- Follow-up study of 70 patients operated on before age 1, assessing occlusion and premaxillary position at 5-7 years.
Main Results:
- 83% of patients operated on before age 1 exhibited malocclusion (anterior/deep bites) by 5-7 years.
- 13% had buccal bite, associated with a smaller premaxilla prior to lip repair.
- Protocol modifications were required for older children, including palate repair before lip repair.
Conclusions:
- Primary repair of BCLP without preoperative orthopedics necessitates protocol adjustments for children presenting after one year of age.
- Early lip repair in infants influences premaxillary molding.
- Premaxillary size serves as an indicator of potential maxillary growth.
Objective:
In developing countries, children with cleft lip and palate present at various age for primary repair. Even if they come at an appropriate age, logistic and financial problems prevent us from providing preoperative orthopedic treatment for children with bilateral complete cleft lip and palate (BCLP). We present our protocol and technique of primary repair for BCLP without preoperative orthopedics at different ages.
Setting And Design:
We operated on 240 children with BCLP from 2001 to 2003. One hundred ten children younger than 1 year were operated on for primary surgeries, 99 children were between 2 and 10 years, and 40 were older than 10 years. Of the 110 patients who had primary repairs for BCLP without preoperative orthopedic before age of 1 year, seventy children were studied for dental occlusion and premaxillary position at age of 5 to 7 years. Children operated on after the age of 1 year had palate repair before lip repair. Children operated on after 10 years, the protocol was modified to tackle protruding premaxilla at the time of palate repair.
Outcome:
Of 70 patients operated on before 1 year of age, 83% had an occlusion with anterior and deep bites of the premaxilla of variable degree at age of 5 to 7 years. Thirteen percent had buccal bite, and these patients had small premaxilla before lip repair.
Conclusions:
Modification of protocol was necessary for children with BCLP who approached later than 1 year of age for primary treatment. Bilateral cleft lip repair without any preoperative orthopedic in young babies will mould the premaxilla. The size of premaxilla can predict the growth potential of maxilla.
