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Published on: September 19, 2015
Early one-stage repair of complete unilateral cleft lip and palate
Albert De Mey1, Dian Franck, Nicolas Cuylits
1Department of Plastic Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium. fdemey@skynet.be
Insights
One-stage all-in-one (AIO) closure for cleft lip and palate offers comparable anteroposterior midfacial growth to traditional methods. This approach results in less maxillary plane opening, benefiting craniofacial development in children.
Area of Science:
- Craniofacial morphology
- Pediatric surgery
- Cleft lip and palate research
Background:
- Complete unilateral cleft lip and palate (UCLP) requires surgical intervention.
- Timing and technique of surgical repair significantly impact craniofacial development.
- Previous studies suggest varying outcomes based on surgical protocols.
Purpose of the Study:
- To evaluate and compare craniofacial morphology in UCLP patients treated with 1-stage all-in-one (AIO) closure versus a 2-stage Malek protocol.
- To assess the long-term effects of these surgical approaches on midfacial growth.
- To compare outcomes with a non-cleft control group.
Main Methods:
- Prospective study of 72 non-syndromic UCLP patients, assessed at age 10 and 15.
- Group 1: 34 patients treated with Malek protocol (soft palate at 3 months, lip/hard palate at 6 months).
- Group 2: 38 patients treated with 1-stage AIO closure (lip/hard and soft palate at 3 months).
- Digital cephalometric analysis compared to 40 age-matched non-cleft controls.
Main Results:
- Both surgical groups showed reduced anteroposterior growth compared to controls at age 10; AIO group showed no significant difference from controls.
- The Malek group exhibited a significantly increased maxillary plane inclination (MxPI/SN) compared to the AIO group.
- By age 15, no significant differences in anteroposterior growth or maxillary plane inclination were observed between the two surgical groups.
Conclusions:
- One-stage AIO closure, guided by Malek principles, yields favorable anteroposterior midfacial morphology.
- This technique leads to reduced maxillary plane opening relative to the anterior cranial base.
- AIO closure presents a viable alternative for UCLP repair with positive long-term craniofacial outcomes.
Background:
The purpose of this prospective study was to evaluate craniofacial morphology in children with complete unilateral cleft lip and palate treated at the Brussels cleft center after a 1-stage complete closure at 3 months and compare the results with a series of children operated on at 3 and 6 months of age according to the Malek surgical protocol.
Methods:
A series of 72 consecutive patients who were operated on for nonsyndromic complete unilateral cleft lip and palate were included in this study at approximately the age of 10 years. Thirty-four were treated according to the Malek surgical treatment protocol: the soft palate was closed at a mean (SD) age of 3.04 (0.20) months, followed by simultaneous repair of the lip and hard palate at 6.15 (0.67) months. Thirty-eight underwent 1-stage all-in-one (AIO) closure of the lip and hard and soft palates at 2.98 (0.16) months. Craniofacial morphology was evaluated by means of a digital cephalometric analysis. Cephalometric data were compared with a noncleft control group (n = 40) matched according to age. The same 2 series of children were followed up until 15 years of age, and the results were again compared.
Results:
Statistical analysis (analysis of variance with post hoc Tukey test) showed in both groups who were operated on a decreased anteroposterior growth compared with the children without cleft at 10 years but the AIO group only was not different from the group without cleft. The maxillary (MxPI/SN) plane was significantly (P = 0.002) increased in the Malek cleft group compared with the AIO group with cleft. At 15 years of age, a difference was not observed anymore between the 2 groups for the anteroposterior growth or for the maxillary plane inclination.
Conclusions:
One-stage AIO closure based on the Malek surgical principles provided good anteroposterior midfacial morphology and resulted in less opening of the maxillary plane to the anterior cranial base.
