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A modified surgical schedule for primary management of cleft lip and palate in developing countries
Insights
A modified surgical protocol for cleft lip and palate (CLP) patients significantly reduces the time between lip and palate repairs. This new approach improves patient compliance and surgical outcomes, minimizing complications like fistulas.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Cleft lip and palate (CLP) patients in developing countries often present late for treatment.
- Delayed presentation increases risks of malnutrition, anemia, and infections.
- Conventional treatment involves lip repair before palate repair, risking patient dropout after the initial surgery.
Purpose of the Study:
- To optimize the timing of palatoplasty in CLP patients.
- To reduce patient dropout after the initial surgical intervention.
- To evaluate a modified surgical protocol for cleft lip and palate repair.
Main Methods:
- A new protocol prioritizes palate repair between 6-9 months of age or upon presentation.
- Cleft lip repair is performed 3-6 months after palatoplasty.
- This modified protocol was compared to the conventional approach (lip repair first).
Main Results:
- The modified protocol in 330 patients showed a median interval of 193 days between surgeries, significantly shorter than the conventional group's 290 days (89 patients).
- The reduction in surgical interval was statistically significant (p < .0002).
- Eight patients benefited from fistula repair during cleft lip surgery, avoiding a third procedure.
Conclusions:
- The modified surgical protocol enhances patient compliance for both cleft lip and palate repairs.
- Palate repair is facilitated by the presence of an unrepaired cleft lip.
- The modified protocol leads to more dependable anterior palate repair with a lower incidence of fistulas.
Introduction:
In developing countries cleft lip and palate (CLP) patients arrive late, and there is a risk of drop out for functionally important palatoplasty after lip repair. Patients may be underweight, anemic, and prone to recurrent infections.
Objective:
To repair cleft palate at an appropriate time and secondly to avoid the drop out after the first surgery.
Protocol:
A new surgical protocol has been designed for patients with CLP in whom the cleft palate is first repaired at 6 to 9 months of age or whenever the patient presents at the clinic. The cleft lip is repaired 3 to 6 months after the first surgery.
Patients And Results:
When cleft lip repair was performed before palate repair (conventional protocol group) in 89 patients with CLP, the median interval between first and second surgery was 290 days. However, when the modified protocol was followed in 330 patients over 13 years, the median interval was 193 days (p < .0002). The reduction in the interval is statistically significant. In eight patients cleft palate fistula encountered after palatoplasty was repaired during cleft lip repair thus avoiding a third surgery.
Conclusions:
The compliance for two surgeries in CLP has improved. Apart from achieving the main aim of the new protocol, a number of advantages were noticed. The palate repair was easier in the presence of an unrepaired cleft lip. The anterior palate repair was more dependable with reduced incidence of anterior palatal or alveolar fistula.
