Adopted children with cleft lip or palate, or both, require special needs cleft surgery

Area of Science:

• Pediatric Surgery
• Craniofacial Surgery
• Public Health

Background:

• Increased international adoption of children with cleft lip, with or without cleft palate (CLP).
• Previous surgical interventions often performed in the country of origin.
• Potential for delayed or altered treatment pathways.

Purpose of the Study:

• To characterize the initial care and treatment of adopted children with CLP.
• To identify challenges faced by cleft teams in managing these patients.
• To provide recommendations for optimizing care.

Main Methods:

• Retrospective review of 25 adopted children with CLP referred between 2008-2010.
• Analysis of patient demographics, previous surgical history, and initial management at the cleft center.
• Documentation of surgical procedures and post-operative outcomes, including fistula rates and MRSA carriage.

Main Results:

• 80% had prior lip plasty; 44% carried methicillin-resistant Staphylococcus aureus (MRSA) on arrival.
• Most patients received timely evaluation and surgery post-adoption.
• 14% developed fistulas post-palatoplasty; challenges included pre-existing conditions and resistant bacteria.

Conclusions:

• Adoption of CLP patients requires adaptation by cleft teams due to varied prior treatments.
• Prioritizing palatoplasty for older, unoperated children is essential for speech development.
• Management of MRSA and coordination of care are key challenges.