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Successful early neonatal repair of cleft lip within first 8 days of life
Borsky Jiri1, Veleminska Jana, Jurovčík Michal
1Plastic Surgery Clinic, Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
Insights
Early cheiloplasty for cleft lip and palate (CLP) in neonates offers excellent aesthetic outcomes and positive psychosocial benefits for families. This neonatal surgery facilitates feeding and improves social integration from an early age.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Neonatal Care
Background:
- Cleft lip and palate (CLP) is a common congenital anomaly requiring surgical correction.
- Traditional cheiloplasty is performed around 3 months of age.
- Early neonatal surgery may offer advantages in wound healing, feeding, and psychosocial development.
Purpose of the Study:
- To evaluate the aesthetic and functional outcomes of modified cheiloplasty in neonates with total cleft lip and palate (CLP).
- To assess the impact of early surgery on jaw segment formation and psychosocial well-being.
Main Methods:
- Modified Tennison cheiloplasty performed on 97 neonates (1-8 days old) between 2005-2008.
- Aesthetic outcomes assessed by scar visibility, lip, and nose symmetry.
- 3D-finite element scaling analysis (FESA) used to evaluate upper jaw segment formation in unilateral CLP patients.
Main Results:
- No major per-operative complications; excellent wound healing and aesthetic results observed.
- Minimal scar visibility and good lip/nose symmetry in most patients.
- Positive psychosocial impact on families and facilitated feeding.
- Observed growth and approximation of jaw segments, influencing incisor and premaxilla development.
Conclusions:
- Early neonatal cheiloplasty for CLP is a promising technique.
- Achieves very good aesthetic results and positive psychosocial impact.
- Facilitates feeding and promotes early social integration.
Objective:
In the children born with a cleft lip, surgery is the first step in correcting the inborn anomaly. In comparison with usually made 3-month surgery, benefits of the surgery in neonates have been reported: a very good wound healing, feeding facilitation, and good socialization of a child from neonatal age. The aims of the present study were to perform cheiloplasty in early newborns affected by the total cleft lip and palate (CLP) by the technique modified to search for optimum aesthetic result, and to assess the surgery outcome from qualitative and quantitative aspects.
Methods:
The operations were performed by the same surgeon in 97 neonates 1-8 days old during 2005-2008. The original technique by Tennison was modified and used. Aesthetic outcome of the surgery was evaluated according to scar visibility, and the shape and symmetry of the lip and nose. The effect of cheiloplasty on the formation of the upper jaw segments was evaluated in a sample of unilateral CLP patients using the 3D-finite element scaling analysis (FESA). We compared 3D models of dental plaster casts made prior to lip surgery (in neonates under 8 days of age) and prior to palate surgery (at 12 months of age).
Results:
Only the children in excellent health state and without an associated inborn defect were allowed to pass the operation. There were no per-operative complications (except the correction of tracheal tube position in several cases). The parents appreciated bringing home a neonate with no visible cleft. This aspect not only facilitated baby feeding, but had important positive psycho-social impact on the whole family. The wound healing and aesthetic effect of the cheiloplasty were very good. The scar was barely visible and lip and nose were symmetric in majority of children. After lip closure, the growth and approximation of jaw segments was observed. This aspect was also associated with incisors development in the anterior portion of the segment including premaxilla.
Conclusions:
Our results show, that early neonatal lip surgery of CLP is promising technique with very good aesthetic results and important positive psychological impact on the child and its family.
