The Americleft Project: Burden of Care from Secondary Surgery

Area of Science:

• Craniofacial surgery
• Pediatric plastic surgery
• Cleft lip and palate care

Background:

• Care for cleft lip and palate extends beyond initial repair, often involving secondary surgeries for aesthetics and speech.
• Children with cleft lip and palate may require multiple interventions to optimize outcomes.

Purpose of the Study:

• To compare the utilization of secondary surgical procedures across different cleft treatment centers.
• Investigate variations in secondary surgery rates for children with cleft lip and palate.

Main Methods:

• Retrospective cohort study of 130 children with complete unilateral cleft lip and palate across 4 North American centers.
• Collected data on all lip, palate, and nasal surgeries; assessed nasolabial appearance using the Asher-McDade scale.
• Compared risk of secondary surgery between centers using log-rank and Cox proportional hazards models.

Main Results:

• Significant center-specific differences observed in secondary lip surgery (P < 0.001) and rhinoplasty (P < 0.001) risks.
• Cumulative risk of secondary lip surgery by age 10 varied from 5% to 60% across centers.
• Cumulative risk of secondary rhinoplasty by age 20 ranged from 47% to 79% among centers.
• No significant difference in nasolabial appearance between children receiving secondary surgery versus primary surgery alone (P > 0.10).

Conclusions:

• Despite variations in surgical rates, secondary surgeries for cleft lip and palate did not yield significantly better nasolabial appearance.
• The decision to perform secondary surgery varies by center, but this did not translate to improved aesthetic outcomes compared to primary repair alone.