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Current Trends in Unilateral Cleft Lip Care: A 10-Year Update on Practice Patterns
John M Roberts1, Aaron Jacobs, Brad Morrow
1From the Department of Surgery, Division of Plastic Surgery, College of Medicine, Pennsylvania State University, Hershey, PA.
Annals of Plastic Surgery
|October 22, 2019
Summary
Surgeons are increasingly adopting new techniques for unilateral cleft lip (UCL) repair, including the Fisher anatomical subunit repair and nasoalveolar molding. However, evidence for technique superiority remains limited, highlighting the need for standardized, evidence-based care in cleft lip surgery.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Unilateral cleft lip (UCL) patient care exhibits significant variability.
- Previous benchmarks for cleft lip surgery practices were established in 2005.
- The study addresses the need to update current practices based on emerging data and techniques.
Purpose of the Study:
- To update current practice patterns in unilateral cleft lip repair among cleft surgeons.
- To identify trends in perioperative and intraoperative choices for UCL care.
Main Methods:
- An electronic survey was distributed to surgeons within the American Cleft Palate Association.
- Surveys collected demographic data and information on perioperative and intraoperative cleft lip care choices.
- Data from 86 responding surgeons were analyzed.
Main Results:
- Nearly 40% of surgeons have modified their UCL repair techniques, with Fisher anatomical subunit repair increasing in popularity.
- Nasoalveolar molding use has risen (41% vs. 22%).
- Nasal floor closure is performed in 83.1% of cases, and primary cleft rhinoplasty in 57%.
Conclusions:
- Modified rotation advancement and Fisher anatomical subunit approximation techniques for UCL repair have seen increased use over the past decade.
- A lack of evidence regarding the superiority of specific techniques or adjunct procedures contributes to practice variations.
- Standardized education on evidence-based practices is crucial for improving cleft patient care.
