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Interdisciplinary Considerations for Nasolabial Repair During a Global Pandemic
Pauline Joy F Santos1, Omotayo A Arowojolu1, Raj M Vyas1
1Department of Plastic Surgery, University of California Irvine, Orange, CA, the United States.
Insights
During the COVID-19 pandemic, a pediatric hospital safely resumed cleft lip and palate repair, prioritizing patient outcomes and family well-being while minimizing system burden. This approach optimized care delivery without increasing COVID-19 risks.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Public Health
Background:
- Global pandemic led to tiered surgical prioritization, classifying cleft lip and palate repair as low acuity.
- Nasoalveolar molding (NAM) clinics were closed, raising concerns about delayed cleft care and increased family burden.
- Existing risk-stratification and perioperative algorithms were reassessed to address pandemic-related challenges.
Purpose of the Study:
- To hypothesize that nasolabial repair could be safely optimized during the pandemic.
- To avoid burdening healthcare systems.
- To prevent increased COVID-19-related morbidity and mortality.
Main Methods:
- A multidisciplinary cleft team reevaluated patient selection for maximal surgical impact.
- Perioperative protocols were adjusted, incorporating COVID-19 preoperative testing for nasolabial repair and suture removal under anesthesia.
- Nasoalveolar molding (NAM) clinic reopening was strategically planned based on decreased patient volume.
Main Results:
- Unilateral cleft repair was prioritized and successfully performed on 9 patients early in the pandemic.
- No COVID-19-related complications were observed in the treated patients.
- The nasoalveolar molding (NAM) clinic successfully reopened once patient volumes were significantly reduced.
Conclusions:
- An approach for surgical management of nasolabial clefts during a global pandemic is presented.
- Despite guidelines suggesting postponement of cleft care, safe resumption was achieved at a dedicated pediatric hospital with low COVID-19 burden and adequate resources.
- The strategy effectively decreased the burden on patients' families and care delivery systems while resuming essential cleft care.
Background:
At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality.
Methods:
Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia.
Results:
Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased.
Conclusions:
We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.
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