Interdisciplinary Considerations for Nasolabial Repair During a Global Pandemic

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.